Frontline Workers

Receptionist Sam Eckstein encourages his co-workers at the Woodland Hills Medical Center lab not only to meet—but to exceed—patient expectations of excellent service. To back up his coaching, he’s using the knowledge he gained in a new LMP course on business and economic literacy.

During the course, Eckstein and about a dozen other workers and managers learned about the rising cost of health insurance in the United States and the trend toward businesses’ shifting more health care costs to employees.

Because patients are paying more, “Their expectations are higher,” says Eckstein, a member of SEIU UHW. “When patients come in without an order [for a lab procedure], we can’t just send them home,” and inconvenience them by making them come back another day, he says. “We have to help meet their needs.”

Eckstein took part in a pilot project to test the Labor Management Partnership’s new approach using popular education techniques to ensure frontline employees and managers have the context and know-how they need to continue improving team performance and keep Kaiser Permanente affordable.

What’s different about popular education?

Popular education turns the old-fashioned schoolroom model of teaching and learning on its head. It is ideally suited to the Labor Management Partnership, which is built on the belief that all employees, managers and physicians bring their expertise and experience to bear on improving service and care at KP. No longer is the teacher or trainer the sole expert in the classroom, there to fill students’ minds with information they passively receive, memorize and repeat.

Instead, popular education taps into participants’ experiences in their communities and workplaces and uses them to generate dialogue. It explores the social and economic context of students’ lives and asks probing questions: What are people happy about? Worried about? Fearful about? Hopeful about? Students are encouraged to analyze that information—and to take action.

UBTs use a performance improvement method called the Rapid Improvement Model (RIM+). It’s a quick way of improving work processes that allows teams to make a small change, test and evaluate it, and then adopt it if it works — or reject it if it doesn’t.

Use these three questions to guide your team’s efforts to improve quality, service and affordability, and to make your department a great place to work:

• What are we trying to accomplish? Clarify the improvements your team wants to make and define how you want to change. Be specific.
• How will we know a change is an improvement? Identify what you will measure to make sure you know whether the change you make is truly an improvement.
• What changes will help us improve? What options are most likely to work? What do we think is a good idea? What have other people done? Keep objectives in mind. Use the team’s knowledge and experience as a guide.

Visit the Use of Tools toolkit to learn more.

Small tests of change

The plan, do, study, act (PDSA) cycle is part of the Rapid Improvement Model. It allows teams to rapidly test a change on a small scale. Risk taking is encouraged and failures are okay because the team learns from them.

The steps are:

• Plan: Plan the test or observation, including how you’ll collect data.
• Do: Try out the test on a small scale.
• Study: Set aside time to analyze the data and study the results.
• Act: Refine the change based on what team members learned from the test.  

Then start preparing a plan for the next test!

Other performance improvement tools

In addition to PDSAs, there are a diversity of performance improvement tools — process maps, fishbone diagrams and more — that can help teams understand what’s not working about their team processes and which are the best ideas for improving them. The How-To Guide on performance improvement is a great place to start exploring performance improvement tools that go beyond PDSAs.

Consensus decision making and interest-based problem solving

In the course of doing performance improvement work, team members use specific methods to help them make decisions and understand one another’s point of view.

Teams use consensus decision making to decide things like which project the team is going to tackle and which improvement idea is going to be tested first. Consensus is a form of group decision making that is often used in collaborative work. Because everyone discusses the issues to be decided, the group benefits from the knowledge and experience of all members. Consensus occurs when every member of the group supports the decision.

Interest-based problem solving is a process that addresses individual and group differences. Participants work together to reach agreement by sharing information and remaining creative and flexible, rather than by taking adversarial positions.

The four steps to interest-based problem solving are:

• define the problem
• determine interests
• develop options
• select a solution

Visit the Team Member Engagement toolkit to learn more about consensus decision making and interest-based problem solving.

UBT members, co-leads, sponsors and all employees can learn more about Labor Management Partnership and unit-based team processes by taking trainings in LMP orientation, consensus decision making, interest-based problem solving and the Rapid Improvement Model. There is also a co-leads workshop for UBT co-leads, and a training in effective sponsorship for UBT sponsors. Learn more about available trainings by consulting the Learning Portal of this website or by contacting your team’s UBT consultant.

In addition to offering trainings, every region has consultants who provide support to unit-based teams. Though they go by a variety of titles depending on the region, these consultants can help teams become more proficient, get necessary training and overcome obstacles. Union partnership representatives offer similar guidance. If you’re not sure who your UBT consultant or union partnership representative is, contact your regional LMP co-leads.

A unit-based team includes all managers, physicians, dentists and partnership union members in the work unit. All employees in the unit participate and support the team in meeting its goals and objectives.

UBT members

For the team to move up and become high performing, its important for all team members  to:

• complete UBT training
• attend and participate in meetings
• represent the interests and perspectives of others — not just their own
• use UBT processes collaboratively and with an open mind toward mutually acceptable results
• maintain open, direct, and respectful communication
• support partnership principles
• communicate regularly with staff in the department
• honor confidentiality agreements
• actively support all team decisions

Visit the Team Member Engagement toolkit to learn more. 

UBT co-leads

Each UBT has a management and labor co-lead. In departments with physicians, it’s ideal to have a physician co-lead as well. Co-leads organize the team’s meetings and huddles and make sure the team’s performance improvement work stays on track.

The role of UBT co-leads is to:

• advocate for partnership success
• prepare for meetings and huddles
• use appropriate meeting management tools
• communicate early and often
• troubleshoot where appropriate
• act as point person for information
• keep team records
• ensure team is following charter and charter is relevant
• communicate with others (including sponsors and stakeholders)
• make off-line decisions when needed
• build relationships and share expectations with co-lead partner(s)

Visit the Leadership toolkit to learn more. 

UBT sponsors

Sponsors are the go-to people for UBT co-leads, providing resources, guidance and oversight for teams.

The role of UBT sponsors is to:

• review the team’s progress on department’s UBT goals
• promote the use of the Rapid Improvement Model (RIM+) to improve department performance
• support full team engagement
• remove barriers and assist, as needed, with attaining data for team’s performance improvement projects
• recognize the team’s accomplishments
• spread successful practices

Visit the Sponsorship toolkit to learn more.