Frontline Workers

The Imagining Care Anywhere exhibit, created by Kaiser Permanente’s Innovation and Advanced Technology team and the Garfield Innovation Center, illustrates how current and emerging technology makes it possible to bring health care directly to a patient’s home—or wherever a member may be—and can transform the way care is delivered at the doctor’s office and in the hospital. Dan Weberg is director of nursing innovation at the Garfield center and has been traveling to Kaiser Permanente facilities, conferences and union meetings to talk with people at all levels of the organization about the exhibit. He was interviewed by LMP Communications Director Andrea Buffa.

Q. As director of nursing innovation, what kind of work do you do?

A. I have a really great job. I’m supposed to help envision the future about three to five years from now and figure out what technologies, what trends, what changes in nursing practices and what changes in health care might occur. And then help guide pilot projects and strategy and brainstorming sessions to move the organization toward that future.

Q. What is the Imagining Care Anywhere exhibit about?

A. Imagining Care Anywhere is the start of a conversation with everyone at Kaiser Permanente to create a vision of what it might look like in the future as we engage members no matter where they are. How can we seamlessly integrate their home life, their school life, their work life and their health interactions with Kaiser all together? How can we help people have a more healthy lifestyle or healthy work-life balance? It’s a tour that’s supposed to provoke people to think about and imagine what that care will look like.

Q. How are emerging technologies changing the future of health care?

A. One example is the smartphone. Many of us use it for everything from tracking our fitness goals to shopping lists to emails to Facebook. But the data and the information behind that can be integrated in with goals for your health life. We’re working on a project now called Profile and Preferences. You might be able to set personal health goals and then use the data you collect already—whether it’s through a fitness app or diet tracking—and upload that into your kp.org profile so you can see how you’re moving along with your goals. And then, when you meet with your care team, we have a better picture of who you are as a person, and we can help you facilitate your goals. Remote diagnostics and remote monitoring are a big deal now, too.

Q. What do you think virtual visits will look like?

A. There are several organizations now that do tele-visits, including Kaiser. I think the future is going to hold more of these as our TVs and our cable providers get faster and faster internet and smarter devices. It may not be a full visit, but it may be a way to engage with a care provider—whether it’s a nurse, a physician, some sort of navigator or a health coach. Keeping people from having to drive into one of our facilities for simple things is going to be key.

Q. How are things going to be different when people are in the hospital?

A. In the exhibit, there’s a “journey home” board, which allows members to know exactly what has to happen before they get discharged. They don’t have to continue asking the nurse or the doctor or the care team by clicking the call light—they can see it right there and they’re able to access it.

The board is also about answering their questions conveniently and in a way they can understand. The exhibit has the idea of using an avatar. After a nurse or teacher comes in to do some kind of education, the member still has some questions. Instead of having to ask the same questions over and over and feeling a little uncomfortable, they’re able to use a virtual person to answer them.

Q. How can KP support its employees and help them advance their careers as these changes begin to take place?

A. I think as an institution we need to keep thinking about how we evolve our roles, what are the things we need to do differently. The technology is coming whether we want it or not, so it’s about continuing to imagine how specific roles might change and coming up with strategies to train our workforce to be able to evolve with the technology.

Q. What role are the labor unions that represent KP’s employees playing?

A. We’re really excited about the engagement with the unions. I think it’s great that they’re using Imagining Care Anywhere as a springboard to talk to their constituents about how the future of health care is going to evolve and also work to create that future with us.

The front line should be driving this because they know what’s broken. And they can help us address that early, before we get too far down the road with a solution that may not meet the real need.

A January UNAC/UHCP steward meeting in Southern California included a traveling version of the Imagining Care Anywhere exhibit, and nurses across Southern California weighed in with their thoughts about the emerging technologies.

Gracie Johnstone, RN
Kern County

Our dermatologist left and we didn’t have one for a while. We did “tele-derm” with a doctor in Orange County. We trained the medical office assistants on how to set up the technology. We could do the biopsies, if needed, at Kern. It evolved really nicely. It saves a visit for the patient. I don’t think all this technology will take jobs from nurses because we still need the human touch. Nurses will become more techno-savvy.

Pam Brodersen, NP
Downey Medical Center

It’s great, but we have to slow down a bit. We don’t want to become an app. We still need that human connection.

Yoshini Perera, RN
Downey Medical Center

I love change, but I’m a little concerned we might get out of touch with the patient. As long as we can listen to and touch and feel the patient, that’s OK.

Nelly Garcia, RN
Panorama City Medical Center

I am concerned about the ability of computer systems to communicate with each other. We need to get the systems to connect in order to provide the best service.

Gerard Corros, RN
Irvine Medical Center

It’s like having a Ferrari all of a sudden. You can drive really fast, but you need speed limits.

Sheryl Miller, a licensed practical nurse and a member of SEIU Local 49, is the technology coordinator for the Coalition of Kaiser Permanente Unions for the Northwest region. She’s worked for Kaiser Permanente for 30 years and has been involved in most of the major electronic changes of our time—including implementation of KP HealthConnect®—and has helped the organization with the challenge of integrating electronics into our everyday work. She was interviewed by LMP Communications Consultant Jennifer Gladwell.

Q. What did you learn working on KP HealthConnect?

A. I look at the people component of technology. If people are paralyzed with fear, they’ll never use the technology. With KP HealthConnect, we learned that peer-to-peer training, sponsor support and funding for labor flex teams—which have the people who do the job become subject matter experts—was a model for success.

In the 1980s, you did not learn typing as part of your schooling as a nurse. When we implemented KP HealthConnect, we had significant generational gaps. Some employees didn’t type. Through the labor flex teams, we ensured peers were training each other around work they understood.

Technology impacts workforce planning. We have to think ahead so we don’t become extinct. Roles will change, but through the partnership and workforce planning, we can plan for the changes and redeploy impacted staff.

Q. How is technology affecting roles today?

A. Self-check-in kiosks are rolling out in the Northwest clinics. This is what some of our patient population has been asking for. Registration representatives are a group of dedicated employees that have been doing customer service behind a desk. Now, they are being asked to be a concierge, a greeter, as well as answer complex benefit questions.

The Visual Dermatology Assist project is being piloted at two clinics in the Northwest. Medical assistants are being trained, following the provider’s order, to take a picture of a skin irregularity on an iPhone and send it to Dermatology. Sixty-eight percent of the photos were reviewed, diagnosed and had treatment plans within 24 hours. A typical appointment could take six to eight weeks to schedule. This is improving access.

Q. Have you been able to spread effective practices from the KP HealthConnect implementation?

A. ICD-10, the new coding system, goes live in October. We’ve been able to engage UBTs and labor so they are part of making the decisions and determining processes. We’re using peer-to-peer training and trying to break down barriers early on so our staff and members have the best possible outcome.

Q. All this technology is great, but what about privacy and security?

A. It keeps me up at night. I have spoken to steward councils about privacy. We are seeing an increase in social media violations that could result in people losing their jobs or being fined. We have to be very careful about what we’re posting in social media. It’s so easy to vent about a bad day, but you have to be vigilant to ensure you are not revealing patient information. I am here for the patient and to educate employees on privacy and security.

Q. You’re a chief steward, yet you seem adamantly in favor of management policy. How do you explain that?

A. I work off of fact. It’s a policy that we do not go into our own medical record or those of others unless we have a business need to do so. I am a union member, but I will never lose sight that I am here for the company, patient and union, and we all have to work together to be successful.

Q. After so many projects—what’s the secret to success?

A. I work with great people, locally and nationally. I’m not a technology expert, but if you remember the people behind the technology, it works really well. If I can help someone in care delivery enhance their ability to take care of our patients, then I’ve done my job. Technology and people are not going away—so we have to be willing to advance with it.

Marcella Austin spent her first six years at Kaiser Permanente as a medical assistant. Three years ago, she became a licensed vocational nurse through a partnership between KP, the Ben Hudnall Memorial Trust, Chaffey College and the San Bernardino County Workforce Investment Board that funded a Pathway to LVN project. That gave her the support she needed to advance her career—tuition, books, tutoring and wages. She was one of the first of nearly 50 KP employees to graduate. She was interviewed by LMP Senior Communications Consultant Anjetta McQueen.

Q. What started you on your journey?

A. My father, who is diabetic, had a heart attack when I was in college. My mom and I were the first ones at the ER with him. It was scary, but I remember those nurses and how they took care of him and us. One of the nurses took an orange from her lunch and taught me how to do an insulin injection. I fell in love with nursing. Six months later, I became a medical assistant. I thought that was as close as I would get.

Q. How did you manage school after years of working?

A. I went to school full time and worked in Urgent Care from 5 to 9, getting my 20 hours a week. The Ben Hudnall trust covered the other 20 hours. I never lost a paycheck. It’s not like I could say I didn’t have the funds—the funds were there.

Q. What about the responsibilities at home?

A. I have two kids, a 16-year-old daughter and a son who is 13. I had a husband, mother and mother-in-law all helping me out. I used to be the one who cooked, cleaned and picked up after everyone. All of this helped my kids become more responsible.

Q. College nursing slots are hard to come by. How did Chaffey College help?

A. I have taken one course or another since graduation from high school. I also took time to get married, have children. Chaffey pulled all of my transcripts from everywhere and offered the prerequisite classes I still needed.

Q. Your wages and tuition were covered, but how did you manage all those other costs?

A. We owe a lot of thanks to the county’s Workforce Investment Board. They saw a need for educating people in the community. We didn’t have to worry about transportation, uniforms or supplies during our clinicals. All of that can really add up.

Q. How did the cooperation of your labor management partners help you?

A. Managers and labor leads stayed with us every step of the way. They had meetings with us. They kept asking us how they could help. If there was a barrier, if a schedule needed changing, they would work together to see that it got done. I especially appreciate the help from Susan Rainey, the department administrator for staffing at Ontario; career counselor Michele DeRosa with the Hudnall trust; Margaret Winningham, a senior Human Resources consultant for Fontana/Ontario; and Valerie Robinson, a Local 7600 representative.

Q. What is different about your work now?

A. In the LVN training, you get the basics—biology, anatomy, psychology—but you also learn about nursing care plans, sterile processing, wound care and get hands-on training all while attending school. I can assist RNs in several procedures, do minor surgical assists, order and co-sign documents in KP HealthConnect®.

Q. What is different about you?

A. My confidence has gone through the roof. I was selected to go to the KP Quality Conference, and I was invited to speak in a leadership meeting about my experience. The girls on the unit tease me now, saying they want my autograph.

Sometimes the best way to spread effective practices is to spread experienced people. That’s what happened when the Alpharetta Ob-Gyn UBT in Georgia zoomed from Level 1 to Level 4 in just 10 months after two nurses from two different high-performing UBTs transferred there at the same time.

Jane Baxter and Ingrid Baillie had been UBT co-leads at two different clinics when they each got a new job with the Alpharetta Ob-Gyn department. They both drew on their experiences to guide their new team when they became co-leads at Alpharetta. “We knew the steps in the process and what to expect,” says Baxter, the department’s charge nurse.

Fledgling teams should begin with small performance improvement projects, they say. “We started with the low-hanging fruit,” says Baillie, RN, a member of UFCW Local 1996. “You don’t need to reach for the stars right out of the box.”

Pick your projects wisely

And, says Baillie, there’s no need to look any further than Kaiser Permanente’s organization-wide and regional priorities to find plenty of ideas for performance improvement projects—and a wealth of data that is being collected regularly.

“KP makes no secret about what is important to it,” says Baillie. “From that alone, you have all the data you need.”

For instance, the Alpharetta team’s first efforts were to improve clinic start time and get a second blood pressure test for patients with high initial readings. “These are important to KP, and they helped us gel as a team,” says Baillie.

“Small wins help develop confidence,” says Baxter. Now the team is taking on more complex cross-departmental initiatives, such as trying to make available online the big packet of paperwork patients need to complete before a first Ob-Gyn visit.

Getting physicians involved also has been part of this UBT’s success. You won’t find doctors who think UBTs are just for clinic staff on this team, says Baxter.

“Our providers are very invested,” she says. “They take minutes at meetings. We are all on an equal playing field.”

It started with a question from Oncology RN Tom Fought, a member of the Oregon Federation of Nurses and Health Professionals (OFNHP), at the Interstate Medical Office in the Northwest.

Why, he wondered, was primary tubing used for low-reaction drugs instead of the less-expensive short or secondary tubing?

That prompted the department’s unit-based team to start an improvement project that wound up saving $25,000 a year.

When patients come in for chemotherapy or other infusion medications, the drugs are administered via an IV: The bag holding the medication is hung on a pole, with a line that goes into the patient’s vein. When primary tubing is used, the valve to stop the flow of medication is very close to the patient’s body.

If the drugs being used have a high potential for an adverse reaction, it’s essential to use primary tubing, so that if there is an emergency and the line has to be shut, only a very little additional medication reaches the patient.

Appropriate times for less expensive options

When the short tubing or secondary tubing is used, the valve to stop the flow of medication is farther from the patient. In this situation, if the valve is closed, more medication is in the line and will flow into the patient until the tube is empty. These types of tubing are appropriate when the medication has a low potential for a negative reaction.

Primary tubing is $4.10 per unit, short tubing is $3.65 and secondary tubing is 65 cents. The costs add up if primary tubing is used when it’s not necessary.

“I had no idea that we would be saving the unit that much money by conforming the tubing,” Fought says.

This team alone was able to save $25,000 a year. If every Kaiser Permanente oncology infusion department adopted this practice, the savings would be dramatic.

“This was such an easy tweak—we just needed to think outside of the box,” says Lacey Anderson, RN, the Infusion Team Lead and a member of OFNHP, who was involved in the project. “The team realized this was such a great idea and wondered, ‘Why haven’t we been doing this all along?’”

Greater camaraderie

Heidi Rolf, the department manager and the UBT’s management co-lead, is proud of the work the team has accomplished. She attributes the success to the leadership of the team and notes that since the team has advanced to a Level 4 on the Path to Performance, team members have more camaraderie and are more engaged.

“At first it was a little difficult to change the habits of the nursing staff,” Fought says. “Within a few weeks, we had everyone on board and our tubing project took off.”