Frontline Physicians

After learning more than a year ago that patients were having trouble getting doctors’ appointments, members of the Keizer Station Family Medicine team in Oregon began exploring ways to improve service and access. Their solution? Offer more video visits.

“What we didn’t realize at the time is that this work would put us in a unique position to be ready for the pandemic, which wasn’t on anyone’s radar in fall 2019,” says Ruthie Berrell, medical office director and management co-lead for the Family Medicine/Nurse Treatment Center unit-based team. 

Collaboration by the team’s frontline workers, managers and physicians has served as a partnership model for UBTs in the Northwest Region. It’s also earned the department applause for improving service and access at a critical time in health care, as teams across the enterprise adapt to the rise of virtual care. 

“It wasn’t always easy,” says Molly Maddox, RN, the team’s labor co-lead and OFNHP member. “This took a lot of working out the kinks and working together.” 

Overcoming resistance to change 

One of the team’s earliest challenges involved staff resistance to virtual care. Worried that patients would perceive virtual visits as a “takeaway,” some staff members pushed back. 

“The culture of how we delivered care was in the medical office, and people had different levels of acceptance across the spectrum,” says Caroline King-Widdall, MD, team co-lead and physician in charge. 

So, team members educated their peers on the benefits of virtual care and developed scripting to help them feel at ease offering video appointments to patients.

“People are more comfortable now taking the lead and scheduling appointments,” Berrell says. Others feared that older patients were less tech savvy and would have difficulty accessing their virtual visits. In response, team members posted informational fliers in exam rooms and emailed instructions to patients before their appointments. 

Building team engagement

Key to the team’s success was engaging everyone, including physicians. Medical assistants and nurses partnered with providers to review physician schedules and flag appointments they could convert to virtual visits. 

Also, UBT members participated in weekly huddles “where we brainstormed new tests of change and talked about what worked and what didn’t work,” says Maddox. The team’s efforts paid off. 

Patient satisfaction scores for ease of scheduling appointments jumped from 53% to 85% between August 2019 and December 2020. And because members access video visits through kp.org, website registration among the department’s patients increased by nearly 10% during the past year. 

The hard work has not gone unnoticed. This past fall, the team received the region’s UBT Excellence Recognition Award for improving service and access. 

Maddox attributes the team’s success to strong relationships rooted in partnership. “We know that we would not have had this success if our team didn’t work together.” 

When it comes to addressing health care disparities, medical office assistant Anna Jenkins thinks her unit-based team is up to the challenge. 

“I can go to my UBT members and say, ‘This is a care gap. Give me your feedback. Give me your ideas,’” says Jenkins, an OPEIU Local 30 member and labor co-lead for the Rancho San Diego Primary Care team. “Our administration listens to us. They’re very open to letting us try it our own way.” 

The Level 5 team is leveraging Labor Management Partnership principles and tools to communicate, coordinate and customize care for Latino patients with diabetes. The approach has led to better health outcomes and improved service for a group disproportionately impacted by diabetes. 

The unit-based team has increased the number of Latino patients ages 65 to 75 whose blood sugar levels are under control, according to recent clinical quality measures. 

“That partnership between management and labor is important,” says Silvia Hernandez, RN, medical office administrator and the team’s management sponsor. “This teamwork helps us to improve patient care and quality with excellent member satisfaction.” 

Adapting approaches 

Key to the team’s success is partnering with Complete Care Management, a specialized strike force that monitors the health of patients who struggle to control chronic conditions, such as diabetes and high blood pressure. 

To better support her Latino patients, care manager Lily Thamiz, RN, has adapted her approach. She books longer appointments for Spanish-speaking patients who need interpreters, refers others to bilingual diabetes education classes, and relies on phone calls to connect with those short on time. 

“The only time we can talk is when they’re driving,” says Thamiz, a member of Specialty Care Nurses of Southern California, an affiliate of UNAC/UHCP. “These are solutions I’d never considered before.” 

UBT members tailor treatment in other ways, too. To ensure continuity of care for Latino patients in their 60s and 70s, they standardized the steps needed to download and share data from glucose monitors. Providers use the devices to track patients’ blood sugar levels and adjust their medications. By consistently managing and sharing data, staff members guarantee they do not miss crucial patient information when communicating with one another. 

“They make you feel like you really matter,” says Mary Hart, 71, a Latina patient who has diabetes. “They really show their concern for your health.”

“Everyone must put on their leadership hat. It doesn’t relate to title or overall responsibility —  it’s what you control and influence from where you stand,” said Ronald Copeland, MD, senior vice president and chief equity, inclusion and diversity officer, at the National Equity, Inclusion, and Diversity Virtual Conference Series in October.

The Labor Management Partnership is designed to foster leaders at every level, to encourage everyone to use their voice and add their ideas to solving the challenges at hand. As our nation and our organization seek new ways to advance equity and diversity — including equity in health care — doing the right thing has never been more important.

“Action matters more than passion, and impact matters more than intent,” Dr. Copeland said. “It’s great to say, ‘I want everybody to achieve equity and inclusion,’ but we have to do the actions that make that occur.”

See equity in action in this issue of Hank with inspiring actions taken by 4 unit-based teams from across the organization. Together, their commitment to achieving equitable outcomes in maternal-child health, and in treating diabetes and high blood pressure, is reshaping what culturally sensitive care looks like for thousands of our members and patients.

COVID-19 is testing partnership as never before.

Management and labor have had to work together quickly to retool the delivery system to support rapidly changing needs. Employees’ and physicians’ skills and talents are needed in new ways and in new places — so leaders from Kaiser Permanente and unions created labor pools to get KP employees to where they were needed.  

It’s one of dozens of innovations made to provide top-quality care at a time when every day is bringing new challenges. The swift work was possible in part because of the foundation provided by the relationships and values of the Labor Management Partnership.

In Southern California's Riverside service area, “It’s all-hands on deck,” says Jiji Abraham, area chief financial officer. “Even physicians are in the labor pool.”

Who knew bubble wrap envelopes could help patients sleep better at night?

That’s what the Sleep Medicine team in Falls Church, Virginia, discovered when it purchased padded envelopes and a postage machine and launched a service that allows patients to receive — and return — sleep therapy supplies by mail. Thanks to the team’s new approach, patient complaints about supplies dropped from multiple times a week to zero in 3 months between February and May 2019.

“Our patient satisfaction has really gone up. No complaints,” says Danielle Long, sleep apnea coordinator and the team’s labor co-lead who is an OPEIU Local 2 member.

This effort to fix a broken process is a powerful example of how management and labor can work together to improve service, access and affordability.

“Every single one of us contributed to making the workflow easier,” says Alireza Mallah, sleep apnea coordinator and a member of OPEIU Local 2.

Not ‘user-friendly’

Most patients seen by the team suffer from sleep apnea, a condition in which breathing is often blocked or partly blocked during sleep. To detect sleep apnea, patients wear a portable monitoring device. Treatment involves using a machine that delivers air pressure through a mask while sleeping.

As a service to patients, clinic staff arranged for members to pick up the sleep study devices and respiratory supplies at one of 10 medical office buildings in the area.

But patients sometimes were slow to retrieve the equipment and supplies, which caused storage problems. At other times, supplies were incorrect, late, or missing — frustrating patients and staff. And because the team relied on in-house couriers to make the deliveries, there was no way to track items, causing waste.

“It wasn’t a user-friendly process,” explains George Sweat, the team’s management co-lead and director of Medical Specialities. “There was no reliable system for supplies to get from point A to point B, and some members would get duplicate supplies because we had no way of tracking them.”

The breakthrough

“Why don’t we mail these supplies?” team members wondered aloud. But without guidance or goals, the talk remained just that: talk. Solutions seemed like a “myth to everybody,” Mallah recalls.

Then Sweat arrived in March 2018 with a fresh perspective and a zeal for data.

“The breakthrough was looking at the numbers,” says Sweat, who discovered that 25 sleep study devices were lost in 2018, totaling $120,000 — money the team could have saved or spent elsewhere.

He shared his findings with the team and helped set goals to mail all supplies by June 2019 and reduce the annual cost of respiratory supplies by 20 percent. Along the way, they would survey patients to see if their efforts improved member satisfaction.

Continuous improvement

Using the Plan-Do-Study-Act model, the team started out with small tests of change. Team members bought a postage machine that enables them to track shipments and experimented with different envelopes.

“For the first week or two, it was a little rocky,” explains Long. “We started out slowly.”

Now the team mails most supplies to patients, who have the option of picking up and dropping off equipment at the Falls Church location. The team also streamlined the inventory of respiratory supplies, eliminated the use of couriers, centralized distribution of equipment, and introduced paperless billing.

“We’re capturing 100 percent of the revenue,” says Sweat, who estimates the department has saved more than $111,000 in the first four months of 2019, putting it on track to meet its financial goal.  

Best place to work and receive care

The team’s process improvements also benefit patients by increasing access and member satisfaction.

Because patients can return the sleep study devices by mail quickly, staff can put the equipment back into circulation faster, enabling providers to diagnose patients within days instead of weeks.

Patients are happier, too. As of August 2019, 96 percent of patients surveyed said they prefer receiving their supplies by mail rather than traveling to pick them up.

What’s more, team members say performance improvement has made their work lives easier. “I don’t have to work as hard to satisfy my patients,” says Mallah.