LMP Focus Area

It’s one thing to identify effective practices in an issue as important as workplace safety. It’s another to educate and engage teams in adopting a consistent set of practices across a region.

The Northwest’s Employee Health and Safety Department has done just that—and earned program-wide recognition for its approach.

In November 2012, the department’s Labor Management Partnership Workplace Safety team issued a challenge to the region’s 16 facility safety committees. The committees, established to help identify and resolve safety issues at the facility level, often differed in their approach and results. The safety challenge provided a fun way for the local committees to get to know more employees in their facilities, follow a consistent protocol and improve safety.

Challenging teams to step up

“The Safety Awareness Challenge provides safety committees an opportunity to work together with their labor, management and Permanente partners to effect real change around workplace safety,” says Chris Mozingo, RN, workplace safety labor consultant for the NW Region.

The yearlong campaign challenged each facility to:

• submit monthly or quarterly safety meeting minutes, to help keep their work on track
• have physicians and dentists attend at least 80 percent of their facility’s safety meetings, to ensure widespread participation and leadership (nonclinical departments were asked to send representatives to each meeting)
• promote safety conversations (a blame-free approach for observing work practices) and ensure at least 25 percent of employees are trained to lead such conversations
• adopt and promote safety awareness plans to help teams identify and correct at least three different workplace hazards (for instance, trips and falls or sprains and strains)
• host a safety fair, safety barbeque or other facility event within the year

“The Safety Committee Challenge goes beyond recognizing achievement. It fosters and reinforces the relations between Regional Safety, management and frontline staff,” says Employee Health and Services Safety Specialist II Brian Cekoric.

Getting results, recognition

Nine facilities completed the safety challenge by meeting each of the five established criteria. These efforts helped the Northwest region—already a leader in some key measures of workplace safety—record a 4 percent decrease in injury rates compared with the previous year. Teams that met the challenge will receive additional funding to support safety awareness promotions in their facilities.

For its part, the Northwest Employee Health and Safety team won the 2013 National Workplace Safety Award for its work in engaging frontline teams.

“The simple focus on injury prevention and raising awareness goes a long way to changing the culture of safety,” says Rob Weiking, Employee Heath and Services program manager.

Leonard Hayes, manager of Environmental Services culture and training in the Northwest, oversees workplace safety for 125 outpatient EVS workers in five service areas. This includes the East Side service area, whose EVS unit he directly supervises and which has recorded no injuries for nearly five years. In February 2014, Hayes won the National Workplace Safety Individual Award. He spoke recently with Jennifer Gladwell, LMP communications consultant, about how he engages teams to work more safely.

Q. You and your department have achieved a great turnaround in workplace safety. How did you do it?

A. You have to give people information and recognition. Workplace safety is a standing item on our UBT agendas. We talk about working safely, acknowledge how well our teams do and tell them “thank you.” I’ve been put in this job to take away the myths that injuries are inevitable, so people can go home at the end of their shift and enjoy their time outside of KP.

Q. What do you do personally to engage your staff on safety?

A. I’m in there with them physically.  I’ve been a worker and I take interest in what the teams are doing. I try to make sure people know I care for them by being available to them and making sure they have the tools to do their job. I am committed to responding to issues as quickly as possible and resolving them. I have a great labor partner and co-lead, Sherri Pang. She’s been my anchor with the campus and the (East Side) team. She helps me a lot by sending emails, creating fliers, understanding and encouraging the team.

If people understand why we’re asking them to do certain things, they are more likely to help find solutions. That’s why unit-based teams, and their sponsors, must understand the implications of the Affordable Care Act to lead meaningful change.

The ACA is producing unprecedented changes in the marketplace. It is opening up health care to people who had little or no access to routine care before, and giving them choices they never had before. But for many, the choice will come down to dollars and cents—which means Kaiser Permanente needs to do two things, in partnership:

First, to attract new members, we have to offer competitive rates. Then, we have to wow them when they call or visit—especially the first time they call or visit

Know your role

As UBT sponsors, we have to ask ourselves: How are we going to do an awesome job of caring for patients and being the most affordable if our team doesn’t understand the impact it can have and isn’t involved in helping find solutions?

We need to understand what our role is in helping teams improve service and efficiency. If we, as sponsors, recognize that unit-based teams give Kaiser Permanente a competitive advantage and a way to drive change, and we provide the support for that work, we’ll largely have succeeded in our role.

Work with your team

When a manager or sponsor comes to me with an issue or area for improvement, one of the first things I ask is: Are you working with your UBT on this? If not, I ask them to try again—because becoming more efficient, cost-effective and member-centered doesn’t happen just in the administrative suite. It happens with the frontline staff and physicians. If sponsors, leaders and managers look to UBTs and their expertise, it will lead to solutions.

Sponsors and leaders also need to ask themselves: Have we figured out what resources the UBTs need to get the work done? Do they need the time, the meeting space, and a facilitator?

UBTs are only as good as the leaders who invest in them. We have more compelling reasons now than ever to leverage the partnership. If team members understand those reasons and are given direction and support by their sponsors, there is no limit to what we can do to help Kaiser Permanente continue to lead in this time of change.

When Donna Fraser sees something that needs doing, “I like to get it done,” she says. Twenty-one years ago, she joined Kaiser Permanente as a clinical assistant, one of the first in the Mid-Atlantic States region in the urgent care setting. After a few years, Fraser led a couple of her colleagues in approaching their supervisor at the Camp Springs, Md., facility about moving beyond registration and clerical duties to assisting nurses with patients’ health care needs.

“I said, ‘We believe you can utilize us.’ I knew I could do so much more to help out when the nurses were busy.”

She found a training program that ran from 8 a.m. to 2 p.m. five days a week. Meanwhile, she worked 3 p.m. to midnight shifts, mainly on weekends, and completed her courses in about three months. After struggling mostly on her own to pay for certifications in performing EKGs, phlebotomy and other tests and specimen collections, Fraser joined the facility’s fledgling class of urgent care technicians.

Hard work, good support

Today she is the lead RN at the Urgent Care/Clinical Decision units at the Largo Medical Center Hub, one of the newest facilities in the region. Fraser, a member of UFCW Local 400, says she owes much of her success to one of the Labor Management Partnership’s scholarship and wage replacement programs.

“I grew up here,” says Fraser. “It’s a great company if you work hard. You have to show up to win, do the best job.”

Trying to get an education while working full time is not easy, even for someone as motivated as Donna Fraser. That’s why LMP’s Ben Hudnall Memorial Trust was created, to support lifelong learning for union coalition-represented employees.

Wage replacement allowed her to take time off from her regular work schedule to attend classes, continue her employment, and keep up her clinical skills and knowledge. She’s taken advantage of the program twice since her first promotion, becoming an LPN in 2009, an RN in 2011. Fraser became a lead RN in 2013.

Click to enlarge.

Taking ownership

Jennifer Walker, the Mid-Atlantic States region improvement specialist who works with Fraser’s unit-based team, has seen greater benefit to the training. “Donna has become the person who organizes her group, serves as a support to all and keeps the team motivated,” Walker says. "And she has done this while working a full-time job and raising a family.”

But Fraser credits the Ben Hudnall Memorial Trust program with giving her a sense of ownership and responsibility for her education and her career. “We did the scheduling,” she says. “The big difference was the empowerment our manager gave us. As long as we could find the backfill, we went to our classes.”

The keys, says Fraser, are a supportive supervisor who “believes in the partnership” and a willingness to look to the union as a positive force: “Sometimes when you are an employee, you think you just use unions for when you are in trouble.”

The greatest challenge is helping people see that if they are involved in the process, it will be easier to move up.

“You can always find places within KP that need your expertise,” she says.

A year ago, Susan Miles bid farewell to her diabetes medication—five insulin injections a day, one at each meal and two at bedtime—and cut her dosage of cholesterol-lowering statins in half. And she was only partway down the road toward improving her health.

“I know all about excuses. I’ve used the best of them,” says Miles, the ambulatory nursing director at the Ontario Medical Center in Southern California. Miles, 60, who's been with Kaiser Permanente for 34 years, tapped into the company’s tools and support systems—and her own willpower—to change her life for good. Despite her bad back, herniated disc and an arthritic knee, she has lost 94 pounds, changed her relationship with food and grown closer to family and co-workers.

“That’s really me,” she says, pointing to a picture on her desk of a much heavier woman.

Fat summer, skinny summer

Miles, an RN, always had a weight problem: “I’d have a fat summer, then a skinny summer.” She earned her bachelor’s and master’s degrees in nursing and moved up the career ladder at Kaiser Permanente. But the married mother of two children found it increasingly hard to take care of herself.

“I just didn’t feel good,” she says. “I loved my job, but it was getting harder to do. I had lost my mojo.”

More than two years ago, she tried taking the total health assessment (THA) but raced through it: Yes, her body mass index, or BMI, was almost 38, and of course, she had high cholesterol.

But when the statins got added to her medication regimen, she decided “it was my time to do something.” In February 2012, Miles enrolled in the weekly weight loss class offered at the Ontario facility. She retook the THA, slower, and “entered each and every line.”

“It puts a spotlight on all of your health issues,” says Miles, who used her THA statistics to help monitor her progress. In 16 weeks, she had shed 38 pounds. Her husband lost a few pounds, too, as he mirrored her eating. And the couple began taking weekday bike rides, breaking the cycle of “dinner, chores, bed”—with the bonus that they “rediscovered” each other.

Taking advantage of what’s available

Kaiser Permanente stands out in the field for focusing members on preventive health care and healthy eating, says Miles, who is quick to recommend KP programs—which helped her “reframe how I think about food”—to colleagues who marvel at her transformation.

“I haven’t stopped living, or eating,” she says. “We forget we are members too, not just employees. We need to take advantage of the programs we have. I really appreciate having KP physicians and dietitians at your fingertips to help you when you need it.”

From Miles’ perspective as a manager and an administrator, a healthy workforce is a happy and productive workforce.

“We depend on everyone being healthy and present,” she says. “We need to be models of that for our members.”

With the increasing complexity and pace of change in health care, “soft skills” such as problem solving, collaboration, cultural competence and team leadership are becoming as important as technical skills. That’s why Kaiser Permanente and the unions in the Coalition of Kaiser Permanente Unions, through the Labor Management Partnership and its unit-based teams, engage the workforce in continuous learning, critical thinking and performance improvement.

Recognizing KP’s unique workplace strategy, the Journal of the American Academy of Physician Assistants invited LMP to submit an article for its July 2013 issue, “Building the right skills for the healthcare workforce of the future.” This link will get you to the journal’s website; scroll past the headline to read the full text of the article.

It’s not every day you hear of physicians offering to step in and help out staff in their assigned duties, but at the Primary Care department at Englewood Medical Office in Colorado, that’s exactly what happened.

The nursing staff, short-staffed due to medical leaves, “was overwhelmed,” says Kate Frueh, DO. Messages from patients were piling up in the electronic inbox in KP HealthConnect. Patients who might have been helped by phone or via email were coming in for appointments—making it hard for those who truly needed the in-person appointments to be seen.

“We think we’ve got some of the best nurses in the region,” says Larry Roth, MD. “We just thought, how can we help the nurses and, at the same time, help both ourselves and the patients?”

Physicians dive in

So the team brainstormed ideas, and the physicians offered to help clear the backlog.

“The nursing staff was flabbergasted,” says Linda Sawyer, RN, a member of UFCW Local 7 and the department’s labor co-lead. 

After testing a couple of time blocks and working together, the physicians began setting aside 30 minutes every morning to help triage messages and call patients back directly without getting the nurses involved—and they do it again in the afternoon.

As a result, the team consistently closes encounters within an hour more than 40 percent of the time. With more problems being resolved by phone, appointment slots have opened up and access for patients needing in-person appointments has improved. Morale in the department has improved, too—and the team recently won the Colorado region’s quarterly “Value Compass” award.

Meantime, team members have been working with Linda Focht, their UBT consultant, to boost their Path to Performance ranking—which was only at Level 2 late in 2012, despite functioning at a high level in most dimensions of the Path to Performance.

Common challenges

Focht says some of the challenges that held the team back are common across the program—a department reorganization (including a reduction in staff), new work procedures and gaps in team training. And there were new co-leads who were unfamiliar with the process for assessing team performance.

With some of those issues addressed in the first months of 2013, the team moved up to a Level 3 in the most recent ranking.

“The team members kept their focus on the goal of more streamlined work processes,” says manager Mary Watkins, RN, “and all of the staff of the Primary Care Department are helping each other to become more successful.”

 Watch a video about this team on the KP intranet.

Louise Dempsey is the business representative for UFCW Local 1996 in Atlanta. She spoke with LMP communications consultant Laureen Lazarovici about her experiences as a union activist in the South.

In the late ’60s and early ’70s, my mom worked for the Social Security Administration. She transferred often for her job, so we moved a lot. She was in the union, and she organized two of the offices she got transferred to in order to get better benefits. One was in the hills of Tennessee, where there were a lot of coal mines and a lot of poverty. She once worked for a group of attorneys and mobilized her co-workers to get better wages. There was a lot of disparity in pay in terms of gender and race. Sometimes, they didn’t exactly like her. She earned the reputation as the go-to person. People would say, “If anybody can get it done, it’s Mildred.”

Unions at Kaiser Permanente

And today, here we are in the South. It is not strong union territory. Because of Georgia’s so-called “right to work” law, employees can work for KP here whether they join the union or not [in contrast to KP regions in other states with stronger worker protection laws]. But people join because they know that the stronger we are, the more we can stand up for ourselves. We have to talk to folks about the benefits of working for a unionized company. I worked for KP as an LVN before there was a union. Our wages were all over the place and assignments were based on favoritism. We’ve had people come to work for KP because it’s unionized.

When they hear about the Labor Management Partnership, they say, “I’ll sign up.” They understand they have a voice, they can be part of a UBT, they can affect the direction their team is going, and say what they need and want and be heard. Sure, we have to educate managers, but we have to educate employees about unions, too. When I talk at new employee orientation, I tell them we are there as a mediator, facilitator, advisor. You are not by yourself anymore. I’ve got your back and your front and your side, too. With the Labor Management Partnership, KP is always offering opportunities for employees to learn, like the Ben Hudnall Memorial Trust. I have been in the medical field for 30 years, and folks are always thirsting for more knowledge.

Getting used to a new way of doing things

Folks in management come into Kaiser and they are not used to unions or the partnership. We have to educate them: We have a union, we have a contract, we have a partnership. We educate them about a union environment and also that we are not the traditional head-butting adversarial union.

Normally, when I go into a meeting at KP, there is not a whole bunch of posturing. People want to get to a solution. There is no name-calling, finger-pointing or yelling. It makes a difference. Partnership benefits the local because I have open access to the employees. I went to five facilities recently. I was not stopped once. It is always, “Hi, how are you, who do you need to see?” My co-workers at the local who represent employees at other companies don’t all have that. KP has not relegated me to a break room or to certain hours. I can have a bulletin board in the break room. I have the time to speak with new hires during orientation. They don’t censor the questions the employees ask or the ones I answer. That’s partnership.

Bringing joy and meaning to work may sound like a lofty aspiration. But if your workplace is lacking these things, it's more than dreary—it’s also dangerous, according to the Lucian Leape Institute at the National Patient Safety Foundation.

Start with the fact that health care itself is dangerous. The institute’s March 2013 report on workplace injuries in health care, “Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care,” noted that:

• Health care workforce injuries are 30 times higher than other industries
• More work days are lost due to occupational illness and injury in health care than in such industries as mining, machinery, manufacturing and construction
• Seventy-six percent of nurses in a national survey said unsafe working conditions interfere with the delivery of care
• An RN or MD has a five to six times higher risk of being assaulted than a city cab driver
• Emotional abuse, bullying, threats and learning by humiliation often are accepted as “normal” conditions of the health care workplace

These conditions are harmful to patients, caregivers and the organization, according to the report:

“Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”

Role of leaders

The authors conclude, “The basic precondition of a safe workplace is the protection of the physical and psychological safety of the workforce.”

Physical and psychological safety is also a precondition to “reconnecting health care workers to the meaning and joy that drew them to health care originally,” said Lucian Leape Institute President Diane Pinakiewicz, at Kaiser Permanente’s second annual Workplace Safety Summit February 12.

“These preconditions enable employers to pursue excellence and continuous learning,” she said. “The purposeful maintenance of these preconditions is the primary role of leadership and governance.”

Systemic causes of harm

While pointed in their assessments, Pinakiewicz and the report’s authors refrain from finger-pointing. Pinakiewicz outlined systemic organizational stresses that work against workforce and patient safety. These include:

• People feeling overwhelmed (58 percent of workers surveyed by the American Society of Professionals in Patient Safety cited overwork as an issue)
• The volume of non-value adding work
• Workforce safety and patient safety being managed separately and non-systemically
• Operating pressures exacerbating traditional behavioral norms

The report identifies several “exemplar organizations,” including the Mayo Clinic, Virginia Mason Medical Center, Kaiser Permanente and the Coalition of Kaiser Permanente Unions, that are working to “create cultures of safety and respect.” KP’s 2012 National Agreement provisions for workforce total health and interest-based problem solving are cited as contributors to that culture.

Seven strategies for improvement

The Lucian Leape Institute offers seven strategies for improving safety and restoring joy and meaning to the health care workplace:

1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.
2. Adopt the explicit aim to eliminate harm to the workforce and to patients.
3. Commit to creating a high-reliability organization and demonstrate the discipline to achieve highly reliable performance.
4. Create a learning and improvement system.
5. Establish data capture, database and performance metrics for accountability and improvement.
6. Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.
7. Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients.

“Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care” is available online from the Lucian Leape Institute at the National Patient Safety Foundation.