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Colorado

Thanks to a diligent chart review process, the Medicare Risk Business Services unit captured an additional $10.3 million last year in Medicare reimbursements unclaimed in 2010. The hospitals Kaiser Permanente contracts with in the region were submitting documentation with incomplete physician signatures, which prevented KP from submitting the bills for reimbursement. The technical error causing the problem was corrected, but the team had to review 26,000 hospital inpatient notes for 2010. The total collected is more than three times what the team predicted when it began correcting the error.

Georgia

When staffers at the Cumberland Medical Office Building pharmacy in Atlanta open bottles of pills to dispense prescriptions, the bottle is supposed to be marked with a big X, a flag for reordering. But often, a pharmacist or pharmacy tech would find only a few pills left in unmarked, open bottles, not enough to fill a patient’s prescription. So the team brainstormed ways to ensure the bottles are properly marked, including posted reminders and giving everyone his or her own marker. The number of unmarked bottles fell from 30 to zero the first week; went back up the next week; then dropped back down and stayed down—lowering costs and improving service.

Hawaii

When the Honolulu clinic’s Obstetrics and Gynecology team members realized patients were waiting six minutes or more for routine injections, they decided to designate one nurse each week as the “shot nurse,” whose priority duty is giving shots, and one as a “floor nurse,” who helps direct patients to the shot nurse and pitches in when it’s busy. Whiteboards let staff know who is filling the roles. The team has dropped member wait times to an average of 3.2 minutes.

 Mid-Atlantic States

Unit-based team storyboards, a homemade “test of change” video shot by the Radiology UBT on its efforts to boost co-pay collections, and a roomful of enthusiasm and healthy snacks marked the inaugural UBT Expo in the Mid-Atlantic States region. A dozen teams at Largo Medical Center in Maryland—from Adult Medicine to Vision Essentials—exhibited projects on service, quality, best workplace and affordability. When attendees weren’t networking at the exhibits, they heard formal presentations from teams, who were introduced by their sponsors.

Northern California

The Redwood City Medical Center inpatient pharmacy is celebrating success after sustaining, for more than six months, a dramatic reduction in the rate of medications administered late (a half-hour past their scheduled time) in the medical-surgical wards. Previously, 26 percent were late; now, the range is 12 percent to 15 percent. Working with the med-surg nurse manager, the team began using color-coded bins to distinguish new medications from discontinued ones and delivering medications 15 minutes before the hour in which they are scheduled to be administered. These and other changes have improved communication and give nurses more information about where to retrieve the medications.

Northwest

By focusing on hospital quiet and Nurse Knowledge Exchange, the Women and Newborn Care arena at Sunnyside Medical Center has earned recognition as one of the best of its kind the throughout Kaiser Permanente, improving its HCAHPS Overall Hospital rating by 17.5 in 2011. The report rooms—where staff members congregate and talk—have doors that close automatically, and nurses try to respond to all call lights within three dings. “A patient does not belong to one nurse, but the whole department,” says Dory Schutte, RN, a member of OFNHP and one of the UBT’s co-leads. In addition, Nurse Knowledge Exchange at shift changes and having nurses join physicians and midwives on rounds has improved communication and patient satisfaction.

Ohio

Giving post-procedure snacks to patients is standard, but Ohio’s Gastroenterology department realized it was averaging $750 to $800 a month on snacks, well over budget. After Carol Zimmerman became manager, the UBT implemented small but key changes: Eliminating rarely eaten snacks, replacing more expensive items (Oreos) with less expensive choices (graham crackers), and removing temptation by keeping supplies locked out of sight. Zimmerman also began to regularly share the department’s budget and costs with staff. The team noticed an impact within two months, with hundreds of dollars saved in short order. Reviewing the budget is now a standing part of team meetings.

Southern California

Faced with the teams using linens inappropriately, Panorama City Medical Center’s Materials Management unit-based team set out to educate other hospital staff about the costs involved—reminding them not to use linens to mop up spills or as makeshift tablecloths and to refrain from overstocking linen in patient rooms. Managers and union leaders worked together to develop a storyboard and presentations and reviewed linen usage and stocking levels with individual departments. The result? The overall costs of linen for Maternal Child Health, one of the first departments targeted, were reduced by 6.8 percent, more than three times the original goal.

You get to a certain age, and it’s time for a makeover. Surely you understand.

We heard you whispering. In fact, it inspired us to conduct a statistically valid survey to make sure what we’d overheard was a true reflection of what you thought. Some of it was a pleasant surprise—such praise! But you were blunt, too: Awkward size. Overly long articles. Not enough variety. And so on. 

So, here’s our equivalent of slimming down and building some muscle. (Amazing what walking a half-hour a day will do!) With our new ’do, you’ll find:

• shorter articles and more of them
• more tips and tools, information you and your unit-based team can put to immediate use
• more coverage from all the regions
• and some fun

While we’re on the subject of our virtues: Our paper is certified by the Forest Stewardship Council, ensuring the use of responsible forest management methods that address social, economic and environmental issues.

Why does that matter? Well—working in partnership addresses profound social and economic issues, too. We hope you like our makeover because we want to serve you—the frontline workers, managers and physicians of Kaiser Permanente—well. Because what was achieved this spring in National Bargaining, the subject of this issue’s cover story, makes it clear what an extraordinary journey we are on together.

Colorado

The Regional Imaging teams in Colorado are lucky to have two effective sponsors: Joseph Gonzales, clinical operations for Regional Imaging, and Rebecca “Becky” Torres, a pharmacy technician and SEIU Local 105 member. Part of their success, the pair says, is the emphasis they have placed on sharing information—with each other and with their teams. The pair also figured out a way to spread effective practices. Using a PowerPoint template, the sponsors asked co-leads to explain what they’re working on, how it supports regional goals, whether it worked and the outcome. Then, the teams came together for a UBT Fair and shared their PowerPoints.

Georgia 

David Jones, MD, has a title unique at Kaiser Permanente: assistant to the medical director for unit-based teams. He mobilizes his fellow physicians in the Georgia region to get involved with UBTs and unleash the power of partnership to improve performance and grow membership. “The first thing I tell physicians about the UBTs is that it is about improving the work that we’re already doing,” he says. “It’s not about adding more work, it’s about looking at the work you're doing and figuring out how to do it better.” Read more from Jones—including how his experience with UBTs has transformed the way he delivers care to his patients.

Hawaii

A small region, Hawaii needed a novel approach to sponsorship: Branch out rather than always branch up. Initially, a five-member unit-based team committee tried to troubleshoot issues for the region’s fledgling teams. Often, those committee members, who also had roles as team co-leads or contract specialists, were trying to wear too many hats and got jammed. So the region, which now has more than 40 teams, has tapped 19 people to receive sponsorship training. The group includes middle managers, directors and other executives, frontline nurses who serve on the Kaiser Permanente board of the Hawaii Nurses Association, OPEIU Local 50, and former labor team members and co-leads.

Mid-Atlantic States

While the Mid-Atlantic States region’s clinical unit-based teams have management and labor co-sponsors, large teams such as lab and radiology are sponsored in a different way: A UBT leadership group made up of labor and management from these area performs sponsorship functions as a united body. “We generated a vision of our UBT sponsorship. We got very specific on how we would work together,” says Jane Lewis, executive director of health plan regional services and a member of the group that sponsors eight pharmacy UBTs. The UBTs report their projects and team dynamics at monthly meetings. The leadership group reviews People Pulse, service scores, quality results and other metrics, identifies struggling teams, and recognizes teams that excel.

Northern California

The region has been on a roll with its “A Leader’s Role as UBT Sponsor” training. Launched in the spring, the tutorial gives management and labor leaders an easy-to-understand yet in-depth look at providing effective support to unit-based teams and their performance improvement work. The short, online training covers everything from outlining a sponsor’s role and how a sponsor can model partnership to tips on developing strong UBT co-leads and high-performing teams. Several facilities have combined the training with in-person, interactive exercises, and early feedback suggests the blended approach is striking a chord with sponsors. The online training can be found at KP Learn.

Northwest

“My role as a senior sponsor is to bring the message of UBTs to physician leadership,” says Rasjad Lints, MD, the region’s executive sponsor of UBTs. Lints is especially interested in helping teams focus on outcome metrics—a measure of the final result of something, such as how many patients with hypertension have their blood pressure under control—and to help everyone on the team understand that improving on process metrics often drives improvement on outcomes. It can be difficult to see the value in participating in process metrics if team members don’t see how it relates to the outcome measures. “At the end of the day, physicians have to drive the care,” Lints says. While working in UBTs presents physicians with some unique challenges, he believes that “if the physicians aren’t engaged, it’s a lost opportunity.”

Ohio

In an effort to improve the quality of team project information in UBT Tracker, the regional LMP support team solicited the help of the people who support the work of teams—sponsors. In June, an improvement adviser met with Ohio’s 20-plus sponsors and asked them to work with their teams to boost the input of that data. To illustrate the value and role of quality data in UBT Tracker, they used the data in Tracker to brief the sponsors on their UBTs’ projects and status. Their approach made an impact: The region has reported an increase in sponsor engagement, and several teams have reported performance and relationship improvements. 

Southern California

The regional Labor Management Partnership department is launching a new sponsor training curriculum that covers the nuts and bolts of what sponsors do and how they do it. Topics include: the responsibilities of sponsoring bodies (such as helping define how the teams should be structured and guiding selection of co-leads); coaching skills to help develop UBT leaders; the similarities and differences between labor and management sponsorship; how managing in partnership differs from traditional management; and how the sponsor role differs from that of facilitators, project managers, trainers and consultants. Also included in the course are basics of the Labor Management Partnership and unit-based teams, such as the key elements for UBT success, the roles and responsibilities of UBT co-leads and members, and consensus decision making.

A friend of mine with a heart flutter had to spend a day in a Kaiser Permanente emergency room recently, and he asked one of the staff members helping him, “Are you in a unit-based team?”

“Oh, yeah,” the staff member said, without much enthusiasm. “We have one of those.”

The exchange may not have been altogether surprising, but it underscores the work that still lies ahead for those of us who believe—as I suspect most readers of this column do—that partnership and unit-based teams are the right way to do business.

Naysayers nurture the old arguments. Partnership means management caving in to the unions or, conversely, partnership means unions selling out to management. Some people just sit on the fence, dismissing partnership as a “flavor of the month” and apparently hoping that if they ignore it long enough, it will go away.

Fifteen years after the Labor Management Partnership’s founding agreement was signed—at 12 flavors a year, that would be 180 flavors later—what’s a partnership advocate to do?

Spread the word. Do what you’ve been doing: Acknowledge the challenges of working in partnership, and cite the considerable achievements being piled up by UBTs. And here’s one more: Do what you can to support the increasing LMP focus on sponsorship, which is the subject of this issue’s cover article and companion stories.

Active sponsors are an essential component of a high-performing team’s makeup—and active sponsors serve as bridges between teams. They are positioned to spread effective practices up, down and sideways. Looking back after another 15 years, we may see that active sponsors were the partnership ingredient that finally turned LMP doubters into players. 

Colorado

When the Minor Procedures department at the Franklin Medical Office added three surgeons to its staff, the impact was positive: Access improved—patients got in faster. But staff members noticed the new surgeons were using $20 to $30 more in dressings and drapes than surgeons who had been in the department longer. The physicians responded positively when shown the information and, while allowing for medically justified exceptions, have standardized their usage of soft goods so it is more cost effective.

Georgia

The Oncology/Infectious Disease staff at the Cumberland Medical Office Building embarked on a medication reconciliation project to keep patients safe and avoid unnecessary hospital admissions. A manual cleanup of patient records came first. To check the accuracy of the records, medical assistants and licensed practical nurses, all members of UFCW Local 1996, called patients and asked them to bring their medications (or a list) to their next appointment. Providers deleted duplicates and worked across clinical disciplines and with pharmacy colleagues to sustain and improve the process. In just three months in 2011, the percent of duplicate medications fell to 15 percent, which translates to $90,000 saved by reducing hospital admissions.

Hawaii

The nurses in the 23-bed Mother/Baby unit at Moanalua Medical Center learned a lesson in human nature when they placed life-saving emergency airway kits—essential for keeping a weak infant's airways unobstructed—at each bedside. Individual parts of the kits come in handy in other procedures and regularly turned up missing. Keeping everything in zippered plastic bags with a “do not remove” sign didn’t do the trick. But after the team started re-purposing breast pump kit bags--which are sturdier and have labels with room to list the kit’s contents, whether an item has been used and if it’s been replaced—the team went from 75 percent of beds with fully stocked kits to 100 percent in four months.

Mid-Atlantic States

The Adult Primary Care UBT in Falls Church, Va., is using the New Member Identifier tool in KP HealthConnect as the basis for targeted welcome letters and phone calls to set up appointments with primary care physicians and help refill prescriptions. And, when a new member comes in, he or she is provided with a new member kit and offered a one-on-one facility tour. Patient satisfaction percentile scores have risen from 84.6 in the first quarter to 87.4 in the third quarter. Cassandra Hodziewich, MD, a family practice physician, says more new members “are getting needed labs (and) screenings."I think it’s made a difference in the quality of their care."

Northern California

Santa Clara Medical Center showcased its performance improvement work in October to eight UBTs from five regions as part of a two-day LMP learning lab. Visiting the Cardiovascular ICU, the delegation learned how the team uses visual boards to share improvement ideas and track projects. The Pharmacy department explained how it used Six Sigma to reduce workplace hazards, and the Women’s Clinic department outlined its use of process mapping to reduce lab errors. On returning home, the visitors were tasked with finding ways to implement some of what they learned.

Northwest

The Primary Care Team B staff at the North Lancaster Medical Office feels especially strongly about the importance of detecting colorectal cancer early, when it’s highly treatable, since some of their own providers have suffered from the disease. The team, which presented a poster at the Institute for Healthcare Improvement conference in December, tracks who’s eligible for a Fecal Immunochemical Test (FIT) kit, makes sure those members get one, and follows up if the kit isn’t returned. And staff members tell patients how early detection made the difference for their co-workers. The return rate is now 85 percent, up from 50 percent. “We add a personal touch by telling our story,” says labor co-lead Bill Waters, a medical assistant and SEIU Local 49 member, “and people respond.”

Ohio

The Parma Internal Medicine UBT has had a host of successes in its journey to becoming a high-performing team. In addition to improving meetings by defining roles and responsibilities, it has ensured sponsor support and increased staff engagement by creating sub-committees to work on projects. One of its innovative tests of change? Team members decided that while continuing to reduce actual wait times, they would work on the perception of time that patients experience while waiting—and created a slide presentation. The slideshow plays on computers in exam rooms and features health information on chronic diseases.

Southern California

The Bonita Primary Care unit-based team in San Diego, which was included in a poster presentation at the annual Institute for Healthcare Improvement conference, set out on a four-month blitz to reduce its supply expenses by 10 percent, or about $4,750. The team agreed to decreased minimum levels of stock and made diagrams of shelves with new quantities. Staff labeled bins and removed, combined and organized the excess stock, and then used the excess as the primary source for exam room restock over the next four months. As a result, fewer supplies were stocked in exam rooms, fewer supplies were ordered and less stock expired (which would have needed to be replaced). In five months, the team saved nearly $24,700.

I am reminded of the old joke about the holiday ham:

A young bride is preparing her first holiday ham as her adoring husband watches. She slices off one end of the ham and sets it aside and puts the remainder in her roasting pan. “Darling,” her husband asks, “why did you lop off the end of the ham?”

“Why—I don’t know. My mother always did,” she replies. Curious, they call her mother, but her answer echoes her daughter’s: “My mother always did.”  When grandma is called, she has the same answer.

Happily, great-grandma is still on the scene. Her answer to the question is quick: “Why,” great-grandma says, “so it will fit in the pan!”

The obvious point being that sometimes we need to question whether old routines still serve us well. A more subtle point for anyone involved in improving performance is to recognize a workaround for what it is. The more than 3,500 unit-based teams at Kaiser Permanente have daily opportunities to question “the way we’ve always done it.” And as team members become skilled at problem solving and create a culture where asking questions is encouraged, they can create systemic solutions to recurring problems.

In these and other ways, they will create more efficient, cost-effective and safer ways to deliver quality health care. It is essential work, as the cover story of this issue, “Affordable Health Care for All,” makes clear. And the work already is well under way: Every story in the Winter 2013 issue if Hank highlights a different way that teams are improving quality while working to keep Kaiser Permanente affordable.

Kaiser Permanente is the model for the future of health care. Check out this issue's stories and be inspired.

Colorado

When people go to school to learn how to perform X-rays or take blood pressure, they don’t generally expect they’ll be bonding with colleagues while getting their commercial driver’s licenses or that putting on snow chains will be part of their job. But members of the “mobile coach” unit-based team, who travel to clinics that do not offer mammograms on site and who are in charge of every aspect of running a mammography lab on wheels, took these tasks on and more. Their unusual assignment is improving the quality of care—they screen an average of 15 patients a day and performed 2,584 exams in 2012, finding 12 cancers.

Georgia

The Pharmacy team at the Cumberland Medical Offices cut labeling costs by more than 50 percent by improving accuracy in printing prescription labels. Techs now take a medication off the shelf before typing in the prescription or passing it off to a pharmacist. This helps them select the right code from the National Drug Code database—reducing the need to reprint labels and the associated medication information sheets that are given to patients. Within three months of the change, the number of incorrect codes on labels went from 13 a week to zero. Spending on labels dropped from $1,355 in November 2011 to $569 in March 2012, and monthly shredding costs dropped from $90 to $30. 

Hawaii

The Gerontology specialty team at the Honolulu clinic uses a distinctive combination of red and blue tape to keep its nursing staff free of accidental syringe needle sticks, which can lead to serious disease. More than a year ago, the team set a goal to have no more than three sticks a year—the number of incidents in the previous year. But telling busy caregivers not to rush was not enough. Today, a designated area blocked off by the tape signals to other staff that a nurse needs to concentrate fully on preparing an injection or disposing a needle. The UBT reinforces the warning with signs and a monthly safety message. There have been no needle sticks since October 2012.

Mid-Atlantic States

When busy patients kept canceling appointments, the Baltimore Behavioral Health unit-based team had to find a way to address the no-shows, which were having a negative impact on the clinic’s workflow. In June 2012, 32.7 percent of open slots for new referrals went unused. Then the team stepped in with personal reminder calls and letters, as well as in-person coaching during the after-visit summary review about—yes—how to cancel an appointment. Once patients learned how easy it is to use kp.org to cancel an appointment and understood how other members benefit from the newly opened slots, the no-show rate dropped to 25 percent in February 2013.

Northern California

When parcels arrive at the Fremont Medical Center, they are placed onto a conveyor that rolls them into a warehouse, where they are processed and staged for delivery. Before the conveyor was installed—a suggestion made by UBT member Pablo Raygoza, a storekeeper and SEIU UHW member—workers had to do a lot of bending and lifting to pick boxes up, handling each one multiple times. The improvement was part of a three-year effort to increase worker safety by redesigning and streamlining work processes. As of March 2013, the effort had kept the Supply Chain department injury free for more than 660 days and earned it this year’s regional President’s Workplace Safety Award.

Northwest

The Northwest welcomed 2013 with a recommitment to the region’s hospital’s unit-based teams at a three-day Value Compass Refresh meeting, attended by more than 300 UBT co-leads, subject matter experts and regional leaders. Groups explored subjects like overtime, process improvement and patient flow. In the end, hundreds of potential projects were identified by co-leads and subject matter experts to take back to their UBTs for discussion and next steps. Representatives from the Operating Room UBT discussed opportunities to improve communication with surgeons. On hand was Imelda Dacones, MD, the chief medical officer of the Westside Medical Center (slated to open this summer). She listened with an eager ear and asked questions of the teams to help understand the challenges. “All the physicians who have privileges at the new hospital,” she says, “will go through the Patient Safety University training.”

Ohio

Members regularly complained about long waits for prescriptions at the Parma Pharmacy, so the unit-based team decided to map the prescription-filling process using a spaghetti diagram. The tangled web of lines captured in the drawing told the story and pointed to the root cause of the problem: Pharmacists did a lot of unnecessary walking and backtracking. The primary culprit was walking to and from the technicians, who are located in the front of the pharmacy, to deliver prescriptions. The team decided to move pharmacists closer to the techs—a small change that gives pharmacists more time to dedicate to filling prescriptions and shaved wait times by 84 seconds, or 14 percent.

Southern California

The eight-person nephrology unit at the Stockdale Medical Offices has always exceeded regional goals for its discipline and prided itself on the care it provides its kidney transplant patients—but it got a rude awakening in January 2012, when it saw fresh data from the regional renal business group. The team was merely average. Team members got busy, analyzing the metrics and scouring patient records. To help flag the care each patient needs, they turned to the Proactive Office Encounter functions in KP HealthConnect™. They hosted a special short-term clinic just for transplant patients. Nurses made outreach calls. And the percent of patients getting five key services shot up—flu shots (up 50 percentage points), dermatology appointments (up 32 points), renal ultrasounds (up 22 points), annual follow-up visits (up 25.5 points) and lab work (up 26 points).

It’s not hard to figure out why people are hesitant to speak up at work. Offering a suggestion for improvement or pointing out when you think something isn’t right exposes a person to any number of possible responses—many of them unpleasant.

There’s the sarcastic retort. There’s the deafening silence. There’s the reply, pointing out exactly why you’re wrong, delivered in the nicest of tones but carrying an unmistakable edge of one-upsmanship. Who needs it? Who wants to create waves and risk a good job?

But when we don’t speak up, we put health and happiness at risk. As Doug Bonacum, Kaiser Permanente’s vice president of quality, safety and resource management, says in this issue’s cover story, speaking up “is mission critical for worker and patient safety.”

In addition to the moral imperative of protecting people from injury, there’s a strong economic incentive for speaking up. Improvement doesn’t typically come from a single person’s great idea—it comes from people sharing ideas. And we at KP have to keep improving, finding ways to deliver care as good as or better than we deliver now with fewer dollars per member. Our future depends on it.  

Since we get good at what we practice, we each have to practice speaking up. Practice means starting with lots of baby steps—don’t tackle the high-stakes stuff first! And let’s practice being good listeners, too, providing the space that lets others speak up safely.

The Labor Management Partnership and unit-based teams provide the framework for transforming what Bonacum calls a “culture of fear” around speaking up. But with that framework in place, it’s still up to each and every one of us to find the courage to address the immediate, particular obstacles that keep us silent.

Colorado

The nurses in the Primary Care department at the Englewood Medical Office were short-staffed due to medical leaves and feeling overwhelmed. Messages from patients were piling up in the electronic inbox in KP HealthConnect. So the team brainstormed ideas, and the physicians offered to help clear the backlog. After testing a couple of time blocks, the doctors began setting aside 30 minutes every morning and afternoon to triage messages and call patients back directly without involving the nurses. As a result, the team consistently closes encounters within an hour more than 40 percent of the time—and, with more problems resolved by phone, access for patients needing in-person appointments has improved. Morale in the department is up, too—and the team recently won the region’s quarterly “Value Compass” award.

Georgia

At the Crescent Centre Medical Office Building in Tucker, the Adult Medicine unit-based team is closing care gaps, managing chronic conditions better and improving screening rates for colon cancer—all key elements that differentiate Kaiser Permanente from its competitors. For example, the team increased the percentage of patients with diabetes getting the recommended blood sugar control and cholesterol tests by enlisting licensed practical nurses who help review, print and process pending test orders. To increase colon cancer screening rates, the team began tracking the number of take-home screening kits handed out by providers and made outreach calls to patients who didn’t return them. Starting from scratch, the team ramped up rapidly and handed out 173 kits between September and December 2012 and achieved an impressive return rate of more than 76 percent.

Hawaii

At the Moanalua Medical Center’s 1 East unit, patients are learning more about their medications,  thanks to a successful test of change by the medical-surgical nurses. Two significant steps helped the Honolulu unit-based team achieve its goal of increasing patients’ medication awareness: Nurses took the time to review a single prescription and its common side effects with each patient, and then they reinforced the information at subsequent office visits. A follow-up survey showed that the percentage of patients saying they understood their medications and the possible side effects increased from 36 percent to 50 percent in just three weeks in May.

Mid-Atlantic States

Several UBTs have joined the region-wide Member Demographic Data Collection Initiative, gathering crucial information about race, ethnicity and language preference. The data is needed to fulfill accreditation and contractual requirements—and, even more importantly, to eliminate health disparities and provide culturally competent care. In Springfield, Va., the Pediatrics team increased data collection from 46.8 percent of patients to 95 percent in less than two months by changing its workflow. In addition to nurses surveying patients in exam rooms, the team’s receptionists start data collection at check-in. Using laminated cards to describe ethnicity choices helped the Reston, Va., Pediatrics team improve by 10 percentage points. Region-wide rates improved 31 percentage points since May 2011, says Tracy S. Vang, the region’s senior diversity consultant.

Northern California

The benefits of performance improvement work aren’t just in the results. Sometimes the work helps teams discover the crucial role they play in providing quality care. That’s what happened when the Richmond Medical Center’s patient care technician team set out to improve its workflow. The technicians, who help hospital patients get up and moving, had been meeting only 45 percent of physicians’ mobility orders. Their goal was to reach 75 percent by October 2012. By September, the team was fulfilling 95 percent of daily mobility orders. Communication with nurses and physicians improved, and the work had an added benefit: By helping patients get up more regularly, hospital stays were shortened, which is estimated to have avoided $600,000 in costs over five months.

Northwest

By eliminating variation and wasted time, the regional lab’s Histology unit-based team improved slide turnaround time by 11.8 percentage points from its starting point in 2011 to April 2013. The team has reduced delays by tracking its slide volumes every hour, implementing huddles and adding additional equipment to minimize downtime due to lack of equipment. These improvements also helped improve employee morale: People Pulse scores for the department Work Unit Index increased by 30 points from 2011 to 2012.

Ohio

The Labor Management Partnership is supporting frontline employees as the region transitions to become part of Catholic Health Partners. Once the process is complete, employees, physicians and operations and administrative personnel who are currently part of the Ohio Permanente Medical Group and Kaiser Foundation Health Plan-Ohio will become part of Catholic Health Partners. They will continue to work in the existing medical offices in Northeast Ohio.

Southern California

Being accurate 98.9 percent of the time sounds pretty great. But the Central Processing department at the West Los Angeles Medical Center sterilizes almost 4,000 trays a month, so even a tiny drop in accuracy can disturb Operating Room efficiency. But with managers and employees working together to analyze the department’s data, the unit-based team was able to reach its goal of 99 percent accuracy between June and August 2012. It continues to maintain that level of precision by using a buddy system to audit instrument trays, involving lead techs in quality assurance spot-checks, posting tray accuracy reports in break rooms and holding weekly meetings with the Operating Room department administrator.

When discussing change, it’s a rare person who doesn’t have that question lurking at some level of consciousness. Since health care reform will bring change to just about every corner of Kaiser Permanente, it’s safe to assume a lot of people are wondering how their jobs will be affected.

The short answer is, no one exactly knows yet.

The better answer is, no one exactly knows and it doesn’t really matter.

Because the 130,000 frontline workers, managers and physicians who are engaged in the Labor Management Partnership already are on a path of continuous improvement, which means taking change in stride is becoming second nature to this crowd.

Doing better tomorrow what we did well today is the name of the game for unit-based teams. Team innovation, as this issue’s cover story notes, may result in a clinic making sure new members understand what they can do to ensure speedier service. It may result in new members getting the kind of attention on their first visit that impresses them and makes them want to stay with KP.

So the best answer to “what about me?” is: It doesn’t matter if a change arrives because a lab decided it wants to get results out faster or if change is a result of health care reform. Change is change. It isn’t out there waiting to roll over us, it’s already here. It arrived when UBTs began using the Value Compass as a guide to providing our members with the best service and quality of care at the best price, while creating the best place to work.

More members on their way because of health care reform? We’re already getting ready—it’s the same work we’re doing to serve our current members well.