Value Compass Concepts

The Family Practice unit-based team at the Sunset Medical Office in the Northwest was thrilled that its work to get members to sign up on kp.org was a success. But team members quickly grew dismayed when the onslaught of new signups had an adverse effect on patients’ experience.

The challenge began in 2014, when the team launched several projects to increase the number of Kaiser Permanente members signed up on kp.org, knowing that people who use kp.org usually give KP higher satisfaction scores. The office is located in Hillsboro, Oregon, near one of Intel’s campuses. Intel offers Kaiser Permanente as a health plan option, so the effort to get more people online made perfect sense.

But, on the flip side, the increased number of messages coming in through kp.org wound up increasing turnaround times for return emails and phone calls.

More than two-thirds on kp.org

The department now receives between 450 to 650 email messages per week. Seventy-one percent of its patients—29,000 members—are signed up on kp.org. The team sought to improve its turnaround time on messages by reducing the number of times staff members and physicians touched each message. Instead of multiple people working a message, each one is now triaged one time by either an LPN or RN. At the same time, the team decreased its time spent on messages per week from 13.6 hours to 10.9 hours.

Ed Vrooman, an improvement advisor and union partnership representative, coached team members on how to test and implement their improvements.

“We learned how to use process mapping, so we could identify where the holes were in how we were approaching the work,” says Eliseo Olvera, the assistant department administrator and the UBT’s management co-lead. “Ed knew where we could get the data we needed and help us understand it, so we could do the work.”

Vrooman also introduced the team to the 6S tool—sort, simplify, set in order, sweep, shine, standardize—to improve its work processes. The team broke into different workgroups and each group identified tests of change. Some of the ideas were abandoned, some were refined and adopted, and some still are being adapted.

Staying on track

“I tended to focus too much on the information and the numbers,” says Rikki Shene, a licensed practical nurse and SEIU Local 49 member who is the team’s union co-lead. “Ed helped keep us organized and simplified the data so that we could keep moving forward and accomplish something in our 45-minute UBT meetings.”

Vrooman’s role in the team has been critical for the team. He attends the co-lead planning sessions and UBT meetings. He stays in the background until needed—and then he speaks up.

“He’s part of our community,” says Olvera. “His expertise with data has been critical. It’s a gift.”

The Mid-Atlantic States region has approximately 220 unit-based teams with more than 5,200 members. 

One problem, though: Some of those who belong to UBTs don’t know it.

The region’s seven UBT consultants, who made a commitment to work together as a UBT themselves, are trying to change that.

“Employees can’t contribute to the success of the team if they don’t know they are part of the team,” says Tracy Schrader, one of KP’s UBT consultants in the region, who is also an improvement advisor and OPEIU Local 2 member. “They don’t realize they can speak up.” 

From their travels around the Capital Beltway to team meetings and huddles, the consultants—each of whom supports about 35 teams—knew there was a disconnect for some UBT members. So when they established their own team’s 2015 goals, they planned two main tactics: to host several UBT Fairs to raise the profile of UBTs, and to improve communications so all UBT members know they are on a team.

The fairs, which the consultants originally were planning to hold at the region’s largest centers over the summer, would showcase the work of the teams at that facility and highlight such LMP initiatives and priorities as Total Health, Workplace Safety and the Ben Hudnall Memorial Trust, which provides a variety of resources for career-advancing education.

“We wanted to hold fairs that would have a strong impact,” says Jennifer Walker, RN, a lead UBT consultant and improvement advisor.

Surprising news

Then—just as happens with frontline teams—they received some data that surprised them. The 2014 People Pulse results showed that some locations the consultants thought would score poorly on UBT-related questions scored well and vice versa. Armed with that data, the consultants decided to hold the first five fairs at the centers that had the most teams with more than 10 percent of members answering “no” when asked “are you in a UBT?”

“It was a real eye-opener,” says Preena Gujral, another MAS UBT consultant and improvement advisor who’s a member of OPEIU Local 2. “Data is very important. It’s perception versus reality.”

The data also led the consultants to combine their two tactics:  The fairs would be the method for communicating the message that all work group members are indeed part of a UBT.

Walker, one of the region’s lead consultants, says it can be difficult to get the message across, especially with large departments. Unlike small departments where everyone participates in UBT meetings, larger departments typically have a core group of employees who attend UBT meetings as representatives of everyone on staff. Employees who aren’t representatives don’t always realize that they are part of the team, too.  

The energy and attendance of the first UBT Fair that the consultants sponsored, held at the end of June at the Fair Oaks Medical Center in Fairfax, Virginia, was higher than they expected, with more than 150 employees stopping by.

“The participation was fantastic,” says Wendy Williams, RN, a UBT consultant and member of UFCW Local 27.

Irene Taliaferro, a gastroenterology nurse practitioner, attended the fair at Fair Oaks in late August. She hadn’t realized she was a UBT member.

“I came to find out more about UBTs. Before I came to the fair, I knew nothing about them,” says Taliaferro. “We have a representative who goes to meetings. I don’t know much about it.”

Providing incentive—and a model

Steve Pereira, UBT consultant and improvement advisor, hopes the blitz of UBT Fairs gives workers like Taliaferro a better understanding of the partnership and an incentive to be more involved.

“People want to know more than their 9-to-5 jobs,” Pereira says. “This is the opportunity for that.”

Because of their commitment to use the same tools as frontline UBTs, the consultants have been using the Plan, Do, Study, Act cycle of the Rapid Improvement Model in planning and holding the fairs.

So, Walker says, “We structured it so the fairs happen before the annual People Pulse is taken again, in September”—that way, the fairs serve as a test of change. Will the communication provided by the fairs improve the score on the “I’m in a UBT” question?

“We’ll look for the next People Pulse results to validate whether this was the best way to go,” she says.

Watch for an update on the consultants’ efforts next year on LMPartnership.org, after the 2015 People Pulse results are in.

Colorado

Unit-based teams are hitting their stride, with 190 out of 261 teams reaching a Level 4 or 5 on the five-point Path to Performance. Teams are engaged in several types of projects, including those that save the organization money. The region will see a financial savings of $1.85 million this year through the 175 affordability projects of UBTs. The five UBT consultants in the region are coaching teams impacted by regional restructuring and helping those teams rebound quickly. Teams also are focusing on workplace safety, patient safety and HEDIS measures (Healthcare Effectiveness Data and Information Set).

Georgia

Starting in May and running through December 2015, Georgia medical centers are conducting an experiment. This region-wide test involves using greeters to usher in members. During the trial period, 15 greeters will make the member feel welcomed and convey the message they are important to Kaiser Permanente. Greeters also will answer questions, escort members to their appointments, maintain waiting rooms, ensure wheelchairs are available and welcome members with a smile. “They will provide a concierge-type member experience,” says Elizabeth Ramsey, the Georgia region’s senior manager of loyalty and retention.

Hawaii

The Hawaii region recently re-set its 57 unit-based teams’ scores on the Path to Performance to Level 1. Three consultants—two also are registered nurses and one is a project manager—will help teams quickly advance as they meet such core requirements as sponsor training. The region is unique in that, for now, one union (Hawaii Nurses Association/OPEIU Local 50) is in the Coalition of Kaiser Permanente Unions, while other unions are not. Although that can be challenging, consultants say teams still focus on the patient and want to do improvement work. “We help each other work through obstacles with our teams and understand the data,” says Lisa Kane, UBT consultant and project manager.

Mid-Atlantic States

In February, when home health orders came in to Health Information Management Services Northern Virginia, the average turnaround time was 4.4 days. By creating red folders for the orders, adding a cover sheet that says “stat” and date stamping the order as soon as it arrives, the team cut turnaround time to three days by April 2015—even as the number of orders went up from 673 in February to 747 in April. “This was important to the workflow, because when home health agencies called to follow up on the orders it interrupted our work,” says LaShawnda Powell, a senior health information management assistant in Woodbridge, Virginia, and member of OPEIU Local 2. “We have determined that our new process is successful and we’ve adopted it.” 

Northern California

Last year, unit-based team consultants and union partnership representatives formed a regional UBT to work on issues related to consistency and accountability for Northern California’s 1,300 frontline teams. Now the group has established three subgroups to review the 2015 National Agreement, which includes new provisions for UBTs. Each subgroup has a distinct focus area: sponsorship, UBT validation and assessment, and tools to support contract expectations. The subgroups will develop recommendations for review by a committee of labor members and management representatives. The regional co-leads will submit final recommendations to the regional LMP Leadership Council by year’s end.

Northwest

UBT Resource Team members have been busy refining the region’s new process for assessing teams on the Path to Performance. Co-leads and sponsors of 415 unit-based teams in the Northwest work with their consultant to ensure each team advances or sustains high performance throughout the year. Improvement Advisors help co-leads create action plans and provide direct training to move teams along or refer them to the appropriate subject matter experts. A majority of teams at Levels 2 and 3 will advance to high performance within the next 90 days due in large part to the work of the UBT Resource Team.

Southern California

Playing games at work usually is considered taboo. But that’s exactly how a group of regional UBT staff members spent a recent afternoon when they learned to play the “Leading Innovation Game.” Created by Kaiser Permanente’s Innovation and Advanced Technology team, the board game is designed to help employees overcome challenges that can doom the best ideas. Starting this fall, regional UBT staff will train team co-leads and sponsors, who will share the game with unit-based teams at their facilities. “Most teams come up with great ideas but they aren’t always aware of potential pitfalls,” says Rosalyn Evans, UBT practice leader for Southern California. “This board game gives them hands-on experience to develop innovation in a risk-free environment.”

“This whole project was a mere idea written on a piece of paper only a few months ago,” says Juan Piantino, MD, “and now it’s a reality.”

Shortly after Dr. Piantino, a neurologist, came to Kaiser Permanente in July 2014, he was approached by another member of the department—Debbie Newcomb, an electro-neurodiagnostic technologist and UFCW Local 555 member. Newcomb’s work includes performing electroencephalograms (EEGs), a test that monitors a patient’s brain waves and helps diagnose patients with epilepsy.

She was interested in implementing ambulatory EEGs (AEEGs), an advanced technology that is relatively new. Because the test is conducted over a longer time period than a routine EEG, it is more likely to capture events that provide the medical team with information needed for a good diagnosis. AEEGs also are less expensive than an inpatient telemetry EEG. But Newcomb needed a physician partner to move forward.

“I wasn’t intimidated about approaching him,” says Newcomb, who’s the labor co-lead of the neurology UBT. “The partnership has given me the confidence to speak up—and in fact, I consider it part of my role as a union steward.”

Swift implementation

Dr. Piantino had experience with the test with other health care systems—as did Newcomb—and was enthusiastic. The pair began figuring out how the test could be implemented in the Northwest region. Newcomb collaborated with the staff at the Stanford Comprehensive Epilepsy Center to understand the specific details of its program. She worked with KP Purchasing to identify the type and cost of the machines that would be needed.

Armed with information, Dr. Piantino met with leadership of the Northwest Permanente Medical Group—and within a few short months, in December 2014, the region was equipped to do continuous ambulatory EEGs.

So far this year, 16 patients have had their treatment guided by the ambulatory EEG as outpatients. Because the test is administered with a camera, the physician reading the results can see the patient in real time and correlate the brain activity to the physical movements of the patient. In addition, being able to conduct the test in the patient’s own environment avoids a potentially stressful and expensive hospital stay.

One adult patient had been in and out of the Emergency department five times in two weeks. Newcomb performed the ambulatory EEG on him; he had five events, all pseudo-seizures. “He is now seeing the proper doctor for his problems—no more trips to the ED,” Newcomb says.

By the end of July, the program already had paid for the cost of equipment. The benefits of an accurate diagnosis for the patient are immeasurable.

“It was the positive attitude and the willingness to improve patient care that made this happen in record time,” says Dr. Piantino.

“The idea came from our manager, when one of our young, alert patients fell and got an injury. We were all upset,” says Jenalyn Andres, RN, one of the union co-leads for her department’s UBT.

That incident spurred nurses on the 4 East-Malama West unit-based team at Moanalua Medical Center in Hawaii to set a goal to cut the number of falls in half within 12 months—from 18 in 2013 to nine or fewer by the end of 2014. The team exceeded its goal and had only six patient falls in 2014.

Steps to success

Team members adopted the No One Walks Alone falls prevention program, pioneered at the San Diego Medical Center, to help them reach their goal. The team set up a standard process to ensure success. Some of the elements of the plan included:

• checking that all bed alarms are on at the start of shift and during the shift
• having alarm pads for chairs readily available in rooms, ready for patients who get out of bed and into a chair
• placing nonskid socks on patients’ feet
• positioning call lights within reach
• using walkers to help patients become mobile

Andres, a member of Hawaii Nurses Association, OPEIU Local 50, says the team educated patients and families by sharing literature with them that included tips on preventing falls and information about the No One Walks Alone protocol. The protocol starts with the assumption that all patients are fall risks, instead of nurses trying to identify which patients are at risk. Patients are accompanied every time they get up, especially to and from the bathroom, which is when most falls occur.

Troubleshooting “hot spots”

As part of the team’s process improvement, it identified “hot spots”—things that could happen that could prevent success. For example, the team quickly discovered that it had different types of patient beds on the unit, with different bed alarms. Some of those alarms weren’t wired into the nurse call system, so staff members had to follow the sound of the alarm to figure out which patient needed assistance—which meant it took longer to get to the patient.

The UBT worked to get the issue fixed, and as a result, “a project was opened with facility maintenance and beds have been switched to a universal cord, which resolves the problem,” says Manlee Velasco, the unit’s manager and management co-lead. “In the few cases where the cord wasn’t compatible, new beds have been ordered.”

The team has had five falls so far this year, which came before the cord issue was resolved. 

Spreading a successful practice

The overall success of the prototcol has been noticed by other teams and “all of the inpatient units at the Moanalua Medical Center are now using the program," says Kim Lu, RN, the 4-East unit’s other UBT union co-lead and also a Hawaii Nurses Association member. 

The practice is a great example of spread for another reason: The “No One Walks Alone” slogan and program was created by a San Diego Medical Center UBT in Southern California that was involved in a Joint Commission pilot in 2012.