Path to Performance Dimensions

I am one of the chairs the LMP leadership team, along with a union colleague from UFCW and two management leaders. I’m also the co-lead of the Woodland Hills’ union coalition. In addition, I’m a full-time certified registered nurse anesthetist in the operating room. To be an effective labor co-lead takes three things: time, collaboration and planning.

Time

I have been doing partnership work at Woodland Hills for 10 years. People respect the time I’ve invested. You have to be on fire for this because it’s an enormous responsibility. It’s going to cost you time, angst and effort. And you can’t build relationships passing in the hall. You have to make the investment of face time. That means showing up at the LMP council meetings, monthly, from 8:00 a.m. to noon.

Planning Ahead

It is important to bring in and plan for new blood. At Woodland Hills, we rotate the labor co-chair in our leadership team every two years. I believe this allows everyone to have a say. It builds trust and experience. And it ensures buy-in from each union—and each segment of each union. We build-in mentorship. For three months, the new person sits in and the current co-lead shows that person the ropes.

We also did this in the Kaiser Permanente Nurse Anesthetist Association when I was president in 2006. I would go with new facility reps to meetings. 

Collaboration

We really foster union efforts at the medical center level. We’ve got a group of long-term union coalition people and our unions speak with a single, powerful voice. There have been issues between unions, and we had to work things out until cooler heads prevailed. People say ‘I’m sorry’ and move on.

Working with management is both easy and difficult. It’s easy because they are so partnership oriented and respectful of the unions, and they welcome input. They lead by influence—not by authority by virtue of where they are on the food chain—just like we do. It is difficult sometimes because it requires us to work hard as partners. Sometimes it would be easier to just go along with their recommendations, but then we wouldn’t really be doing our jobs as union leaders. At certain points, you have to say, ‘Well, let me think about that,’ and ask your constituents what they think.

Hospitals are traditionally very hierarchical. The partnership is such an opportunity to have a voice.

When you get to the leadership level it’s easy to become disconnected and to forget that where the rubber meets the road is at the front line. Sponsoring a unit-based team helps me stay connected—and that helps me be a better manager.

Staying connected

As a sponsor for the Medical Secretaries and Scanning Center, I help the teams see where they fit in the bigger picture—and they help me see the challenges that teams face every day.

I check in with the teams and their co-leaders regularly, make sure they’re accomplishing their goals and doing work that meets regional and national goals. They have their own ideas for improving department operations and doing their own small tests of change. I help them think strategically about how they can impact the region and Kaiser Permanente as a whole.  

There will always be the manager-employee relationship, but when you walk into a UBT meeting, you leave the hierarchy at the door. To build credibility, everyone on the UBT must have an equal voice at the table. I believe in the partnership and, yes, there are a few times when a manager shoulders the responsibility and has to make decisions about regulatory compliance issues, regional strategic direction and planning, scope of practice discussions about licensures and policies, and personnel management. But there are a lot of other decisions that staff can be a part of making in a group setting, and getting buy-in from the folks who do the work makes all the difference in the world.

Removing obstacles

Because I’m in a leadership role, it is important that I help the teams overcome barriers. If they need help understanding a goal, metric or budget, I can gather the information and package it in a way that is most helpful to the team.  When I started working with these teams in 2007, they were already doing good work despite some major obstacles. The chartroom transitioned to the scanning center, and the medical secretaries had a lot of manager and staff turnover, and had difficulty meeting performance metrics. Now both teams are high functioning. They have accomplished so much in the last two years.

So to other sponsors I say, don’t be afraid to jump in. It’s so rewarding to see your teams grow. If we are going to improve performance, we’ll need engagement at all levels of the organization, and the UBT process allows that to happen.

I have worked at Kaiser Permanente for 33 years, starting as a distribution worker in materials management. Being on the front lines helped me better understand the challenges staff face—and helped me, in my current role, see what it takes to spread and sustain change in a complex organization.

When we launched our first unit-based teams in 2007, I knew they could give our managers and teams a powerful tool for change. But to achieve their full potential, UBTs need the support of leaders at every level. In working with UBTs every day, I have found five practices that can help teams achieve their goals, and have helped me be a more effective leader.

Have patience

I’m not a patient person by nature, and it took a visit to the world-class health care system in Jonkoping, Sweden, for me to see that it takes patience to sustain meaningful change. When you’re solving problems in a team-based workplace, real systemic change takes time. But it also takes hold deeper into the organization.

Really see the work

Spend time with a UBT, or hear teams present their test of change, to understand what they’re working on and how you can support them. There’s no way you can feel the excitement and energy from the team members and not feel proud and motivated by their work.

Spread good work

In Orange County—which has two large hospitals, in Irvine and Anaheim—we expect all teams to continually test and then spread their ideas and successful practices. We call it “One OC” and we talk about it all the time. You’re never going to achieve greatness globally if you don’t spread good work locally.

Provide tools

Early on we formed an Integrated Leaders group of senior labor and management leaders who meet monthly to monitor and assist our 107 UBTs. If a team is struggling, the IL group doesn’t descend on them and try to fix the problem. We provide tools and resources that help the team work through a problem and get results. For instance, we put together a UBT Start-up Toolkit with information on everything from setting up teams to finding training. We’re also looking at toolkits on fishbone diagramming, conducting small tests of change and providing rewards and recognition. And we’re asking how to make it easier for teams to access resources quickly—for instance by identifying go-to people for questions on budgeting, patient satisfaction metrics and so on.

Then, get out of the way

 I have a saying: “Hire great people, give them the coaching and mentoring they need, then get the heck out of their way and let them do what they were hired to do.” I think that works at all levels of the organization, whether or not people are your direct hires. You don’t tell people to make a change or streamline a process without any encouragement or support, but you don’t need to micromanage them either. Delivering great health care is not just a job. It is a calling. Whether you’re a housekeeper preventing infection or a surgeon treating cancer, people’s lives are in our hands. That shared mission drives us to be the best.