Best Place to Work

The patient at the center of the Value Compass isn’t always a KP member, as two Colorado RNs proved on a flight home from the Mid-Atlantic States region last fall—and the experience they shared in the air also brought a fresh appreciation of their shared values and commitment to partnership.

Debbie Zuege, Colorado’s senior director of Nursing and Women’s Health, and Becky Sassaman, a nurse at the Arapahoe After-Hours clinic in Denver, work together as co-leads for the Nursing Partnership Council but had never teamed up clinically. That changed on their return flight from the Mid-Atlantic States, where they had talked about partnership with a group of union stewards.

Shortly after takeoff, Zuege was settling in and starting to read a magazine when something caught her eye.

“A flight attendant came down the aisle, holding an oxygen tank,” Zuege said. She alerted Sassaman, and they joined the flight attendant, who was tending to a woman lying down in the aisle. The woman was pale, sweating excessively and seemed confused. She’d been sick to her stomach. Two physicians on the flight joined in to help move her to the back of the plane.

The hastily formed team concluded the woman was dehydrated. Her pulse was weak. They elevated her feet and gave her liquids to drink; Sassaman placed an IV into her hand to administer fluids they found in the onboard medical kit, and Zuege administered oxygen. The woman responded well, with her pulse and color returning to normal. The doctors and nurses decided she’d be fine for the duration of the flight, and the attendant rearranged passengers so Sassaman could sit with her. The team kept the IV in place, suspending the fluids from a hanger hooked to the overhead bin, and gave her medicine for her nausea. Zuege and the two physicians checked in throughout the flight.

“The lady was so incredibly sweet and grateful,” says Sassaman, who helped her get clean, found her jacket and even lent her a pair of workout pants. “She kept saying ‘Thank you’ and ‘How can you do this?...I made a scene.’ I told her we are nurses, and it is what we do.”

“Team” is a noun. “Teaming” is a verb, defined by the woman who coined it as teamwork on the fly, coordinating and collaborating across boundaries, without the luxury of stable team structures.

That woman, Harvard Business School Professor Amy Edmondson, talked to the 2012 Union Delegates Conference about why teaming is such a crucial skill, especially for those in health care settings where work is complex and unpredictable.

“In health care, many times people are interacting with each other in an emergency room, for instance, now, for five minutes, but they don’t know each other,” says Edmondson. “The catch is we have to act as if we trust each other…because we often don’t have the luxury of having a lot of time to get to know each other.”

A “team” is a static, stable entity. But, says Edmondson, “In health care, if we wait until we have the perfectly designed ‘team,’ the moment has passed. We have to get together quickly, do what needs to be done, and then disband and do other things.”

In the absence of long-term work relationships, Edmondson says allegiance to an organization with a compelling vision can be the glue that holds these teams-on-the-fly together. “There is the pride in working for KP,” for instance, she says. “That is a real bond.”

Looking at the performance improvement work of unit-based teams at Kaiser Permanente, the principles of teaming still apply. While not as fluid as an emergency room, UBTs still see plenty of flux. Just think about the manager that gets promoted or retires, or the labor co-lead who rotates out of that role. The team has to be able to keep focused on improving performance even as the cast of characters changes.

UBTs can be stable teams that do great work. They are a very powerful tool,” Edmondson says. “And yet, I also want people to be able to quickly get up to speed, do what needs to be done with other people in the absence of those stable structures.”

A UBT needs to be a scaffold that is strong enough to withstand the flux, says Edmondson.

“If there is clarity about what the structure looks like—independent of the people who are in that structure—you are better off,” says Edmondson, a point explored in research she’s conducted with Harvard colleague Melissa Valentine. “We won’t always have the same human beings in those roles, but the roles are reasonably static.”

The theme of the 2012 Union Delegates Conference was “You Gotta Move”—and Amy Edmondson’s advice for the delegates was “you gotta learn.”

The Harvard Business School professor studies what she calls “learning environments.” To support innovation and teamwork, it’s essential the Labor Management Partnership and unit-based teams foster learning environments throughout Kaiser Permanente.

Imagine the ideal learning environment: People feel free to take risks. They feel psychologically safe. They believe they won’t be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. “Without that kind of psychological safety, it’s very hard for an organization to learn,” says Edmondson.

Now imagine the opposite of a learning environment, one where no one speaks up. “Nobody ever got fired for being silent,” says Edmondson. “And yet many bad things happen as a result of silence. Silence is a strategy for individuals to stay safe, but not necessarily for patients to stay safe or for organizations to stay vibrant.”

Creating a learning environment is up to leaders—to those people with influence, whether or not they have a formal leadership role.

“Leaders have to go first,” Edmondson says. They “have to be willing to ask questions themselves, invite participation, acknowledge their own fallibility, and to explicitly state we don’t know everything yet.” These behaviors help an environment where others can take the risks of learning.

But, she cautions, “The learning environment doesn’t live at the ‘organization’ level. For the most part, there are pockets of learning environments.…In a large, complex system, answers don’t come from central headquarters or the CEO. The answers come from the people at the front line doing the work.”

A labor management partnership like the one at Kaiser Permanente “is an important foundation” for building a learning environment, says Edmondson. “A true partnership is completely consistent with the context for mutual learning.”

Both management and union UBT co-leads can help create a learning environment by articulating the unit’s or department’s purpose and goals “in a meaningful way that touches hearts and minds, that motivates and encourages,” she says.

They can—and must—also reduce the fear people experience that makes them reluctant to speak up. The LMP helps develop and support people, helping them be their best and most courageous, Edmondson says.