Savings - Color

The new goal was dramatic: Reduce hospital stays to 23 hours for total joint patients.

Renee Portillo, RN, was worried.

“It was a shocker. Our staff was used to patients going home in two to three days,” says Portillo, former assistant clinical director and management co-lead of the 7 South medical-surgical team at Fontana Medical Center in Southern California.

The accelerated time frame meant that the unit’s nurses, who care for total joint patients following surgery, would have less time to prepare them for discharge. They’d also need to help choreograph care across multiple departments—Orthopedics, the operating room, Physical Therapy, Home Health—from pre-admission to discharge.

Who best to help the team through this change? The team itself.  

“We used our UBT to help change the culture,” Portillo says.

Wave of the future

“We helped our nurses be successful by having them anticipate patients’ needs and prepare them for discharge,” says Enrique Rivero, RN, a surgical nurse and UNAC/UHCP member who is the team’s union co-lead.  

Fontana is among a growing number of hospitals across the United States to offer a combination of shorter hospital stays and more outpatient care for hip and knee replacement patients. The trend is driven by less-invasive surgical techniques, improved pain management and rehabilitation practices, and patients’ desire to return home as soon as possible.

“There were a lot of challenges. A lot of it had to do with bringing people together,” says Mary Hurley, MD, chief of Orthopedics, who championed the new approach. “They all had to buy in and be willing to support this in order to have a successful program.”   

The new approach, which Fontana introduced in January 2014 after months of researching best practices, gets patients walking within hours of surgery and enables them to recover within the comfort of their own homes. The initiative takes advantage of Kaiser Permanente’s integrated model of care and is designed to improve clinical outcomes and reduce costly hospital stays.

As more and more unit-based teams answer the call to improve affordability for health plan members, they are finding new tools that can help manage their cost-improvement projects.

One such tool, a handy spreadsheet, can help teams track and report their cost savings.

Teams track own savings

Developed by UBT consultants and financial analysts in Colorado and later adopted by UBTs in the Northwest, the tool can help teams determine the economic benefits of a performance improvement project with little or no assistance from a consultant or sponsor.

“It’s a great add-on to teams’ reporting in UBT Tracker,” says Luanne Petricich, chief pharmacist, Pharmacy Professional Affairs, in Colorado and a sponsor of 12 UBTs in the region. “It can be a very impactful way for co-leads to show their teams and others what their savings were and how they achieved them.”

In addition, teams can now record their financial results directly into UBT Tracker thanks to a new data field, Annual ROI, that allows teams to share how much money a project saved or generated. The field can be found under the Project Details tab (see graphic below).

Click to enlarge.

Tool use spreads

Petricich sends the spreadsheet to any of her teams working on a cost-reduction or efficiency project to help them document their results.

One team that used the tool was the pharmacy UBT at Baseline Medical Offices in Boulder. The team had completed an inventory-reduction project that far surpassed its goal—which was to reduce its drug inventory by 10 percent, or $50,000, in three months. By adjusting order quantities to better match usage and returning overstocked medication to the mail order pharmacy for use before the expiration date, the team saved $143,000—nearly three times its original goal.

“It’s important to track your results, and this tool can help teams do that in a simple way,” says Don Larson, Baseline’s pharmacy supervisor. “It’s something we would use the next time we do a similar project.”

Cutting waste and saving money for Kaiser Permanente members and patients is good. But 350 Environmental Service workers in Southern California are taking that mission a step further by tending to Mother Earth as well.

Kaiser Permanente and two Labor Management Partnership-funded workforce development trusts are among the health care partners nationwide that are training frontline workers and managers in improved recycling, waste disposal, energy conservation and other green practices. The U.S. Department of Labor and the Healthcare Career Advancement Program, a national partnership of unions and hospitals, are leading the effort.

“‘Carbon footprint’ is a phrase that’s thrown around a lot,” says Milford “Leroy” Alaman, EVS operations manager at the Los Angeles Medical Center. “Now our staff is able to understand that when you are talking about conserving energy, water and electricity, you are talking about looking at the resources we have in our facility and holding on to just what we need instead of creating more waste for us and the planet.”

Leading change at work

Along the way, these “green teams” also are reducing operating costs, enhancing employee skills and morale, and improving patient and workplace safety. 

For example, the EVS department is now using environmentally friendly microfiber mops to clean a single patient room. This has the benefit of not spreading infections between rooms and preventing lifting and straining injuries caused by wringing traditional mops and hauling buckets of water.

The department also has started a project that is reducing the cost and trouble of replacing the 500 D-cell batteries used in the hospital restrooms’ automatic towel dispensers. The traditional batteries wore out in a matter of weeks—costing about $3,000 a year to replace and adding some 6,000 batteries a year to local waste or reprocessing streams. Starting in February 2012, workers installed new rechargeable batteries. Overall, EVS' green projects, including the use of rechargeable batteries, are saving an estimated $12,000 a year.

Enhancing skills, raising sights

“I feel better having conversations with anyone…doctors, nurses, I can tell them how to be green,” says EVS attendant Jose Velasco, an SEIU UHW member and a recent graduate of a green certification course offered at West Los Angeles Community College.

The program also was piloted at KP Riverside Medical Center, where the EVS unit-based team is reaching out to others with its newfound expertise. Now an EVS member is embedded with the Operating Room UBT—with others to follow—to help tackle waste and hygiene problems there.

The SEIU UHW-West & Joint Employer Education Fund and the Ben Hudnall Memorial Trust have helped underwrite the cost of the training for Kaiser Permanente’s LMP-represented workers. Eventually, frontline workers may be able to use their certifications for higher pay and promotions as medical center “green leads,” a program that would be negotiated between KP and the unions.

But the training already is making a difference to workers as well as to KP and the community. “They have more tools, more knowledge, so they are able to catch things,” says Angel Pacheco, management co-lead of the EVS UBT at Riverside. “We talked about saving the environment for future generations.”

The Moanalua Medical Center in Honolulu is saving the planet, one unit-based team at a time.

The Ambulatory Surgery Recovery UBT started collecting small bags of recyclables on its own in March. But team members resorted to some “trash talking,” and now the entire medical center collects about 30 pounds of recyclables each week.

“The original goal was to help our aina (land) thrive,” says Avis Yasumura, RN, the team’s union co-lead and member of the Hawaii Nurses Association, OPEIU Local 50. “Being on an island, there are limited space and resources.”

The region estimates that since October 2010, the recycling has diverted 7.1 tons from the landfill and saved several hundred dollars in recycling fees.

The ASR team started by identifying items on its unit that a local vendor was willing to collect and recycle: irrigation bags, wrappers for intravenous tubing and operating room “peel packs” (sterile wraps for drapes, instruments, gowns and gloves). The team used tests of change to successfully gather and segregate the items.

ASR shared its effective practices in several ways, including:

• a PowerPoint presentation on products that can be recycled
• “Going Green” editions of its UBT newsletter and fliers with pictures of recyclables
• helping other units order blue recycle containers and arranging for pick up with the EVS department

The team also promoted the project at Hawaii’s first UBT fair, with a colorful storyboard display, complete with examples of recyclable products.

“It was the talk of the UBT fair,” says ASR co-lead Janet Lundberg, nurse manager of procedural sedation. “This recognition inspires all UBTs to take risks.”

More than 10 teams at the 300-bed center are recycling now.

Where did the ASR unit get the recycling bug in the first place? Carolyn Sandison, an HNA nurse, was inspired by an LMP bulletin board poster in her break room about the blue-wrap recycling project at Sand Canyon Surgicenter in Southern California.