Q2/Q3-2017

The word “affordability” can be a lightning rod. Union members often think it is a code word for layoffs and cutbacks. They might question why it is suddenly up to them to sweat every paper towel and latex glove and wonder if higher-ups are pitching in. 

Managers might wonder how in the world they are supposed to squeeze more out of their already-tight department budgets. 

If everyone suits up for battle every time the word is mentioned, then progress on saving money becomes harder, if not impossible. 

Luckily, at Kaiser Permanente, our values create value. After all, Henry J. Kaiser and Dr. Sidney Garfield founded KP to be an affordable (there’s that word again), high-quality health plan for working families, with incentives to keep our members healthy (rather than profit when they got sick or injured). 

With the advent of the Labor Management Partnership 20 years ago, we cemented another core value: Listening to the voices of frontline workers, managers and physicians, who do the work and are closest to the patients. They know where the waste and inefficiencies are. And addressing inefficiencies goes hand in hand with improving care.

In 2005, the National Agreement negotiated by KP and the Coalition of Kaiser Permanente Unions further refined these values by laying the groundwork for unit-based teams. UBTs emphasize performance improvement and, more importantly, ensure everyone at every level of the organization has access to PI methods and tools so they can contribute. 

Read this issue of Hank, and make peace with “affordability”—confident that our values create value.

“The No. 1 reason for the success of our teams has been personal engagement,” says Alan Kroll, a primary care area administrator in Colorado who co-sponsors nine unit-based teams with his labor and physician partners. “Everyone needs to buy into the process to make partnership work.”

Building engagement and ensuring a consistent work experience have been goals of the Labor Management Partnership since the beginning. But, at the same time, there’s been a good deal of variation around these efforts from location to location across Kaiser Permanente, to the frustration of many managers, workers, and KP members and patients.

That’s why the 2015 National Agreement mandates partnership training for everyone, including the mid-level managers and union leaders who guide others. Early versions of the partnership training for mid-level leaders, which will be available this year, have gotten high marks from UBT sponsors and other leaders who have taken it. 

Consistency counts

The agreement calls for “a learning system that supports sustained behavior change, partnership and performance.” This includes joint training and refresher courses—delivered in-person
and/or online—to “achieve the same partnership and employment experience wherever one works in KP.” 

The new training for mid-level leaders will include segments on: interest-based problem solving examining the forces that support or undermine partnership core partnership behaviors and principles the strategic importance of the LMP 

Joint training is key 

The programs are designed to develop successful leaders who can model partnership and spread successful practices—and to ensure that the managers or union representatives helping teams have what they need to support those teams.

“It is very powerful for managers and union leaders to be in training together,” Kroll says. “It sends the message that everyone is important, and sets a foundation to work from when an issue gets stuck.”

The training served as a reminder that good partnership practices also are good leadership practices. 

“People want to hear from their leaders,” he says, and to “know what issues we are dealing with and that we can help remove obstacles.”

See the 2015 National Agreement, section 1.E, Education and Training (pages 31–33) for additional information.

Northern California: Staff laptops make life easier 

Even in a fast-paced Emergency Department, change doesn’t always come swiftly.

“I’m old school,” says Jacinta Laupua, a clerk and SEIU-UHW member, who was one of the last holdouts when her team decided to try using laptop computers to gather member signatures. 

“I thought of every excuse in the book. But now I love it,” she continues. “If I don’t have a laptop assigned to me, I ask other clerks if they are using theirs, because I want one. In fact, we need more.”

The laptops, provided through a regional initiative, are at the heart of a successful unit-based team project to reduce paper and copying costs in the Emergency Department at the South Sacramento Medical Center. The total savings came to more than $88,000 in 2016. 

The Level 5 UBT’s project got under way in late 2015, when clerks and the team’s co-leads—Bianca Ruff, a clerk and SEIU-UHW member, and managers Susan Velasquez, administrative services manager, and Neeta Kumar, administrative clerical supervisor—brainstormed ways to improve cost savings and efficiency. Their first goal was to save $27,820 over four months. 

Soon team members were trying out the use of laptops with signature capture pads. The technology makes it possible for clerks to register patients at their bedside and record their information and signature electronically. Not only does this eliminate the need for paper registration forms, it also increases the clerks’ mobility and efficiency.

There were many small tests of change needed before everything was working smoothly, but the project has been so successful the department has invested in nine laptops on wheels. And all Emergency Department clerks are trained on
the computers. 

“It’s almost too painful to remember how we used to process forms,” jokes Ruff.

—Tracy Lee Silveria

Northwest: Pharmacy team ‘owns’ its inventory, saves thousands

When team members at the Community Care Pharmacy in the Northwest region did a routine inventory, they were astounded at the value of their expired medications that no longer could be returned. 

“We took a $70,000 loss,” says Rob Yancey, the pharmacy’s manager. The pharmacy serves patients in extended care facilities and often fills prescriptions for costly and uncommon drugs.

Susan Luu, an inventory technician and member of UFCW Local 555, spearheaded a successful project that drew on the free-to-speak culture and collaborative spirit that helps make this a Level 5 team. 

“I knew it was too much to do by myself,” Luu says. “I felt comfortable talking with my manager, and his response was, ‘Let me see how can I can help.’” 

Different staff members “owned” a section of the pharmacy to check for outdated or slow-moving medications. By the time the team did its next inventory, losses had dropped to $7,000.

—Jennifer Gladwell

Mid-Atlantic States: Tackling unwanted side effect of a computer upgrade

When the South Baltimore County Medical Center laboratory in the Mid-Atlantic States region upgraded its computer system in December 2015, it inadvertently increased lab costs. 

The problem? While the new system has many great features, it doesn't have a way to alert staff when providers add a new test to an existing order. In May 2016, the lab missed 32 percent of these “add-ons,” a total of 30 tests, says Samuel Endalew, the lab’s lead technician, a UFCW Local 27 member and the team’s labor co-lead. 

The mistake inconveniences members, who must return to the lab to provide a new specimen. Each missed add-on costs Kaiser Permanente about $35 in extra supplies and employee time. 

The solution: a system to check the lab’s inbox for add-on tests and a team binder to track their progress. By February 2017, the team was missing only 2 percent of add-ons and saving about $1,050 a month.

Leaders from other area labs are considering adopting the process.

—Otesa Miles

Budget-savvy shoppers know you can save money by buying in bulk—even, it turns out, when you’re buying pharmaceuticals. Just ask the team members of the Zion Outpatient Pharmacy in San Diego.

The unit-based team was able to save more than $1 million over five months by buying drugs in quantity and managing specialty medications better. And, adopting a practice that would make Goldilocks happy, the pharmacy now keeps just the right amount—no more, no less—of high-cost meds in stock. Managing costs helps keep expenses down for members, and the team’s improved communication means better service for patients, whose medications are there when they need them.

Not so long ago, the financial picture looked bleak for the 24-hour pharmacy, which serves discharged hospital patients and other members at the bustling Zion Medical Center. Inventory had swollen to more than $3 million. It was a signal the pharmacy had too much stock on hand and wasn’t turning it over frequently enough. 

“We realized that we needed to do something,” says Nathan Close, outpatient pharmacy supervisor and management tri-lead of the 45-member team, which is at Level 4 on the five-point UBT Path to Performance.

Honest assessment

Team members set a five-month goal to reduce their bloated inventory by $600,000, from $3.2 million to $2.6 million, starting in January 2016. 

Their first step was to review the pharmacy’s ordering and inventory practices. Team members quickly realized they were overstocking oral chemotherapy, Hepatitis C and antiviral medications. At $10,000 a bottle, rarely used pharmaceuticals suck up resources when they sit on shelves. Worse, if they aren’t used or returned to the manufacturer before they expire, they’re a costly mistake.

To get a better handle on prescription trends, team members reached out to ambulatory care pharmacists, who are part of a different team and who collaborate with physicians to treat members with cancer or chronic conditions. By partnering with the pharmacists, the team was able to plan ahead better.

“Once we know what patients are going to need, we make sure that we have that in stock,” says Wesley Frani, a pharmacy assistant and UFCW Local 135 member who is one of the team’s labor tri-leads. 

Key to the team’s success is another labor tri-lead, Jane Corby, an inventory control assistant and also a UFCW Local 135 member. She carefully monitors stock levels to ensure that when patients present their prescriptions, the right medications are on hand.

“My union members’ biggest passion is providing good service and high-quality care,” says Nate Bernstein, health care director of UFCW Local 7, which represents about 2,000 of Kaiser Permanente’s Colorado employees. “And we also know the company needs to be sustainable financially.”

But frontline staff can’t do it all on their own. Unit-based teams need leaders who share goals and strategy, helping them connect the dots between quality, service and affordability. 

Knowing the difference such information can make to frontline workers, KP Colorado Health Plan President Roland Lyon provides regular, in-person updates on membership numbers, service scores, financial results and more.

He emphasizes a few key business goals, and he provides a vision: “The best way to deliver affordable care is to deliver high-quality care.” 

Providing that high-quality, affordable care is everyone’s job, at every level. Local, regional and national KP leaders are, for example, revamping purchasing practices and taking advantage of tech innovations to keep a lid on the rising cost of care. In 2016, 4,800 UBT projects reduced expenses by more than $48 million, savings that help keep costs down for members. The sum may seem small in a $65 billion organization, but it speaks to a deeper commitment. 

Leading change

“Workers know where the challenges are,” Bernstein says, “and have led change over the years to improve the patient experience and reduce costs.”

The challenges often directly affect workers. Colorado saw an influx of new members in 2014 and again in 2016. The region still is growing, but a big chunk of the new members left after a year because of changing market dynamics as well as internal service, access and cost issues. 

“The ups and downs of membership growth create strains on our system—and it’s hard on ourteams,” Lyon acknowledges.

Lyon’s updates and other regional communications provide UBTs with information on the types of projects to take on to support Colorado’s strategy. To solve some of the access issues, for example, the region is making greater use of digitally enabled services, some of which were developed by frontline teams and some by leadership.

But success requires the know-how of the teams and, says Lyon, “engaged, enabled and empowered” team members to identify and remove barriers to service, pilot new approaches and help take waste out of the system.

The result is that UBTs in Colorado reduced waste or captured lost revenue to the tune of more than $9 million last year. And they’ve helped the region reduce its expense trend by nearly 1 percent.

But “you can’t cut your way to long-term success,” Lyon tells managers and workers. “You can’t really do more with less. And you can’t do it alone. But we can do more with a little bit more. It’s about providing more access to the best care to more people.”