Team-Tested Practices

Elizabeth Rollice, RN, always knew that the Intensive Care Unit at the Woodland Hills Medical Center in Southern California was a great place to work.

As a staff nurse there, she and her co-workers enjoy good teamwork and excellent communication, and they deliver high-quality care to the sickest patients.

Now they have proof of their success.

This spring, the unit received the Gold Beacon Award for Excellence from the American Association of Critical-Care Nurses, the world’s largest specialty nursing organization. The award recognizes hospital units that demonstrate exceptional care through improved outcomes and greater overall patient satisfaction.

The team will be honored at the National Teaching Institute & Critical Care Exposition in San Diego, May 18-21.

“I knew that we did a good job and that everyone worked well together,” says Rollice, a member of UNAC/UHCP and a representative on the department’s unit-based team. “This award validates the quality of our work and tells us, ‘Yes, we are doing a pretty good job.’ ”

What’s best for the patient

Superb communication and a culture of collaboration among all members of the care team are key to the team’s success, enabling the consistent practice of evidenced-based medicine that has improved the quality of care.

Daily multidisciplinary rounds, for example, involve everyone on the care team who touches the patient.

“It’s about working in partnership with physicians, nurses and other staff to deliver high-quality care based on the newest evidence,” said Lynne Scott, RN, a clinical nurse specialist for the Critical Care and the Definitive Observation Unit. “We’re constantly moving forward.”

Nurses say team rounding gives them an opportunity to speak up and influence care decisions that affect their patients.

“We’re able to talk together about what’s best for the patient,” said Erica Bruce, RN, a UNAC/UHCP member who is the team's union co-lead. “If I feel that something is inappropriate, then I get a chance to ask the doctor. Family members get to ask questions about their concerns, too.”

Multidisciplinary rounding has produced an unintended benefit—higher member satisfaction. “I started in the ICU in 2002. We didn’t have a big rounding team at the time. Families sometimes felt unsupported,” recalls Paramjeet Dhanoa, RN, a staff nurse and UNAC/UHCP member. “Now that we have a big team, our families are more satisfied, because they feel they are not alone in making decisions. They are more comfortable.”

Open communication

Communication is vital in a department where staff members work around the clock in rotating shifts. To ensure information is consistently shared from shift to shift, the team:

• practices Nurse Knowledge Exchange Plus (NKE Plus)
• holds monthly UBT meetings, with members of the representative team responsible for sharing information with individual staff members
• holds quarterly staff meetings; those who miss the meeting must review the staff meeting binder and sign a form indicating they’ve read it
• uses a bulletin board to post important news and activities

The bulletin board, sandwiched between the nurses’ station and the staff restroom, attracts passersby with colorful fliers and posters.

“Your eyes are drawn to that communication board,” Rollice says. “You pass by a wall full of fliers, notes and postings, you can’t help but stop and look. It’s in a prime location.”

Conducted at the patient’s bedside, NKE Plus provides nurses with a template for patient safety and communication.

“It helps promote open communication and it helps us understand what’s going on with the patient,” says Judy Stone, RN, a staff nurse and UNAC/UHCP member, of the structured, in-depth, face-to-face handoff between the outgoing and the incoming nurse.

Stone says an additional itemized checklist “forces us, as nurses, to have all the pieces of the puzzle ready in the morning for multidisciplinary rounding. It really focuses us on everything that is going on with the patient so that we can deliver the best care that we possibly can.”

Clinical successes

Building the culture of collaboration and openness has had a big payoff:

• No ICU patient has contracted VAP since the first quarter of 2011.
• There have been no central line-associated bloodstream infections since the fourth quarter of 2011.
• The unit achieved the 86th percentile on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient satisfaction survey from January 2013 through August 2014.

“To consistently deliver the best patient outcomes, you must have the processes and structures in place,” says Kareem Younes, RN, nursing project coordinator for Woodland Hills. “It’s about doing the right thing at the right time, every time.”

Patient safety is about more than the hands-on care delivered in a hospital or clinic. It’s also about what caregivers do to close care gaps and be sure patients get the care they need.

To ensure this happens with every abnormal prostate, breast, pelvic, osteoporosis and fecal exam, the Georgia region established a centralized Outpatient Safety Net Program. Almost four years ago, borrowing techniques from Southern California’s successful safety net program, the Georgia region dedicated the equivalent of four full-time and one part-time nurse. Their jobs: to continue reaching out to patients who don’t respond to an initial contact regarding an abnormal test result.

The program is saving lives—and has earned KP’s 2014 David M. Lawrence Patient Safety Award in the transfer category, an award for a region that successfully implements a project from an earlier award winner. The Southern California safety net system had won a 2012 Lawrence award for its work.

“If you have an abnormal stool test, you should be seen in gastroenterology,” says Rahul Nayak, MD, who served as physician program director of patient safety for Georgia when the program launched. “It will raise a red flag in our system if that doesn’t happen in a certain amount of time. That’s why it’s called a safety net—it’s the net below the tightrope walker.”            

Making contact with patients

Sonja “Patrice” Evans, RN, is the manager of Georgia’s outreach effort and leads the group of nurses. She also steps in to convince members who initially say they don’t want to come in for further testing. “We can prevent something small from turning into something big,” she says.

The nurses receive a list of patients who have abnormal results. They make two attempts to reach them by phone and send a certified letter if the calls don’t work. “Our team tries to catch a small group of patients before they fall through the cracks,” Evans says.

So far, it’s working.

A systematic approach

In 2013, the most recent year for which data are available, 4,000 members were contacted about abnormal breast exam results. Of those, 93 percent were successfully scheduled for a follow-up appointment within the prescribed seven days. For abnormal pelvic exam results, 2,000 members were contacted, and 95 percent of those were scheduled within seven days.

Five hundred members—most of whom had declined or not responded to previous contacts—were reached within 100 days of abnormal prostate exam results; 87 percent scheduled a follow up. The team contacted 200 members with abnormal osteoporosis exam results, and more than 70 percent scheduled a follow up within 30 days, which exceeded the Medicare 5-Star guidelines.  

Dr. Nayak, UBT co-lead for gastroenterology at Southwood Medical Center, says one of his patients benefited from the program.

“Our safety net caught a positive (fecal occult blood test) that I had missed two months prior,” he said when accepting the Lawrence award on behalf of the team. “That patient had an advanced adenoma which was well on its way to malignancy. Without the safety net, there is no guarantee that we would have found this polyp” in time.

Now, Georgia’s program is expanding and will include other types of patient notifications.

Inspired by the goals of the worldwide “Baby-Friendly Hospital” initiative, the Health Education UBT at the Manteca Medical Center in Northern California set out in early 2012 to increase the percentage of new mothers who exclusively breastfeed. At the time, the number stood at 70 percent.

Steps emphasized by the initiative, sponsored by UNICEF and the World Health Organization (WHO), include training health care staff to inform every pregnant woman of the benefits of breastfeeding and to help mothers begin breastfeeding within one hour of giving birth.

Closing care gaps

The challenge was that while Manteca health educators provided prenatal services to expectant mothers, the moms went to Modesto to deliver their babies. The Manteca employees didn’t always learn whether their patients ended up breastfeeding. In order to make sure their patients were getting full support for breastfeeding as they made the transition from prenatal care to labor and delivery and beyond, the members of the Manteca UBT reached out to their hospital colleagues.

“As a Health Education department, we provide breastfeeding education during their prenatal care, but we were not reaching 100 percent of…moms after they switched to hospital services,” says Maria Prieto de Milian, a health educator, lactation consultant and active SEIU-UHW representative on the Manteca UBT. “There was not a consistent breastfeeding message.

“Our moms were in need of a continuum of care for breastfeeding.”

Researching best practices

The Manteca team, which meets monthly, is linked to a larger Health Education UBT at Modesto. The larger team meets quarterly and includes Modesto employees as well as the employees from the smaller teams at Manteca, Tracy and Stockton.

After researching best practices in breastfeeding support and exploring what other Kaiser Permanente locations were doing, the Manteca team introduced two small tests of change:

• Working with the larger Modesto UBT and with full support from the Women’s Health department, the Manteca team set in motion a collaborative approach to breastfeeding support involving health educators, lactation consultants, physicians, pediatricians, medical assistants and nurses. This includes hospital employees encouraging observance of the “golden hour” immediately after birth, when a newborn is placed skin to skin on the mother’s chest to promote bonding and breastfeeding.
• The team worked with other employees to make sure mothers-to-be were asked about breastfeeding at the regular 28-week prenatal visit, and that their questions or concerns were directed to lactation educators for follow-up.

The results were dramatic. By the end of 2012, 92 percent of Manteca prenatal care patients who delivered at the Modesto hospital were exclusively breastfeeding.

The umbrella UBT decided to spread Manteca’s idea.

“We turned it into a service-area initiative. It started as a pilot just for Manteca, and then the group decided it was so beneficial we’d roll it out to the whole Central Valley,” says Jose Salcedo, the management co-lead for the larger UBT. “The results were really conducive to parents and moms having a great experience. It’s a whole pathway from the early stages of pregnancy to the delivery and then to the pediatricians.”

“The breastfeeding initiative is now regular workflow throughout the Central Valley,” Salcedo said.

Good results sustained

At the time the Manteca UBT started its effort to improve breastfeeding rates, the Modesto hospital was working to achieve the Baby Friendly designation from the UNICEF-WHO program. After making significant progress toward that goal, it switched its focus to implementing the Northern California region’s Breastfeeding Toolkit, a new program that encompasses the same goals.

It's now been almost two years since the small tests of change, and Prieto de Milian says the Manteca UBT no longer is tracking the rate for its moms, viewing the project as a continued success.

New ideas are continually being added to strengthen the process. These include the advice call center providing 24/7 breastfeeding support while also scheduling follow-ups to the calls with lactation educators. In addition, lactation consultants are available to assist pediatricians by phone or by email on KP HealthConnect® during patient appointments.

With everyone’s minds and hearts on one goal, Salcedo and Prieto de Milian say, teamwork was seamless.

“What I like about the UBT is it’s a joint effort,” Salcedo says. “We have really good lactation educators who think outside the box, search for best practices and apply them. They went ahead and ran with it and made the recommendations. Management supported them all the way.”

Do you doubt you can lead changes that make Kaiser Permanente a better—and safer—place to give and get care?

A small group of nurses at the San Diego Medical Center showed that leading change is, in fact, part of their job.

Brittni Demers, RN, and three of her colleagues spearheaded a successful effort to reduce needlestick injuries, and now their expertise is being tapped throughout Kaiser Permanente to bring the voice of frontline workers to safety initiatives.

Demers, a member of UNAC/UHCP, is on KP’s National Sharps Safety Committee. It is one of the many sourcing and standards teams that advises KP on everything the organization buys—and it is the only one with union representation. As such, it gives the caregivers who actually use needles, scalpels and other sharps a way to influence purchasing decisions. It also impacts workplace safety and tools workers use every day.

From July to December 2013, a huge remodeling project at the hospital shut down two medical-surgical units, leaving several nurses temporarily without anywhere to work. Demers and RNs Jessica Heffern, Leanne Vitacco and Lucas Pepin got together to tackle a problem that had been concerning them: needle and sharps injuries. By July 2014, the team’s project had led to an astounding 76 percent decrease in needlestick injuries in inpatient nursing units. There were similar improvements for all sharps injuries throughout the San Diego service area.

Here’s what the team did:

Peer-to-peer training

Only two years out of nursing school, Demers quickly saw that “real life” didn’t always comport with what she had learned in her classes. “You go to school, you learn correct techniques, then you go into a hospital and it’s different,” she says. “People like doing things their way.” The team devised a quick refresher for nurses, by nurses, that emphasized what the evidence and research said about safe needle handling. The nurses traveled from unit to unit in the hospital, and to some outlying clinics, to make their case. “When you emphasize safety—our own and the patients’—and provide the supplies, then people will do it,” she says.

“The peer-to-peer approach was effective because the team understood the nurses’ day-to-day concerns,” says Mark Trask, the director of environmental health and safety in San Diego. “There is empathy and understanding, which allows for more dialogue.” In addition, because the trainers were registered nurses, they could spell other nurses for the 10-minute refresher. More than 700 nurses, physicians and lab techs took the training.

Standardize supplies

While demonstrating safe needles to other units, the team members often would hear, “Oh, we don’t have that one.” So they got to work standardizing the needles throughout the medical center. “We went through every single medication room,” says Demers. “They became supply chain experts,” says Trask. By adjusting the types and amounts of equipment, they also reduced waste and saved money.

Share expertise

These nurses now participate in incident investigations when there is a needlestick injury, which is an important part of the region’s workplace safety program. Plans are in the works to spread the training to primary care departments in the ambulatory setting.

Identify resources

Demers’ participation on the National Sharps Safety Committee extended her reach system-wide. The committee field tests safety sharps in every KP region to identify products that most effectively prevent injuries. Based on user feedback, the committee selects the highest-rated safety sharps as KP’s national standard.

Why did the four frontline nurses step up? For Demers, the answer is easy: “You have to be focused on safety when you have a needle in your hand.”

On her last day at work before going on maternity leave, something started going wrong with Juanita Ichinose’s pregnancy—and she found herself in an ambulance, on her way to the Downey Medical Center. Her husband, Trav, followed in his car. The images from an ultrasound foretold a grim story: Juanita was expecting twins, but one of the boys was not moving. “Code Pink” began blaring from the overhead speakers as she was wheeled to the operating room. What caregivers and the family feared came to pass. One twin survived, but the other did not.

“We had some moments with our other son,” says Trav Ichinose. “Then I went to see Teo. He weighed a pound and a half. The doctor told me, ‘He is very small.’”

Thus began Teo Ichinose’s four-month stay in the neonatal intensive care unit, a journey that led his father to become an active member of the department’s parent advisory council. Today, Teo is a happy 4-year-old, obsessed with his toy airplane from the latest Disney movie. And his father continues to bring the voice of the patient to Downey’s NICU unit-based team, where his input has helped shape numerous improvements.

UBTs exist to include all voices—employees, managers and physicians—in efforts to improve performance. And some UBTs are bringing in one more crucial voice: the patient’s.

To be sure, there are UBT members who resist. Objections range from “we don’t have time” to “patients can’t possibly know how our department runs.” But for others, it is a step that literally brings the patient-and-member focus of the Value Compass to life.

“UBTs have a lot of expertise. They know what is and isn’t working,” says Hannah King, director for service quality for unit-based teams. “What is missing is the perspective of the user, someone who might be afraid or in pain. We don’t know what they go through before and after they come to us. So we need to ask.”

Read on to see how UBTs have included patients and members in their work and improved performance.

Whose handoff is this, anyhow?
Downey NICU finds a way to keep parents involved during shift changes

During his son’s four-month stay in the NICU, Trav Ichinose became concerned that parents were prevented from visiting during shift changes, when the Nurse Knowledge Exchange Plus occurs.

“Parents want to maximize their time with their babies, and the policy was undermining that,” he says.

Nurses wanted to integrate parents into the process but also needed to prevent interruptions. “During the report, the parents tended to interject,” says Marnie Morales, RN, the team’s union co-lead and a UNAC/UHCP member. “That was a safety issue,” because it is important nurses not get sidetracked.

So, together with Ichinose and the parent advisory council, UBT members devised a system that met the needs of caregivers and parents. There would be “quiet time,” when parents listen and jot down notes while the outgoing nurse updates the incoming nurse. Once they’re done, it’s the parents’ turn to discuss their baby’s care with the nurses.

In testing the process, the nurses realized they needed to be able to discuss sensitive information out of the parents’ earshot—if, for example, there was a domestic violence situation or mental health problems in the family. So they came up with a discreet cue that signals the need to step away.

“The patient is getting better care because there is better communication. Information that wasn’t getting shared before is now,” Morales says. “As nurses, we get so involved with charting that we forget the patient is sitting there. Now, we are explaining as we are doing it because the parent is there watching.”

The change gave the team a boost in its satisfaction scores, which rose from 74 percent in the third quarter of 2012 to 88 percent one year later. It works to maintain the scores by holding refresher trainings with staff.

“With long stays like ours, your emotional resilience is tested to the max,” Ichinose says. “There are things that happen in the NICU setting that can undermine that resilience—or bolster it. Bolstering our ability to take in information, to be physically and emotionally present for the care of our child, affects our satisfaction with the care.”

Preserving pride, preventing falls:
A comment provides a San Diego team with fresh insight

Why do patients fall when they are in the hospital? Is it because they are elderly? Or under the influence of medications that affect their balance? The leaders, physicians and nurses at the San Diego Medical Center considered a range of possibilities and tried everything in the usual playbook, posting pictures of falling leaves on patient doors and using color-coded armbands to indicate fall risk. But nothing was working.

Then the UBT on the 5 West medical-surgical unit cared for a patient who was a member of the facility’s patient advisory council—and they asked his wife for her opinion. She said her husband—normally a self-sufficient, strong man—was too embarrassed to call a nurse to help him to the bathroom, especially given that he was wearing a flimsy, possibly revealing hospital gown.

That “aha” moment led the UBT to take a new approach: No one walks alone. Instead of trying to figure out who is at risk for falling, caregivers would treat everyone as a fall risk and provide assistance. The pilot program was so successful that it is being spread to the entire hospital. Before the campaign began in November 2012, the hospital had been averaging 16 falls a month. In June 2014, that figure was 3.4 a month.

Seeing the experience through the patient’s eyes was the key to the solution.

“I felt as if I was part of the team, and my input was just as valuable as any other member’s,” says Pat, the patient’s wife (last name withheld at her request). “If you go to patients with the attitude that they will be helping you do your job better, you will get an honest evaluation of what can be done to help, and they can make your job easier and more rewarding.”

Reluctant to change?
Some ideas for including patients as part of a UBT

Sheryl Almendrez, the management co-lead of the Definitive Observation Unit (also called a step-down unit) at the San Diego Medical Center, acknowledges that caregivers on her team were hesitant to have a patient join its improvement work: “They were interested, but were they ready to hear ‘the real truth’?” And what if a chronic complainer ate up valuable time?

As it turns out, there was little to fear. Patients’ requests were reasonable. For example, they want nurses to give them a heads-up when using an ear thermometer. “We’re used to it,” says Almendrez, but they may not know what it is. “They may think it’s an injection coming at them.”

For the Urgent Care unit in Largo, Md., listening to patients’ feedback about long wait times when coming in with a sore throat led that UBT to work with colleagues in the lab to fast-track tests for strep throat.

“Our team was very hesitant about bringing a member in because there could be more complaints than real feedback,” says Donna Fraser, RN, the team’s union co-lead and a member of UFCW Local 400. Making it clear why it was including patients helped: “We told the patient that we want to know what we are doing wrong, because how else will we improve?”

Morales of the Downey NICU says she no longer flinches from criticism, whether or not it’s phrased “constructively.”

 “Some of the people we have on our advisory council are the ones who complained the most,” she says. “You know what? They became the advocates for all the other babies. They helped us change a lot of things on our unit for the better.”

The Molecular and Cytology Lab unit-based teams in Stapleton, Colorado, were facing a challenging trifecta. Increased membership, changes in guidelines from the Centers for Disease Control and Prevention (CDC) and slow work processes made it tough to quickly process two widely used tests.

Membership in the Colorado region has grown by more than 60,000 members since 2013 in part because of the Affordable Care Act. Total membership in the region is now at its highest ever, with more than 600,000 members. The influx of new members is a strain on the system, and teams are digging in deeply to meet those members’ needs, from the first point of contact in the medical office to the last encounter as they pick up their prescriptions on the way out.

The lab teams are feeling the pressure, too—especially since they also process samples for the Georgia region, which is expected to grow, and they still do some work for facilities in the former Ohio region, which was sold to another health plan last year.

“We knew there would be an increase in the number of tests we would be doing. We also knew that our process was very labor intensive,” says Roxanne Whitesides, the Molecular and Specialty Testing manager. “Already this year, we’ve increased our workload 10 percent because of an increase in membership.”

Preventive care approach

The screens in question are for the human papillomavirus (HPV) and the Papanicolaou (Pap) test. Both detect disease at an early stage when treatment is highly effective, and so are central to Kaiser Permanente’s preventive care approach. As of June this year, the Molecular and Cytology teams—each of which has a role in processing the screens—already had processed 23,300 Pap screens and 16,800 HPV screens.

Meanwhile, CDC guidelines on HPV were revised in recent years and now recommend that women age 30 to 64 have an HPV screening and that girls as young as 11 receive the vaccine. The agency says HPV is the most common sexually transmitted infection in the United States. Some strains can cause cancer, and the CDC says about 21,000 of the HPV-related cancers each year could be prevented by the vaccine.

Because of the changed recommendations, even before the enrollment jump, the labs were seeing an increase in the number of HPV screens they processed. In 2012, the labs processed 650 HPV screens a month. By this spring, the monthly average had more than quadrupled: the average for March, April and May 2014 was 2,800 per month. In May alone, 3,354 samples were processed.

Labor-intensive processes

The final hurdle the teams faced was that their processes were labor intensive, requiring significant hands-on time from the technician. There was frequent back and forth between the Cytology and Molecular departments, which caused delays and interruptions. The complex work processes added to the pressure of the growing workload and caused frustration and tension.

The teams began an intensive study of what other labs were doing, including researching the latest technology. They visited other sites and vendors and decided to go with a cutting-edge Roche instrument. The pathologists—who work closely with the labs—supported getting the new equipment, and the lease was fast-tracked for installation. The instrument was in place within two months.

At that point, the teams set to work to figure out how their processes would change with the new equipment.

Cross-training provides insights

“We trained each other on the new equipment and on the processes within the two departments,” said Luann Martin, a cytology technologist, UFCW Local 7 member and co-lead of the Cytology unit-based team. “I could appreciate things going on in both departments.”

The collaboration between the Molecular and Cytology departments enabled them to improve their work processes and interactions—and ensured that as one problem was fixed, another wasn’t created.

“It’s important to keep talking. People have different expectations and comfort levels,” says Beth Fisher, a medical technologist, UFCW Local 7 member and co-lead of the Molecular UBT. “Be patient with one another,” says Melissa Baca, a cytologist lab assistant, SEIU Local 105 member and union co-lead of the Cytology UBT.

Most important, Fisher says, the new equipment is enabling the teams to meet the growing demand.

“The big payoff is that we're able to process all those HPV samples in less than half the time it used to take, so we've been able to absorb the workload increase with no new staff,” she says. “And we're able to identify the HPV strains that are most linked with cervical cancer as part of the initial screening. That saves money, because we don't have to send out all the positives for additional testing.”

Summer interns often are put to work fetching coffee or making copies. But last year, UBT consultant Geoffrey Gamble wanted to create a more valuable experience for the teens of KP’s Summer Youth Employment Program at the Modesto Medical Center. So he trained a small army of performance improvement consultants to help support unit-based teams.

Despite initial skepticism from some team members and managers, the results were stunning. By the end of the summer, 12 of the 13 teams supported by the interns advanced at least one level on the Path to Performance. What’s more, four of the 19 projects carried out by the UBTs yielded savings or cost avoidance totaling $400,000. The program was such a success, it has returned to Modesto this summer and has spread to the Sacramento and San Jose medical centers. And in the process, the interns are gaining on-the-job training that translates to their studies and to the work world.

“I went in thinking we were going to do grunt work, but in reality it was like, ‘Wow, I’m actually doing something I can apply,’” says Nate Aguirre, who interned in Modesto’s Emergency Department last year. “It was a life-changing experience.”

The Community Benefit program has offered training and work experience to teenagers in underserved communities since 1968. In the past, that experience included clerical work or coaching on speaking in front of a large group. When Modesto’s internship coordinator retired in 2013, Gamble agreed to oversee the program as long as it supported his work developing UBTs.

Overcoming doubt with results

“When I first proposed the idea, directors were very skeptical,” Gamble recalls. “People would say, We’re struggling to do this with professionals—how do you expect to get momentum from a 16-year-old?’”

But Gamble saw the opportunity to offer teams a fresh perspective and the daily support many need to get started. He also wanted to show team members that performance improvement didn’t have to be complicated and could be incorporated in their daily work.

“I told managers that I was going to treat (interns) like adults and give them the skills I would give employees,” Gamble says. “If you hold them to that expectation, they will rise to the occasion.”

In the first few days of the eight-week program, Gamble trained the 16-year-old interns in basic performance improvement tools, including the Rapid Improvement Model, process mapping and Labor Management Partnership basics. By the second week, the youth were assigned to Level 1, 2 and 3 unit-based teams and started helping the teams launch projects and enter data into UBT Tracker.  

Rosemary Sanchez, Modesto’s Emergency Department supervisor, was one of the loudest doubters.

“At first I was like, ‘Ugh, one more thing to do.’ But then I thought, ‘OK, this could work and help us accomplish our goals and share our knowledge.’” 

Intern Nate Aguirre was crucial in helping the team on its project to streamline and standardize supplies in the treatment rooms.

“Nate was awesome,” Sanchez says. “He was so enthusiastic collecting data.”  

Getting the ball rolling

Aguirre also spent time talking to employees in the department to learn about their jobs and the challenges they face in their work.

Meghan Baker, an Emergency Department clerk and union co-lead for the UBT, says that sparked interest and support from UBT members—a shift from before, when they had struggled to get employees involved.

“People were into having their voice heard by someone,” says Baker, who's a member of SEIU-UHW. “Now people are talking and getting the ball rolling on things. And we’re making it known that people are being heard.”

At the start of the program, the Emergency Department UBT was ranked at Level 3. The team advanced to Level 4 after completing the work.

Michelle Smith, manager of Specialty Surgery Reception, appreciated the new perspective and support her team received from its intern for its project to reduce surgery no-shows and last-minute cancellations.

“It was nice to have someone get our project going,” she says, “because we were at a standstill.”

The team’s intern walked the UBT members through mapping out their process. New workflows emerged that included calling patients ahead of scheduled surgeries, which reduced no-shows and increased service scores.

When the teams were asked what they thought helped them advance, many said it was because of the interns coming to the departments every day to help push and support the work. 

“We would have eventually worked on the project, but having her come in and start us off in a positive way was great,” Smith says. “She taught us how to be a team, because we realized we all had to be part of the work.”

Want a safer workplace served up on a silver platter?

Then stop by the operating room at Kaiser Permanente’s West Los Angeles Medical Center in Southern California. Surgeons and the other health care workers there pass sharp instruments to one another on silver trays—rather than passing them hand to hand—which reduced injuries related to handling sharp instruments during procedures by 34 percent between September 2013 and May 2014.

“We can see the results,” says Lisa Duff, a surgical tech and workplace safety champion at the facility. This success is part of a new emphasis at the facility on task standardization—analyzing each step of an activity, identifying the potentially hazardous steps, coming up with a safer way of doing things and then ensuring everyone follows the new process the same way, every time.

How to reduce risk

“Injuries occur when there is not consistency,” says Tracy Fietz, chief administrative officer for Southern California Permanente Medical Group at West L.A.  “If you break [a task] apart on a fishbone diagram, you can identify where the risks are. It is about removing variation.”  

Standardizing practices also has helped several departments reduce—and in some cases eliminate—sharps-related injuries for up to 17 consecutive months. It’s also helped reduce injuries to EVS workers by 75 percent when they clean floors.

Another practice that is improving safety at West L.A. Medical Center is regular monthly meetings between senior leaders,  including Fietz, and the labor and management safety leaders of targeted departments. Departments that have special line-of-sight safety goals (see below) in the region’s Performance Sharing Program get special attention. The gatherings are a space to analyze processes, see what’s working—and what isn’t—and collect information to share with others.

How partnership helps

“I work with managers and the workplace safety champions, because it’s a partnership,” says Nor Jemjemian, the chief administrative officer for Kaiser Permanente Hospital/Health Plan at West L.A., who also leads those meetings. “I want the employees doing the tasks to be part of the solutions.”

Union-represented employees, for their part, appreciate the crystal-clear message top leadership is sending.

“You need management to back you up when you speak up,” says Duff, a member of SEIU-UHW. “Employees know that our managers will back them up 200 percent.”

Open communication, trust and partnership processes are the foundation of a safer workplace, says Jemjemian.

“When I was an employee, there were [hazardous] tasks I did that my manager didn’t know about,” he says. Today, in contrast, “UBTs create a venue and a forum to discuss the everyday work.”