Facility Leaders

Patient transportation workers at Sunnyside Medical Center in Portland were in a tough spot: No matter how hard they scrambled, they were constantly running late to pick up patients. 

Some of the challenges were clear. The transport workers, members of SEIU Local 49, are qualified to backfill certified nursing assistant positions—and short-staffed nursing units were calling on them to do just that. 

In addition, a new computer-based dispatch system had automated patient transfer requests but required fewer dispatchers. The resulting staff upheaval, along with rumors about changes to their certification requirements, threw the unit-based team into turmoil. 

Delays and frustration

Amid frustration and mounting delays—the team was only infrequently meeting its goal of getting to the patient within 15 minutes—improvement advisor Lolita Burnette worked with the team to resolve its issues. To better understand its challenges, she created a process map of the team’s workflow. That turned up a variety of obstacles that were thwarting efforts to improve times. 

“Shadowing the team was an eye-opener. We discovered issues that were immediately actionable,” says Burnette. Because of the complexity of the situation, team members called for an issue resolution to identify solutions.

“My staff are really concerned about their patients. They had valid concerns about what was hindering our on-time performance,” says Marta Witsoe, the team’s management co-lead.

The issue resolution took place from July to September last year and helped further identify issues that were impacting on-time performance, as well as showing how delays affected imaging appointments and patient satisfaction.

As it tracked the source of delays, the team discovered that often, the patient was not ready to be moved when transporters arrived. The patient might need a different gown for imaging, or needed to take medications before being moved. Making matters worse, nurses and other staff members had gotten accustomed to transport arriving late and often put in orders ahead of time. But if the transport person arrived on time, the resulting delay had a domino effect, making it more difficult to be on time for subsequent transport requests.

New equipment, new hires

As a result of the issue resolution, the team is partnering with other units to become more efficient. Several improvements are being worked on simultaneously to increase productivity and overall satisfaction—and the team is confident the changes will lead to improved metrics. 

In perhaps the most significant change, hospital leadership agreed to hire additional transport staff. The new positions are dedicated to support the Emergency Department, a frequent source of patient transfer requests.

“With time and commitment,” says Esther Logan, the team’s union co-lead, “we agreed upon issues that needed to be addressed within the department.”

Olivia Devers, a labor partner with SEIU Local 49, added, “This IR process was the most positive that I have witnessed in many years—the team and management worked in true partnership from start to finish.”

Henry J. Kaiser, Kaiser Permanente’s co-founder, famously told fellow industrialist Warren Bechtel, “Problems are only opportunities in work clothes.”

If you work with unit-based teams—as a co-lead, consultant or sponsor—you might be rolling your eyes right now and thinking, “Well, if that’s true, I sure have a lot of ‘opportunities.’ Grrr!” 

When a team has problems, it’s difficult—if not impossible—to boldly improve service and quality for our health plan members. Especially if problems linger and fester, eroding trust and goodwill. These can depress morale and even endanger patients. 

Lucky for us, the leaders of Kaiser Permanente and the Coalition of Kaiser Permanente Unions had the moral imagination more than two decades ago to envision a better way to solve problems. Together, they formed what would become our Labor Management Partnership.

As we celebrate our partnership’s 20th anniversary this year, we can look back and see how we have built the tools, structures and culture that support this alternative vision of how workers and employers can interact.

One of those tools is issue resolution. As you will see in the stories that follow, this process bypasses more traditional forms of problem solving in favor of going deeper to really uncover the source of the difficulty. By doing that, union members, managers and physicians not only can preserve their working relationships, but also make them stronger. This, in turn, fosters innovation and improvement. 

Now that sounds like a great opportunity.

Part of a manager’s job is to look at the big picture—and job stress and burnout are usually part of the picture in health care. Operational leaders from two regions share their thoughts on keeping workplace energy and morale high.

Wendy Watson (Northwest)
Regional vice president, Professional, Clinical and Continuing Care Services 

There’s very little downtime in our work. We want to deliver great service, quality, affordability. The pace is fast, as our industry is changing rapidly. That can be a formula for stress. No one can do this work alone—we all need to support one another.

Build strong teams

High-performing unit-based teams are part of the solution. Solving even one problem at a time can help a team increase job satisfaction and get results, and that reduces stress. If you are leading teams you have to be very purposeful—making time with your team, creating space to talk and making our meeting time productive and solution-focused.

Some of our facilities have Living Room huddles, where people from all departments gather before the start of business, and one department presents a topic. It’s an opportunity to learn and build relationships across the facility. The more connected we are, the more we can support each other.

Make time for yourself

Running is my No. 1 antidote to stress. I try to run regularly—early in the morning before the workday, and longer on weekends. It’s my way to expend physical energy and feel mentally reenergized.

You have to make time for yourself, and that includes exercise. It’s not easy to do. But when you make exercise a priority, you create energy to be able to deal more effectively with stress.

Corwin Harper (Northern California)
Senior vice president, Area Manager, Napa-Solano

It’s hard to generalize about stress because everybody has a different stress meter. We all handle things differently. It’s an issue of work-life balance, and we’re in an industry where we all invest our personal energy, because health care is about caring for others.

People have to be aware of that and think about what they can do to manage their energy and stress levels. We should proactively manage things at work that sap energy and invest in things that raise our energy.

How do you help others?

As a leader, I have to be aware of what I can do to minimize energy-wasters and reduce job stress.

We talk about stress in our workplace safety conversations. I address it as part of leadership rounding. And rounding is not just checking the box. It’s focused on engaging with people about how they’re doing, letting them know you care, encouraging them to spend time with their families and calling out work-related issues that are barriers to performance.

We focus on creating a culture where we understand and respect one another.

Know yourself

I hate sitting all day long. I do core exercises at work in my spare moments. You have to know when to step away and recharge. I try to eat right, exercise, listen to music and pray. I’m still working on getting enough sleep.

Rounding for results

Rounding is a powerful tool for creating a culture where employees are free to speak. Having a short list of open-ended questions to ask each person on a regular basis makes it easier for staff members to raise concerns—and that, in turn, helps reduce stress levels.

You say your unit-based team has reached Level 5 on the Path to Performance? Great, everyone take the rest of the week off!

Your UBT is stuck at Level 1 and has been for years? Just hide in a dark corner and hope no one notices.

Not so fast.

Teams soar. Teams stumble. And we need them all to stay in the game.

Unit-based teams are Kaiser Permanente’s platform for improving performance. They’re also the union coalition’s instrument for amplifying workers’ voices in the workplace. All of which has paid off for KP members and patients, through UBTs’ efforts to improve quality, service and affordability. None of which is easy for teams to pull off.

Enter union partnership representatives and UBT consultants. They are recruited from frontline positions in union and management, so they know firsthand what it takes to deliver high-quality health care. They also receive special training that enables them to coach and mentor unit-based teams.

Our leaders knew teams would need such support. But it’s a balancing act. The tightrope for these folks is to gradually build the skills and confidence among team members, then step back at the right time so teams can fly on their own.

Few of us can truly go it alone. We all benefit from coaching—someone to hold up a mirror and offer frank advice (diplomatically delivered!) on how to improve in our jobs. A consultant’s most important skills are listening and observing. Those are skills we’d all do well to improve.