Frontline Workers

When Helen Bevan told her National Health Services colleagues in the United Kingdom she would be speaking at a conference of Kaiser Permanente union employees, they were surprised.

“What could they possibly learn from us?” they asked.

A lot, she says.

“Kaiser is a role model for us,” explains Bevan, chief of service transformation at the NHS Institute for Innovation and Improvement, part of the largest government-sponsored health care system in the world.“We look at and learn a lot from Kaiser in terms of innovations, efficiencies, use of new technology and its approach to patient care.”

We have much to learn from them as well—especially when it comes to large-scale change.

How to move forward

“To move forward in health care, leaders must tell their story, make it personal, create a sense of ‘us’ and include a call for action,” says Bevan, one of the plenary speakers at this year’s Union Delegates Conference in Hollywood. “The way to build and sustain health care reform is to learn the lessons of social movement leaders.”

Bevan’s point is on the mark. The 700 delegates attending the conference, themed “You Gotta Move,” were called to act on improving their own health and the health of their communities. They took that message to the streets of Hollywood, distributing fliers with tips on easy steps to take to improve health. Some also gathered for a flash mob in front of Hollywood’s Grauman’s Chinese Theatre, dancing to Beyonce’s “Move Your Body”—a song made for Michelle Obama’s “Let’s Move” campaign to end childhood obesity.

“It’s such a great experience to see the extent to which union members are stepping up to be a part of the change process,” Bevan says.

Building commitment and energy

The actions at the delegates conference—and beyond—are precisely what’s needed to reform health care in America and the world, she says, adding: “We can only create large-scale change if we build a platform of commitment and energy.” 

Because unit-based teams, KP’s platform for improvement, engage frontline workers, managers and physicians, they “already have that commitment and energy,” Bevan says. UBTs “create a sense of coming together around a common cause and achieving the same outcomes.”

But UBTs alone can’t bring about the large-scale change needed to meet the unprecedented challenges to improve quality and reduce costs.

Engage and inspire

“Transformation needs to occur at all levels of the organization in order for it to be sustainable,” Bevan says. “Senior leaders need to stop being pacesetters and start engaging, inspiring and emotionally connecting with employees. The passion is there. We just have to tap into it.”

As the task of delivering health and health care becomes more complex and the scale of change increases, “We need to think widely and innovatively about how we define the role of senior leaders,” Bevan says.

That’s where social movement thinking comes in. “Successful movements often have charismatic leaders—think Martin Luther King or Nelson Mandela—but what ultimately guides and mobilizes the movement are leaders at multiple levels.” The key, she says, is to depend less on reorganizing structures and processes as the catalyst for change and more on unleashing emotional and spiritual energy for change.

“People are much more likely to embrace change if it builds on the passion, the sense of a calling that got them into health care in the first place,” Bevan says. By connecting to that shared passion through storytelling, “We can create an unstoppable force for change.”

What happens when things change in your job and you have to rethink what’s always worked in the past?

For me, that moment came two years ago when I moved into a management role. I had spent 24 years as a frontline nurse, union steward and labor partner to hospital administration before my job transition.

Frankly, I wasn’t sure what to expect going in, but having been a steward and a labor partner helped me become a better manager. Kaiser Permanente has given me opportunities to grow as a leader that I don’t believe I would have had elsewhere. Along the way I learned six lessons that I think can help others lead in a collaborative team environment:

• Speak well and connect. As a labor partner, I developed my speaking and presentation skills—skills that most don’t learn in nursing school. My confidence grew with each presentation and I now feel a connection with my colleagues that helps us all gain value from our conversations.
• Give and get respect. As a nurse, I was respected at the bedside by physicians, managers and other nurses. I don’t think I would have been as respected as a manager if I hadn’t been respected at the bedside first. My clinical experience helped give me credibility.
• Understand operations. As a labor partner I learned valuable lessons about hospital operations. That allowed me to build on my experience as a caregiver and begin to see the bigger picture—how things are intertwined and why certain decisions are made.
• Listen and hear. You have to be a great listener and actually hear what people are saying. You have to be able to take things in and think about how to respond. As a steward, I always mulled things over before reacting, and I try to do that still.
• Know your contract. Most union leaders know their contract inside out—certainly I did when I was president of the RN bargaining unit. Managers should, too. The National Agreement gives us many tools that can help both sides stay on track.
• Stay flexible, be practical. Nurses are very solution-oriented. The solution to a problem has to make sense. I learned over the years that different people might get to the same outcome, but there are many ways to approach the problem. You need to be willing to try a different route to get to the solution so that everyone feels they have a voice in the process.

As a labor leader, I learned to believe in people and know that there’s always another side to any story. My staff understands they can come to me any time. And our unit-based team helps us draw on everyone’s knowledge and allows everyone to be heard.

In the end, it wasn’t that hard to make the transition from labor leader to manager. In both roles you have to consider diverse points of view, and sometimes you have to step back and ask, “Does it make sense?” You’re not always popular, but I’m OK with that.

We may not always agree. But there is no “we” or “them,” we are all one—because we always put our patients first.

I can’t get that old Springsteen song “My Hometown” out of my head: “Foreman says these jobs are going, boys, and they ain’t coming back….” That was a hit back in the early ’80s, when auto, rubber and steel factories started closing in the Midwest.

Looking back from the ditch we’re stuck in today, you can see that economic steamroller of devastation flattening industries and states.

Despite a few bubbles here and there, people keep losing their houses and their jobs, and let’s face it—they ain’t coming back anytime soon. Since 2000, the median income for ordinary Americans dropped by $2,197 per year. Most of us who are working feel fortunate to have any job at all. Those of us who have meaningful jobs—like keeping people healthy and caring for them when they are sick—we’re really lucky.

At Kaiser Permanente, we’ve got more than good fortune on our side. Not only do we have good jobs, with industry-leading wages and benefits, but we’ve got a strategy to make them great: We take value creation to heart.

That’s the point of the Value Compass—creating value.

As we work in our unit-based teams to improve service, quality and affordability and create the best place to work, we create more value for our members and patients, which will protect and improve our good jobs.

The Value Compass is not an initiative, a symbol or a checklist. It’s a shared vision.

It reminds us the sum of team collaboration produces value greater than our individual efforts alone. It reminds us how important our contributions are—and why we work so hard at improvement. It acknowledges that work has meaning not just for the “leaders” but for everyone.

When your team is on the same page, you all succeed—individually and collectively. By using these team-tested best practices, you can create a proven unit-based team strategy.

1. Provide sponsors and teams with ample and frequent training.

Offer frequent refreshers on Consensus Decision Making, Interest-Based Problem Solving, and the Rapid Improvement Model and its plan, do, study, act steps.

2. Make good use of your local experts.

Work with your management and union leaders and your facility’s project managers to identify their areas of knowledge and assign them to teams needing that expertise.

3. Create one consolidated list.

Include all the just-in-time, classroom and web-based (KP Learn) courses that meet Path to Performance requirements. Make the list and course-request process easily accessible.

4. Involve sponsors and subject matter experts.

They should sit in on the LMP Council and require regular updates. Identify common issues and address them.

5. Have teams do a “project prioritization matrix.”

This should be done annually after year-end assessments. Download the tool at LMPartnership.org.

6. Distribute and use LMP and performance improvement tools.

Everyone should be looking to learn on a continual basis.