Collaboration

When I was asked to represent The Permanente Medical Group at 2012 bargaining, I leapt at the opportunity. My own experience with partnership at Fresno Medical Center showed me what great things could be accomplished with collective problem solving.

I sat on the subgroup that looked at how to improve partnership to enhance performance and Kaiser Permanente’s operational agility. I was amazed at seeing so many people with different backgrounds sharing their thoughts and shaping the outcomes. From the highest levels of Kaiser Permanente and union leadership to the front line, everybody was around the table, and they were all equal in this venue. Everyone was heard and engaged.

I personally learned a lot from the different perspectives voiced by all of the individuals representing their fields. I strongly believe that collective wisdom is better than individual wisdom, and that with collective wisdom you can achieve anything in life. Interest-based bargaining, which assembles voices from all levels and reaches of Kaiser Permanente, is a great example of collective wisdom.

Another thing that struck me—how much folks craved the physician perspective. When I spoke, all 25 to 30 people in that subgroup really listened. And there were issues where a physician perspective was critical. That was a strong message I brought back to physicians. In most unit-based teams at Fresno, there is physician involvement. The intention is to bring those perspectives together to enhance the care for our members and patients. But does that mean if I walk into a UBT meeting I’ll see a doctor? Maybe yes, maybe no.

I’ve worked at Kaiser Permanente for 34 years, and I saw the pre-partnership years. They were contentious ones. We’ve had relative peace with coalition unions since partnership. That’s not to say that working in partnership is perfect in every way. It can’t be done without trusting each other. And how do you develop trust? Through transparency. The whole bargaining process was about transparency; essentially, everybody could share everything. That doesn’t mean people didn’t disagree.

The interest-based, collective approach takes into account everyone’s perspectives to reach a better outcome, which is ultimately a common goal—superior care for our members and patients.

I just used interest-based problem solving (IBPS) while I was at a union convention in Philadelphia. We got five people to rent a car together and go sightseeing on our one day off. So we had to decide what to do in Philadelphia for 24 hours. We brainstormed, then identified the ideas we all supported. We went to Valley Forge, Amish country and the boardwalk in Atlantic City. It worked great.

My husband and I used interest-based problem solving to make a decision about a major purchase recently. I used IBPS to get to “yes.” IBPS is the easiest way to organize your mind. My mind automatically goes to it and that whole process. If a conversation gets confusing, you can go back to the structure provided by it.

Being at a round table with interest-based problem solving is the best way to move health care forward. What we do at the bargaining table with IBPS is great, but we need to do a better job bringing that back to the workplace. We can make it better by having more frontline managers at the bargaining table.

Frontline managers, especially the newer ones, need a sense of the history and commitment of our National Agreement. And frontline managers need more support. There are still problems with backfill, with allowing employees to be involved in LMP activities.

The way we do business at Kaiser Permanente is the Labor Management Partnership, so we need to have those interest-based discussions. I’ve been involved in 2000, 2005, 2010 and 2012 bargaining. I am in awe of the great work labor and management representatives do—and how we can come up with common goals in a nonadversarial manner. I hope we all see it as a value.

No one does it like we do.

Our negotiations for a new National Agreement will be one of the largest private-sector contract talks in the United States this year. No one else brings together such a large and diverse group of representatives from labor and management—plus physicians—to arrive at a single contract for so many union locals nationwide.

We’re so accustomed to this being our norm, it’s easy to forget how revolutionary our Labor Management Partnership is—and how democratic our interest-based methods are.

“At the table, everyone has an equal right to speak and explain their interest,” says Linda Gonzales of the Federal Mediation and Conciliation Service, which helps facilitate the negotiations. “There’s more open dialogue and sharing of information.”

The tone set by interest-based bargaining carries over to the work of unit-based teams. UBTs were one of the outcomes of 2005 bargaining. Today, they are the engine for performance improvement at Kaiser Permanente. They are also the structure giving frontline workers a voice in making decisions. The work UBTs do to improve care for KP members wouldn’t be happening if partnership weren’t in place, and if each successive national agreement didn’t commit everyone to finding innovative ways to address common interests.

It’s not always smooth sailing. But the interest-based model grounds everyone in shared values.

“There are some hard issues, and bargaining still has to take place,” says Joel Cutcher-Gershenfeld, a professor at the Institute of Labor and Industrial Relations at the University of Illinois. “At the end of the day, you have to find the right balance.”

Bernie Nadel is director of customer service and call center operations at Patient Financial Services in Southern California. He co-chairs the Regional Operations LMP Council, bringing together 27 business units, including the regional laboratory, central refill pharmacy and optical services.   

None of us was born into a unit-based team. Partnership is learned. Teams and their leaders need guidance and a playbook.

I tell other managers partnership makes my job easier. I have 10 other people helping to come up with solutions. I know some managers are uncomfortable with that approach. They act as though they can opt out of the Labor Management Partnership. It’s as if they said, “I know we have KP HealthConnect™, but I want to use this other computer program.” I say, if you don’t want the LMP, don’t work at Kaiser Permanente. You don’t get to opt out of the company’s policy.

Owning the work

Recently, our UBT went through a list of issues to work on. Call volume is up 30 percent, and we’re figuring out how to deal with that. We are going to do several tests of change. UBT members are gung ho about it. If I were to try to make those changes myself, I’d miss things. I would not get the insights of the people who interact with our members every day. And the people doing the work wouldn’t have the ownership and energy that comes with having a voice. Employees know I believe in partnership—and I give them the time to do it. That is a challenge. But you can’t solve the problems if you don’t invest.  

Not that long ago this call center was a toxic environment. There was low trust and low morale. All that has switched 180 degrees. A big step was my predecessor attending a sponsorship training class, which led her to involving UBTs more in day-to-day operations. I wanted to build on that.  

Taking the first step

LMP is a dance between labor and management, and management has to take the first step. When labor sees that management is serious, that’s when it changes. We’ve shown that you can change the culture.

Recently, we had a meeting with top executives about improving the consumer financial experience. Our UBT representative group prepared a report, and it gave our executives insights they couldn’t get any other way. It was not slick, it was real. I’m grateful to the group for the experience, commitment and knowledge they bring to this work every day.

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.”

 “I was almost devastated,” says Karen Cardosa, a grocery clerk in Albany, Oregon, “when UFCW told us they were no longer offering Kaiser Permanente as an insurance option.”

Cardosa and her family had been KP members for years through the union’s Local 555 Employers Health Trust. That changed in 2009 when a variety of issues resulted in KP losing the account, which covered many Local 555 members. The union continued to represent nearly 2,000 Kaiser Permanente pharmacy and radiology employees, who—as KP staff members—continued to have KP health care.

Today, it’s a new story. Thanks to a 36-month KP offering that was finalized in April, Kaiser Permanente is again an option for up to 15,000 UFCW members and dependents in the Northwest region who are covered by the health trust.

“Our work with LMP is probably some of the most important work done in Public Sector strategy in the last two years. Working with our union partners, we’ve been able to come to the table with customer solutions that meet everybody’s needs—including the unions that aren’t part of KP, who have tremendous influence in purchase decisions. We are unique in having a strong labor partnership in our own business, and we can speak that language.”

—Kate Kessler, a Member Sales and Service Administration director

“When I was hired four years ago, my manager told me my Number One job was to get UFCW back,” Ehren Cline, a KP Sales and Account manager. Cline, including Jeston Black, the region’s senior labor liaison, and other colleagues partnered with Dan Clay, president of Local 555, to do just that.

“KPNW brought us a package we couldn’t refuse,” Clay says. An affordable price, high quality, a new hospital, expanded clinics and a new billing system helped seal the deal.

Clay’s own union members pushed for the new commitment.

“I have not been to a union meeting in the last five years where someone didn’t ask, ‘When do we get to go back to Kaiser?’” Clay says.

But something else was also at play. Thanks to Labor Management Partnership, Kaiser Permanente enjoys a joint union-management approach to winning and keeping health plan members that is almost unheard elsewhere in this country.

Read on and learn how it all comes together.

How the LMP Growth Campaign Works

Click to enlarge.

For more than 10 years, Kaiser Permanente’s Child Health Program has been veiled in relative obscurity despite the extraordinary service it offers.

Even more unknown is the role KP enrollment processors in Northern California, who are represented by OPEIU Local 29, are playing in helping the charitable health program fulfill KP’s mission of serving our communities.

“I like to say that we’re the best-kept secret of KP,” says Sharlene Jones, an enrollment processor who screens applicants for eligibility and guides them through the sign-up process. The community benefit program provides comprehensive medical, dental and optical coverage at little or no cost to children ages 19 and younger whose family income falls below the federal poverty level and who have no other coverage options.

Since August, the Oakland-based enrollment processors have attended more than 40 health coverage enrollment or outreach events across Northern California, from informational sessions at small medical clinics to large events like the “We Connect Health Care” enrollment and resource fair in Fresno, which drew thousands of people. The processors answer any question thrown at them about the Child Health Program and help enroll those who qualify.

“Our processors are able to help families right on the spot,” says Sara Hurd, a former employee who until recently led outreach for the program. “They know what challenges are and how to work through them.”

Long-lasting value

The Child Health Program has a goal of enrolling 80,000 qualified children across Northern and Southern California. The work the Local 29 members are doing to help meet that goal fits within the framework of Labor Management Partnership efforts to grow the number of Kaiser Permanente members—and to establish positive member relationships that can last a lifetime.

As outreach coordinator, Hurd’s priority was getting the word out about the program and forging relationships with community organizations. She also served as the sole contact for prospective applicants at outreach events—but she didn’t have the detailed enrollment knowledge the Local 29 processors have.

Maury Rosas, manager of Charitable Health Coverage operations, reached out to enlist the processors’ help. Including them in the work, Hurd says, “has been invaluable”—and as of May 2014, more than 77,000 children were enrolled.

“We needed people who really understood what the applications are about and could help people with eligibility,” Rosas says. Before he requested their help in the field, the enrollment processors’ interactions with potential qualifying applicants were by phone or letter.

“We’re able to answer their questions,” Jones says. “It allows us to put a face on KP.”

Many of the processers who attend the events have bilingual certification and are skilled in walking applicants through enrollment in Spanish.

“It’s important to show (the public) that we’re not just sitting behind a desk, pushing papers,” says Miriam Garcia, an enrollment processor. “We’re the labor force behind it all….We’re here to work with the community and are proud of KP.”

Demonstrating a commitment

The effort has been an unqualified success, Rosas says, from community agencies asking for repeat visits to the response of the children’s parents.

“They took me by the hand and walked me through the process of completing the application and made me feel comfortable with the process,” says Rufina Garcia, speaking through a Spanish interpreter. Garcia enrolled her three children in the program at an outreach event in March. “This has been the first time when I could walk in and give my information and be signed up right there.”

Delivering on KP’s mission in partnership between labor and management also helps build relationships with potential union-oriented purchasers of health care, says Katy McKenzie, a consultant to LMP and its membership growth work.

“It goes a long way when you’re talking to unions that represent low-wage workers,” McKenzie says. “They see that we actually do care about caring for people and our communities. It’s not just about selling something to them.”

McKenzie and others involved in the growth work helped promote the Child Health Program to unions representing low-wage or part-time workers, such as laundry or home care workers—people who don’t get dependent health care coverage as part of their job benefits or who can’t afford what is offered to them.

 “It’s a great opportunity to see that management is working with labor as a team,” Miriam Garcia says. “We’re not only supporting KP, but we’re supporting our own labor force.  We’re showing that we can work together and make a change. We’re helping make a change that carries over into the community.”

That kind of caring makes an impression. Rufina Garcia, who only has catastrophic medical coverage for herself, says she would choose Kaiser Permanente for her whole family given the chance.

“It has been a wonderful experience,” she says. “The way they treat my children is incredible. (The doctors and nurses) are very caring—they have more patience and actually listen to the kids….I believe they take better care of my children.”

Some departments glide effortlessly into becoming high-performing teams. Not so for the San Rafael Health Information Management team.

Now at a Level 5 on the Path to Performance, the team had to overcome numerous hurdles to get to where it is today.

“They went through a lot of hell to get there,” says Richard Orlanes, a regional LMP consultant who worked with the team during some of its darkest days. “To see the transformation they made in about a year—it was almost like they fired the old people in the department and brought new people in.”

As recently as 2011, the team members, whose work is to maintain KP’s medical records, were negative and distrustful, their morale was low, and they didn’t participate during UBT meetings.

“You could hear a pin drop at the meetings—nobody said anything,” says Richard Incaviglia, an outpatient ambulatory coder, SEIU UHW member and the team’s labor co-lead. “At one time people even said they wanted to dissolve the UBT.”

Sponsor involvement is key

But instead, the co-leads—with assistance from Joan Mah, the local UBT consultant—reached out to the LMP regional office for help. They brought in Orlanes to observe the department and lead a series of interest-based problem-solving exercises. He also suggested including sponsors in the exercises; when the management sponsor accepted and also brought her boss to the meetings, it sent a message to the team that leadership really wanted to turn things around. To provide a sponsor perspective on the union side, the co-leads involved Kisha Fant, a union partnership representative, and Zachary Adams, a contract specialist.

“Bringing in the sponsor means everything. Her being there told us that this was a serious effort,” Incavigilia says.

The management sponsor, Freida Smith, the Marin/Sonoma HIM director, is now the team’s management co-lead. As she remembers it, she wasn’t so much invited to participate in the problem-solving sessions—she invited herself.

“I stuck my nose in,” Smith says. “I had to step in and assume some responsibility because the sponsor needs to be involved and is ultimately responsible.”

Discussing positions and interests

Smith believes that the turning point for the team came when they discussed their positions and interests with Orlanes as the facilitator.

“We had to decide as a team that there was nothing we could do about what happened in the past,” Smith says, “but we could step out on faith and move forward.”

After working with the LMP regional consultant for several months, the team members were finally ready to start working together on their common interests. They prioritized the issues of communication, trust and honesty, and transparency, and worked to transform the negativity in the department. One of their early tests of change was to introduce a daily 8 a.m. huddle. The team huddles over the phone because half the team members work remotely. After the huddle, Smith sends an email to the whole department summarizing what was discussed.

“Once we started communicating and voicing opinions, and we realized we didn’t need to worry about retaliation, everybody started participating,” Incaviglia says.

On to high performance

Now the team has a long list of successful performance improvement projects under its belt, including a project to reduce the number of medical records that have missing documentation and another to make sure charts are coded within four days or less.

Smith believes that being transparent was the key to success.

“No matter how small or large the issue, be transparent,” she says. “I share every single thing that impacts the team’s day-to-day existence, including the budget.”

These days Smith is not only the management co-lead of the San Rafael HIM team but also the sponsor of a team in Santa Rosa. Her advice for other sponsors of dysfunctional teams? “I think the key is to communicate with the UBT co-leads first and then, if things don’t improve, take it to the whole team.”

On one level, the pediatric clinic at Georgia’s Panola Medical Center Offices is like any other pediatric clinic. Babies squawking and squealing are part of the soundtrack—and under that, there’s the murmur of parents and nurses cooing to get the little ones to stop crying.

But the Panola clinic’s unit-based team stands out. Its members work at one of the several pediatric clinics in KP’s Georgia region that have significantly improved preventive care and screenings for their young patients, who range in age from newborn up through their teens.

The pediatric teams have achieved these goals in the midst of competing demands by staying laser-focused on a handful of quality measures in the Healthcare Effectiveness Data and Information Set, or HEDIS.

“Our projects are usually HEDIS-related,” says Panola’s labor co-lead, Sheryl Boyd, a licensed practical nurse and member of UFCW Local 1996. “HEDIS is so measurable.”

The work is a good example of how, instead of driving an agenda from the top down, achieving a goal can be inspired by engaging frontline teams in understanding how they contribute to KP’s brand promise of total health.

“The teams are not ‘being told what to do,’ but rather they see the big picture and see what they can do to affect it,” says David Jones, MD, Georgia’s physician co-lead for UBTs. Dr. Jones says he and his labor and management LMP counterparts stay abreast of Georgia’s regional goals and priorities, then work with UBT consultants to communicate those to frontline teams.

“We incorporate UBTs as a lever to execute our clinical goals,” says Dr. Jones, creating a vital loop of communication and support.

Collaboration pays off

One of the Panola UBT’s successes has been to increase the number of girls getting the human papillomavirus vaccine (HPV) by their 13th birthday. The vaccine can help prevent a virus that increases the risk of cervical cancer.

The project kicked off in October 2011. At the time, the team wasn’t tracking how many of the girls in the target population had received the vaccination, which is delivered in a series of three shots over six months. The team’s initial goal was to get 5 percent of the girls eligible for the shot vaccinated. In the first six months, the team succeeded in getting 10 percent of the target population started on the series—and by October 2013, nearly 20 percent had gotten the complete series, a significant achievement. While it has yet to reach the national HEDIS average for the vaccination, the team is steadily closing the gap.

Team members achieved these results by working with the clinic’s information technology staff to get a list of patients—11- and 12-year old girls—who needed the vaccine. They contacted parents and made appointments. In the exam room, nurses discussed HPV and the importance of the vaccine with patients and their parents.

And they worked with their IT colleagues again, modifying the computer system so they could book appointments six months in advance. That allowed them to act on a crucial step—scheduling visits for the two follow-up booster shots right then and there.

The parent education was extremely important, says Erica Reynolds, the charge nurse and management co-lead.

“Some parents think we want people to come back in for appointments because we want the co-payments,” she says—but in fact, if the shots aren’t completed in the proper time period and the immunization series needs to be started all over, it requires even more visits. To avoid that, she says, “Scheduling a nurse visit for the second and third vaccines has become a part of our workflow.”

Hard-wiring success

That kind of hard-wiring of successful practices is the holy grail of performance improvement.

As labor co-lead Boyd puts it, “Our projects are not ‘projects.’ They are ongoing.”

In addition, Dr. Jones says, the integration of partnership and performance is taking place at all levels in the region.

For example, he says, physician leaders “integrate the Labor Management Partnership and performance improvement into existing meetings so it is not viewed as outside those discussions.”

As a result, when Georgia earned a five-star Medicare rating in fall 2013 for the first time—bringing all of KP’s regions into that rarified club of health care excellence—Rob Schreiner, MD, the region’s executive medical director, specifically credited UBTs and the culture of continuous improvement for the achievement.

Driven by those two engines, says Schreiner, “We’ll improve quality, service and affordability at a tempo that exceeds that of our competitors.”