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Will robots replace our jobs?

As technology rapidly reshapes work, the future may be scary, but it’s also filled with opportunities, especially in health care. Kaiser Permanente workers can stay ahead by continuing to learn both technical skills and human skills such as communication and problem-solving, experts say.

“Cultivating our uniquely human skills may be the best way to prepare for an uncertain future,” says Michelle Weise, chief innovation officer at Strada Institute for the Future of Work.

“Don’t be a bad robot. Be a good human being,” says Benjamin Pring, director of Cognizant’s Center for the Future of Work. “We don’t want to see a robot doctor. We don’t want to see a robot nurse. A lot of (future) jobs are caring jobs where we want to have the human touch.”

Weise and Pring headlined events in November and December in the Future Ready Workforce of the Future Thought Leader Series. The webcast series, sponsored by the Labor Management Partnership and presented by National Workforce Planning and Development, aims to help prepare Kaiser Permanente’s workforce for tomorrow’s jobs.

“We want to ensure our employees have the skills necessary for the jobs of the future,” says Jessica Butz, co-director of the Partnership-supported Ben Hudnall Memorial Trust.

The goal is to build on record usage for Kaiser Permanente’s tuition reimbursement and 2 Partnership-supported education trusts and have employees continuously skill up to meet changing work needs.

Building skills

“It’s a skills-based world that we live in,” Weise says. “For so many learners, a degree is a bridge too far. They just need to survive and get their foot in the door in a job that pays well.”

Today, 44 million adult Americans lack a college degree, don’t earn a living wage and face being left behind by the future of work, according to a Strada report.

“We’re going to need to reimagine education as much more like a variety of highways with lots of on- and off-ramps,” Weise says. “Sometimes when we’re skilling up, it’s going to be for technical expertise or digital fluency. Sometimes it’s going to be for a broadening of human skills.”

Jobs of the future

Pring also is optimistic.

“We think in the future there will be net job increases,” Pring says. “They’ll just be different jobs.”

These new jobs, highlighted in Cognizant’s “21 Jobs of the Future“ and “21 More Jobs of the Future” reports, include fitness commitment counselor and artificial intelligence-assisted health care technician.

As work changes, technology will enhance most jobs and create new opportunities.

“The only way to deal with disruption is to be proactive,” Pring says. “Invent your own future rather than allow the future to happen to you.”

Kerene Hoilett always knew she wanted to work in health care — inspired by her grandmother, a nurse.

When she learned that nursing didn’t fit her, she forged her own path.

Hoilett joined Kaiser Permanente in 2007 as an ultrasound technologist in Georgia. Since then, she has completed a project management certificate, landed an internship and earned 2 college degrees on her way to becoming a diagnostic imaging quality consultant.

“I always have that drive to challenge myself,” Hoilett says. “How can I tap into my strengths more?”

To help employees and managers tap into their strengths, Kaiser Permanente has a new career paths tool.

The new tool at kpcareerplanning.org/paths is interactive and personalized to help you explore career options. Follow the prompts to fill out a profile and find opportunities that link your skills, interests and education to careers at Kaiser Permanente.

“Kaiser Permanente encourages career mobility,” says Monica Morris, director of National Workforce Planning and Development. “With career paths, we’re trying to show you all the different career opportunities and directions you could go in the organization.”

Partnership unions negotiated to include career paths in the 2005 National Agreement with Kaiser Permanente.

“The new career paths tool reinforces our commitment to supporting lifelong learning and career development,” says Jessica Butz, workforce development director with the Alliance of Health Care Unions. “Career paths are a fundamental piece to help give employees a road map for success.”

Pursuing opportunities

After Hoilett became lead ultrasonographer in 2013, her journey took a turn to pursue leadership opportunities.

As a United Food and Commercial Workers (UFCW) member, Hoilett talked with a Partnership union-supported career counselor from the Ben Hudnall Memorial Trust, leading her to a project management pilot program. A project management certificate and 6-month internship at the regional office followed. The trust paid her to work at the internship one day a week, while she worked her regular job 4 days a week.

Hoilett applied for open positions but was unsuccessful, so she reviewed her experience gap with her career counselor.

“She encouraged me. I knew one day I would get that opportunity, and she helped me to be confident,” Hoilett says. “I wasn’t left in the dark. The career counselor was able to light my path.”

Hoilett’s persistence paid off. In 2018, she earned her master’s degree in project management and became a diagnostic imaging quality consultant. She’s using her people, project and technical skills to improve productivity and performance for imaging techs.

She isn’t stopping there. She continues to increase her impact in her current role while exploring learning opportunities in organizational leadership. And she encourages colleagues to learn, take courses and grow their careers — just like her.

“Don’t be afraid,” Hoilett says. “If you keep going, you will be successful.”

For Jennifer Cuevo, an urgent care nurse in Pasadena, the opportunity was too good to pass up: Earn a Bachelor of Science in Nursing without paying fees.

For Joel Boyd, manager of pulmonary clinical services in South Sacramento, teaming with a trust fund created an opportunity to teach nearly 500 respiratory therapists ways to improve care and lower costs.

From earning degrees to learning best practices, Kaiser Permanente employees are using the 2 Labor Management Partnership-supported education trusts (Ben Hudnall Memorial Trust and SEIU UHW-West & Joint Employer Education Fund) in record numbers. Program enrollments rose 26% in 2018 to 113,494; there were nearly 59,000 enrollments in the first half of 2019, on pace for another record year.

“We can address solutions,” says Rebecca Hanson, SEIU Education Fund executive director. “There’s overwhelming demand among the workforce for training opportunities aligned with patient care delivery needs.” 

Through the trusts, employees can build skills, meet targeted needs in training programs, and work with career counselors to set career goals and create plans to achieve them.

“We’re preparing our workforce for the jobs of tomorrow,” says Jessica Butz, Ben Hudnall trust co-director.

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Going for it

Cuevo, a 16-year Kaiser Permanente employee and UNAC/UHCP member, started as a licensed vocational nurse, then became a registered nurse. She always wanted a bachelor’s degree but put her dreams on hold while raising her children — until she talked with a Ben Hudnall career counselor and learned good news.

With a few additional courses, Cuevo could qualify for a bachelor’s program. The trust would pay the fees.

“I’m so thankful,” Cuevo says. “I wouldn’t have done this without the help of the trust and the partnership of Kaiser with the universities.”

Most classes were online, which Cuevo took at home. She did in-person requirements on days off — coordinating with her manager and family — completing her degree in 4 semesters. Her 17-year-old daughter is “really inspired,” Cuevo says. “She wants to go into research or be a doctor.”

Cuevo’s inspired, too. In November, she started a master’s program – paid again by Ben Hudnall. Cuevo, who wants to teach nurses, encourages colleagues to use trust services.

“Go for it,” she says. “It’s so worth it. Get your degree. Move up. You can do it. I did it. I love it.”

Benefits of partnership

When Boyd and pulmonary clinical services colleagues in Northern California reviewed their operations, they saw a need to standardize some patient care practices. Their goal: to decrease the length of stay for patients on mechanical ventilation to reduce the risk of such complications as pneumonia, improve care and lower costs.

They partnered with the SEIU Education Fund to organize 8 group trainings for respiratory therapists at Kaiser Permanente’s Garfield Innovation Center.

Working with the education fund was easy and helped get employee buy-in and participation, Boyd said. The trainings were so effective, more may be offered in Northern California and other regions.

“Nothing at this scale has ever been done for respiratory therapists,” Boyd says. “It was a true example of how we can get positive benefits from the Partnership.”

Carol Fiskio takes pride in helping good employees move on.

As revenue cycle director for Kaiser Permanente’s Woodland Hills Medical Center, Fiskio has seen 3 of her department’s admitting clerks earn college degrees and advance to new positions.

Their formula: a desire to learn, flexible scheduling and a valuable employee benefit. Hers: supporting employees’ lifelong learning to make them, Kaiser Permanente and her department stronger players.

Kaiser Permanente encourages such learning, providing employees up to $3,000 each year for completing courses to continue their education, get a certificate or earn a degree. Tuition reimbursement course applications reached a record 73,224 in 2018, nearly doubling since 2015, when benefits increased for many employees after that year's Labor Management Partnership National Bargaining. 

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Psyched for psychology

When Olayinka Rahman started as an admitting clerk at Woodland Hills Medical Center in 2007, she had a vision: to become a psychologist. She balanced working and going to school, using tuition reimbursement to earn bachelor’s (California State University, Northridge), master’s (Pepperdine University) and doctoral (Azusa Pacific University) degrees in psychology.

“I don’t think there would be a better place (than Kaiser Permanente) for me to get my degree and continue to work,” Rahman says. “They’re so supportive. I hear about other organizations that aren’t as flexible and don’t have tuition reimbursement.”

After a yearlong internship in Michigan, Rahman returned to Kaiser Permanente. She completed a postdoctoral psychology residency in San Francisco and now works as a psychological assistant in Antioch. She’s preparing for the licensing exams to become a staff psychologist.

Rahman encourages others to continue their education.

“It was definitely challenging but well worth it,” Rahman says. “Talk with your manager, and say, ‘How can we make this work?’ Open communication with management is key.”

Strength in education

Fiskio, who used tuition reimbursement herself to earn an MBA, praised Rahman and her other former direct reports for advancing their careers through education.

“It’s not easy to go to work and to school,” Fiskio says. “That takes real dedication. It’s a benefit to the organization.” 

One of a manager’s most important roles may not appear on the job description — but goes hand in hand with getting results.

“Managers have a key role in helping employees build successful careers,” says Maria Aldana, a career counselor with the SEIU UHW-West & Joint Employer Education Fund, one of two education trusts supported by the Labor Management Partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions. “A great leader creates other leaders.”

Fortunately, Kaiser Permanente managers have many ways to support their employees’ development and ensure their department’s success. Here are five.

1. Have career conversations with employees. Talks can be brief and happen anytime and anywhere during the work day, not just during annual performance evaluations. Get tips at Kaiser Permanente’s leadership and management portal (sign-in required) and at Skillsoft @ KP (sign-in required), an on-demand, mobile-ready catalog of learning resources.

“We need to keep and grow our people so they are ready for the changes in health care,” says Beth Levin, a career counselor and outreach coordinator with the Ben Hudnall Memorial Trust, which serves all members of the Coalition of Kaiser Permanente Unions outside of SEIU UHW.

2. Know what resources are available. HRconnect and KP Learn have resources available for all KP employees, and the LMP website offers tips, tools and practices for individual and team development. Employees can learn about the four critical skills, explore career paths and access tuition reimbursement at kpcareerplanning.org.

The two education trusts offer courses at every level of development, many at no cost to employees, as well as career counseling, tuition assistance programs and more.

3. Work with career counselors. Education trust career counselors can tailor training, provide one-on-one career planning and coaching, and help with skill assessments.

For example, an indexing clerk manager in Colorado told Aldana how his employees needed more computer skills to keep doing their jobs effectively. She met with employees, discussed changes in their field, informed them of available resources and developed a plan that included onsite training.

4. Schedule time for employees to take classes. “Labor and management can come up with a schedule that works and we can offer the training,” Aldana says. “We usually can find vendors that come on site.”

5. Look for development opportunities for employees. Managers can suggest that an employee lead a huddle, serve on a committee, or become an active unit-based team participant or health and safety champion to “gain experience, build skills and network,” Levin says.

Building such engagement can get employees excited about change and encourage them to build their skills.

“When one person is successful, it inspires and motivates other people,” says Levin.

In 2011, the Medical Records unit-based team in the Northwest received 1,222,361 pages of outside records that required indexing into patients’ electronic medical records—a staggering 725,000 more pages than it received in 2010.

Yet team members met and mastered the challenges facing them, whittling down an enormous backlog and reducing the turnaround time for processing from 62 days in December 2010 to three days by December 2011—benefiting both their internal customers and KP’s members and patients. And they’re sustaining that success.

The steady increase had been debilitating. Overtime hours went through the roof, with more than 2,450 hours logged in 2010. The 37 team members work 24 hours a day, seven days a week and have seven different work classifications. Staff members were worn out. Piles of paperwork were stacked high, waiting for processing. Morale was at an all-time low.

The case illustrates vividly that service is not just a bedside issue at Kaiser Permanente. For a variety of reasons, many KP members see outside providers—and when those providers submit paper or electronic records with the patient’s medical information to Kaiser Permanente, the records have to get indexed into KP HealthConnect. If there’s a delay, the patient’s regular physician may be missing important information the next time the member is seen at KP.

“When the clinician needs medical information on their patients in order to treat their current medical condition, we’re able to provide updated and accurate records,” says the team’s union co-lead, Kathleen Boland, a data quality clerk and SEIU Local 49 member. And, she notes, members aren’t having to repeat critical tests and procedures, saving them time and money.

Things started to change when, through unit-based team training, team members learned such skills as process mapping and how to understand data. They created SMART goals (specific, measurable, attainable, realistic/relevant, time-bound), started huddling and developed a greater understanding of roles and responsibilities.

The team receives more than 700 different types of documents, so variation was rampant. Team members developed cheat sheets to standardize how documents should be prepped for indexing and to get everyone to use the same process for each task. They also cross-trained and helped each other out when someone was on vacation or ill.

“In the beginning,” says Bruce Corkum, RN, a UBT resource team specialist, “they didn’t share the work. Then they started understanding how they could help each other work toward the same goal.”

Not only did the backlog disappear, but the need for overtime is nonexistent now, they’ve improved attendance and “morale has improved,” says Burgandy Muzzy, a health records clerk and member of SEIU Local 49. People are happy to be at work.

“People are talking about us in a positive way now,” says manager Debbie Lang, “instead of as ‘those people who lose everything.’ ”

Cheryl Kusmits has been a licensed practical nurse for 16 years at Ohio’s Fairlawn Internal Medicine department, a small clinic with a close-knit staff known for its personal service. She loves her job and prides herself on doing it with compassion and a smile.

Kusmits knows all the longtime patients, and they know her. At least, she thought they did. Then she was trained in the service practice known as AIDET—Acknowledge, Introduce, Duration, Explanation and Thank you.

“Until I started saying, ‘My name is Cheryl,’ I didn’t realize, ‘Oh gosh, they see me all the time but I never say my name,’” she says.

When Kusmits introduced herself to a regular patient, he responded he’d been coming there for years and knew her face but had never known her name. It was nice, he said, to finally “meet” her.

Kusmits, who had her doubts about AIDET’s value, was sold on the service training right then.

There’s more to service than being nice

Top-notch service is not just the purview of five-star hotels or, where they still exist, full-service gas stations. These days consumers expect superlative service from their health care providers—and rightly so. No matter how technically superior the care, an inconsiderate or simply indifferent provider spoils the experience. Patients deserve healing, not just fixing.

As a result, providing stellar service to patients and members has never been more important for Kaiser Permanente. Our survival in the competitive health care market rests not only on the quality of care but also the quality of the service we provide to our members. The better the overall experience, the more likely we are to retain current members and gain new ones—ensuring the strength and stability of our model of care, which in turn leads to long-term job security.

“Members’ and patients’ own experiences, or the stories they hear from friends and family, make a huge difference in whether people choose Kaiser Permanente,” says Vickie Cavarlez, an LMP senior labor liaison for public- and private-sector accounts. “As unit-based teams develop, they are making a real difference in the story we can tell.”

The good news is that unit-based teams working to provide our members with the best service possible at every touch point in the system don’t have to start from scratch—they can get a big jump ahead, fast, by taking advantage of KP-endorsed programs with proven track records. Here are the stories of two instances where such programs, AIDET and Nurse Knowledge Exchange Plus—which was pioneered by KP’s Innovation Consultancy—have had dramatic effects.

Could your team be next?

AIDET: More than a surface polish

In 2010, management, physician and union co-leads for all of Ohio’s unit-based teams were trained in the tactic known as AIDET to pump up the region’s service. As a small market that competes in the shadow of the renowned Cleveland Clinic, KP’s Ohio region must go above and beyond in quality of service and care provided.

“We don’t have a physician on every corner. So you have to make it up somewhere, and we make it up in quality and service,” says John Hightower, manager for organizational excellence in Ohio. “It’s part of who we are and who we’re trying to be.”

The region turned to AIDET because of its simplicity. At its core, the training is about communication behaviors and basic courtesy– from acknowledging a patient’s presence with eye contact to explaining that a physician is running late.

Fairlawn Primary Care, where Kusmits is the UBT union co-lead, always had received good service ratings from patients—with scores ranging from 81 percent to 83 percent—but the facility had experienced a small dip in 2010 after it moved offices, dropping to 75 percent. So when nurse manager Paula Hadley, the team’s management co-lead, heard about the AIDET training, she talked with her co-leads—Kusmits and Keith Novak, MD—and volunteered Fairlawn as a pilot site. Initially, reviews were mixed.

“Well, I thought, I’m nice all the time. We’ve always had high scores. I thought, ‘How can I do any better?’” recalls Kusmits, an OPEIU Local 17 member. “But we did. It was kind of amazing when it all happened.”

Fairlawn saw its service scores jump by 10 percentage points within a couple of months after it began using the AIDET behaviors. Office wait scores jumped from 67 percent in January 2011 to 76 percent in August the same year. In the area of staff courtesy and helpfulness, Fairlawn started at 83 percent at the beginning of 2011 and is currently at 89 percent.

The service tool is not a script. It’s not about just being nicer. It’s a set of behaviors, Hightower stresses, that enhances communication and shows respect for the patient.

“And not doing it like a robot,” Hadley says. “It’s genuinely using the behaviors so it’s part of what they are doing every day.”

Of course, there are still those times when an experience isn’t perfect. In such “service recovery” cases, having AIDET under the belt is even more critical. Ohio saw this firsthand at the start of 2012, when it reduced its extensive outside provider network and redirected patients to Permanente physicians. Suddenly patients who had longstanding relationships with outside primary care physicians had to switch to a Permanente primary care physician.

Going above and beyond in service was never more essential.

“I can only tell you that there are some members who are going to be upset no matter what,” Hadley says. “And how we treat them—even if (we’re not giving them) the answer they want—will make a difference in the outcome.”

The power of a seamless handoff

While AIDET provides a foundation for superior service regardless of location, providing a good care experience at the bedside takes additional skills. In the hospital setting, providing a seamless handoff between revolving shifts of caregivers is critical, as is keeping patients informed, involved and confident in their care. Which is where Nurse Knowledge Exchange Plus comes into play.

Longtime nurse Jennifer Toledo remembers “the old days”—which were really only a few years ago—on her medical-surgical unit at Panorama City Medical Center in Southern California. When the registered nurses would change shifts, the incoming nurses would crowd into a conference room and listen to the charge nurse give a brief report on each of the patients. “And we’d all take notes,” says Toledo, a member of UNAC/UHCP.

The practice never sat well with Toledo. “There was no way to validate what the charge nurse was saying,” she says. “And, there were no patients involved.”

Today, shift change on the fourth floor med-surg units is radically different. Incoming and outgoing nurses pair off in patient rooms for the “Nurse Knowledge Exchange Plus”—a structured, in-depth, in-person handoff that puts the patient at the center. Use of NKE Plus has increased nurse time at the bedside by nearly 19 percent and is improving nurse communication service scores among unit-based teams at Kaiser Permanente hospitals in Southern California.

With NKE Plus, the outgoing nurse introduces the incoming nurse to the patient before going off shift. Together, they review and update the patient’s in-room care board. They go over the plan of care, and make sure the patient understands it and has a chance to provide input. Some units use catchy acronyms—this is Kaiser Permanente, after all—such as HEAL to help nurses remember all the elements they need to review (High-alert medications, Environment, Alarms, Lines and drains).

This strategy “encourages more participation from the patient and gives them the security of knowing that someone is looking after them,” Toledo says. “We all agree on the plan, and we can correct misperceptions right then and there.”

Eric Zambrano, a relatively new nurse, agrees with his more seasoned colleague. “It makes the patients less anxious,” he says. “Patients know the plan for the day. It gives them comfort because they are not wondering what is going to happen next.”

NKE Plus “has catapulted our HCAHPS and nurse communication scores” at Woodland Hills, says Nancy Tankel, the nurse executive there, referring to the federal Hospital Consumer Assessment of Healthcare Providers and Systems survey. In fact, between January 2011 and January 2012, HCAHPS scores on a set of questions measuring the quality of nurse communication jumped from 71 percent strongly positive responses to nearly 82 percent. And the staff is as satisfied as the patients.

“I’ve had one nurse tell me, ‘I can sleep at night,’ ” says Tankel.

Lasting impressions

Ultimately, beyond the critical role stellar service plays in Kaiser Permanente’s survival, providing the best experience we can, for every patient and every member, every time, is simply the right thing to do. It’s core to Kaiser Permanente’s mission.

From the moment our members come into contact with Kaiser Permanente, whether online, by phone or in any of our facilities, our interactions with them build or break their trust and loyalty. Providing for a great care experience goes beyond correct diagnoses and treatments. It means asking ourselves if we are looking someone in the eye; if we are examining whether our protocols and procedures make sense, not just for us, but for the members who have to navigate them; and if we are taking care that the many handoffs we make along the way are clear and seamless for our patients and their families.

“We want to keep our patients,” says Ohio LPN Kusmits. “So we need to make them happy and make them feel like we care. And we do care. We need to make sure they’re aware of that.”

To learn more about AIDET, NKE Plus and other evidence-based practices aimed at improving the experience for patients and members, please visit the National Service Quality website.

Amy Edmondson says innovation depends on a culture of focused chaos.

Those words sound like opposites. They are. Don’t worry. It’s not a mistake.

In fact, innovation depends on four pairs of seeming opposites. As unit-based teams ramp up, involving frontline managers, physicians and employees in finding new ways to improve performance and transform health care, they can benefit from creating a culture of innovation. This is how Edmonson, a professor at Harvard Business School, defines the four cultural contradictions of innovation:

• Chaotic/focused
• Playful/disciplined
• Deep expertise/broad thinking
• Promotes high standards/tolerates failure

Let's take a more detailed look.

Chaotic/focused

“An innovation culture is focused,” says Edmondson. “It is really intent on improving a process or inventing a new business model or coming up with a new product.” At the same time, it is chaotic. “Any idea is welcome and possible—at least until we sort it out. No idea is a bad idea—at least early in the process.”Chaos, says Edmondson, “is about welcoming all ideas, even ‘wacky’ ideas.” Only in a psychologically safe learning environment will employees feel open enough to offer these “wacky” ideas, she adds.

Playful/disciplined

The Labor Management Partnership offers a disciplined process for innovation in the form of the Rapid Improvement Model (RIM) and the plan, do, study, act cycle. But, Edmondson emphasizes, teams use these tools “without knowing in advance what the answer is.” There is a careful and well-managed process, but the content of the conversations about improving performance must be open and inclusive. As teams begin a performance improvement project, UBT leaders need to be very clear about what aspect of performance they are trying to address—not on how the team is going to do it.

Deep expertise/broad thinking

An innovative team is one that values those who bring deep expertise (in a specific topic, subject area or clinical specialty, for instance) and people who are broad, general thinkers who span boundaries. “Both of those skill sets are absolutely essential at the same time,” says Edmondson.

Promotes high standards/tolerates failure

In an innovative work culture, “We hold very high standards but we are also very tolerant of failure,” says Edmondson. “That sounds ‘wrong,’ at first,” she admits, “but it is essential because, in innovation, you will never get it right the first time. You try something, test it out, it’s not going to work quite right and then you either tweak it or throw it out altogether and try something else.”

Spreading new ideas that get results throughout a large organization such as Kaiser Permanente, says Edmondson, requires finding ways to “shine a very quiet spotlight”—another seeming contradiction!—on innovators so others become aware of what they are doing and are drawn to try it too. 

“In today’s world, there are two ways to get the word out,” she says. The first is face-to-face communication, “positive buzz that starts locally and spreads.” The other is internal online social networks as “a way to listen, motivate and share practices that are potentially better.”

“It can catch on,” says Edmondson. “When there are pockets of effectiveness, other people see them, and they want to play too.”

In health care, there is no such thing as “normal business hours.” Babies insist on being born at 3 a.m. A car crash or bursting appendix can land a patient in the Emergency Room at noon or midnight or 5 a.m. To prevent infections, the cleanliness of hospital rooms is just as important at 4 a.m. as at 4 p.m.

So what’s a unit-based team to do? Full participation in a team’s performance improvement work from all members on all shifts can send service and quality scores soaring—while shifts left out in the cold can drag down a whole department. It’s hard enough ensuring all members of a single shift are on board.

But getting everyone onboard around the clock is a daunting challenge. Shifts that pass in the night may be oblivious to the other’s particular challenges and culture. They might not fully understand how their own work affects the other shift’s workflow. Rivalries and finger-pointing can ensue.

NIGHT OWLS IN THE LAB

As the double doors swing open, cold night air blasts into the receiving bay at the Regional Reference Laboratory in North Hollywood, California. Employees are ready, bundled up in knit scarves and hoodies. It’s 11:30 p.m. on a mid-February night, and couriers are delivering gray cooler bags filled with vials and tubes of specimens from all over Southern California. Clinics from Kern County in the north to San Diego, nearly 180 miles south, have closed for the evening. Now all of those blood tests and urine samples have to be processed and analyzed so providers can detect disease or spot the warning signs of a developing chronic condition.

At the specimen processing department, the graveyard shift is the busiest. “We’re like the mailroom,” says Leland Chan, supervisor and management co-lead. More than 10,000 specimens go to the automated chemistry department during the graveyard shift, compared with about 4,300 in the morning and nearly 9,000 at night.

Michael Aragones, the labor co-lead, likens the three shifts to gears all rotating together and powering each other forward. But not so long ago, the gears were getting jammed up.

Building resentments

Something was going on: Staff members on each shift thought the workload wasn’t being distributed equally—and they were getting the short end of the stick. Employees with different duties on the same shift felt the same way about their peers.

“There was a lot of ‘back talk’ between the shifts,” says Aragones, a lab assistant II and member of SEIU UHW. “People would say, ‘How come they are doing this or that?’ and ‘How come I have so much work?’ ”

The unit-based team was the vehicle for improving the workflow. Team members from all shifts got involved collecting, collating and analyzing data about the specimen count, hour by hour.

Riverside EVS attendant Virginia Gonzalez, a United Steelworkers Local 7600 member.

The results revealed why employees were feeling overworked: Between 2008 and 2010, the number of specimens going to bacteriology, for instance, increased from fewer than 4,000 to more than 5,000. Moreover, the time of night that most specimens arrived had changed. The lab used to see a big spike around 9:30 p.m.; now the rush came about 11 p.m. So the team adjusted the start and end time of the graveyard shift to match the flow of work coming in.

“At first, there was a lot of resistance,” Chan says, with employees worried about child care arrangements and traffic. The data, however, “gave us a better understanding of the workflow,” which let staff members see why they were being asked to make changes. “It was the UBT that helped solve that.”

 “It wasn’t managers saying, ‘Well, you just have to,’ ” Aragones says. “We have to look at workflow for the whole department, not just one shift. It’s like a spider web. You pull one strand, and it affects the whole thing.”

Now that the work is flowing better, the UBT is working on new initiatives.

“The UBT makes my life easier,” says Chan. “It allows me to work more closely with the crew because we are on equal terms. Sometimes, as a manager, you don’t have all the answers. They do the work, they are the experts.”

COOKING UP CAMARADERIE

It is 7:15 p.m. in the kitchen of the Downey Medical Center. “Huddddlllle!” shouts Francisco Vargas, a gentle giant of a man. The sound of his booming voice echoes off the tile floors and stainless steel work surfaces. One of about 20 SEIU UHW members working the night shift in the Food and Nutrition department, Vargas gathers the troops before they begin to wash dinner trays and deliver late meals to patients.

Assistant Department Administrator Patricia Villareal and her union partner Amelia Cervantes review new data on the team’s improvement projects, such as cooking less soup on weekends so less is wasted, and give a reminder about clocking in accurately.

The huddle ends with a team cheer—“Work hard, stay positive!”—and with that, food service kitchen worker Nancy Rudeas, an SEIU UHW member, and a colleague scurry off to prepare two late dinner trays. They double-check to see that a patient’s special request for green tea is being filled (it is).

“I love doing this,” Rudeas says, heading up on the elevator.

A few late tray deliveries have become a fact of life for the department, a consequence of abandoning set meal times in favor of a “room service” model: Patients simply make a phone call when they are ready for a meal, just like a hotel guest might.

This patient-centered innovation meant the workflow changed. Foreseeable peaks and valleys in cooking and cleaning became a less predictable, variable demand. Tasks that once had been the domain of one shift or the other “leaked” into the next shift. Tensions rose among employees as the distribution of work was thrown into flux.

“Because we have a UBT, we could sit down together and ask, ‘How can we get this resolved?’ ” says Villareal.

Together, the team experimented with adjusting start times for different jobs in the department until it settled on a mix that’s working. “The morning picks up for the night shift, and the night shift picks up for the morning,” she says.

From OK to great

The department set out to improve its customer service scores in September 2008. Though a respectable 86.7 percent of patients surveyed agreed with the statement “the people serving my meals were polite and professional,” that was nonetheless among the lowest scores in the Southern California region.

Together, the UBT members came up with a script that encourages food service workers to introduce themselves by name, ask if they can open any containers, and—most crucially—ask if there is anything else they can get for the patients. By consistently using the script, by October 2010, the score shot up to 99 percent.

Night-shift workers like Rudeas have contributed to that success. The shifts share information in huddles and bulletin boards.

“What goes on during the day, we know at night,” she says. “And what goes on at night, they know during the day.”

A SWEEPING SUCCESS

The Environmental Services department at Riverside Medical Center is continuing its winning streak: In 2010, it went 260 days without a workplace injury. The UBT received a huge banner congratulating it on the achievement, and the co-leads thought it would be nice if each team member signed it before hanging it up.

The banner remained out for a few days to make sure all staffers had a chance to sign—including the workers who come in at 11 p.m. for the graveyard shift. Only then was the banner hung up on the unit wall.

“This made a huge difference,” says Angel Pacheco, who will become the new management co-lead in May and who himself works the night shift. “This actually shows that everyone is involved and can take pride and ownership.” After all, performance metrics are measured by department, not shift, and night shift workers contributed to creating a safer workplace as much as their day shift counterparts.

The EVS team posts a flipchart sheet after every monthly UBT meeting with three to four important items of information to pass on to the rest of the staff. Each shift reviews the sheet at a daily huddle held at the beginning of each shift. The quick review of UBT business, including key performance metrics, follows the team’s stretching exercises that have helped reduce workplace injuries and won it recognition throughout KP.

The sheet hangs on the door of the supply closet, where each staff member comes when starting work to get carts, trash bags and keys to the offices they have to clean. This strategic placement ensures workers from all shifts have access to the daily UBT updates.

Face time matters

Face-to-face communication augments written communication and helps build the camaraderie that helps teams improve performance. For instance, Pacheco makes a point of visiting the night workers in the outlying medical office buildings—he drives an hour to Temecula to see one employee.

“It’s worth it,” he says. “I just take the time to reflect on things.”

Paula Cunningham, an EVS attendant and member of Steelworkers Local 7600, is one of four union members on the 6 p.m. to 2 a.m. shift responsible for passing information from the UBT’s representative group meeting to her shift colleagues.

“They trust us to deliver the information to them,” says Cunningham, whose work schedule is adjusted so she can attend representative group meetings in the early afternoon. “We talk frequently and rely heavily on huddles.” Other night shift workers also rotate into the group’s meetings.

Because he’s an on-call employee, Robert Casillas works all the shifts, so he has insights into what makes each shift unique.

The morning shift is more hectic, he says. The evening work is much calmer. More people are cleaning sections solo, but they pass one another in the hallways and share information with each other then.

“We have our communications plan, which we share with the other staff,” Casillas says. “We don’t want anyone to think we’re hiding stuff. And when the information comes from us, it’s less like a demand from management. It’s more about figuring out ideas to help us do our work.”

Sometimes, seeing the hospital at the end of the day as they do, it is night shift employees who spur the entire department into action.

The night workers noticed the hospital was running low on privacy curtains. When the ones soiled during the day were taken down, there were not enough from the laundry to replace them. Cunningham brought the information to the representative group, and the co-leads secured more curtains.

“What affects the night shift,” she says, “usually affects all of us.”