Communication

When employees speak up, teams score high on patient safety, quality, service and workplace safety. But it can be hard to speak up when you don’t feel safe or comfortable. Gain the confidence to use your voice with these tips from two frontline workers with the Ambulatory Care Pharmacy team in West Los Angeles. 

Chakana Mayo, pharmacy technician, UFCW Local 770, Workplace safety champion

Practicing speaking up when you feel safe. “When we first began peer rounding, people were comfortable speaking to one another versus speaking with management. Once people were comfortable speaking with one another, then they felt like they could be comfortable speaking with management.”

Your voice can make a difference. “It’s important to speak up early because you can prevent long-term injuries from occurring. If you’re confident enough to speak up to your manager and just let them know what’s going on, they’ll appreciate it more.”

Employees who feel free to share their ideas and concerns help keep our patients safe and make Kaiser Permanente a better place to work. Managers can help team members feel comfortable speaking up by creating a “psychologically safe” work environment—one where no one is afraid they will be embarrassed, rejected or punished for speaking up. Here are four tips from supervisor Nee Tang, Pharm.D., Ambulatory Care Pharmacy, West Los Angeles, on how to help workers make their voices heard.

Follow up and take action. “When an employee brings up something, look for the solution and be accountable. Make sure things are done. Having that accountability is really crucial to employees.”

Be authentic. “Having a manager who is open-minded and who truly, genuinely wants to create a safe environment for everybody, that’s the key.”

Be patient and persistent. “In the beginning, people may not be as comfortable speaking out. But once they see we’re coming every month no matter what [to do peer safety rounding], they’re speaking out. We’re really getting the equipment that is needed and reminding everyone about the proper ergonomic positions. People know we’re serious about making an environment that is safe for everyone.”

Find people who want to share their passion with others. “Another key is to have people who are passionate. Angie Chandler, our labor co-lead, is really passionate about ergonomics. I’m passionate about eating healthy. We have another employee who is passionate about exercise. Everybody wants everyone to be safe and healthy and to work well together. We’re passionate about what we do and want to spread that to everybody.”

I’m in a UBT, you’re in a UBT, we’re all in a UBT! Hooray! Let’s start our performance improvement project, collect our data and make a PowerPoint presentation to explain our results.

…Whoa. Not so fast. Unit-based teams were launched as part of the 2005 National Agreement, but we all still hear stories about frontline union members, managers and physicians who don’t realize they’re on a UBT. This is a big deal. When people don’t know they’re on a UBT, they’re missing out on an opportunity to take part in improving service and quality for our members and patients.

That’s why negotiators hammering out the 2015 National Agreement added a requirement: In order for a UBT to move up to Level 3, it has to have “a communications structure to reach all members of the department” in place.

Over time, this will help everyone in the department realize they’re part of the UBT—and will lay to rest the myth that “the UBT” is a small group of people who lock themselves in a meeting room, drink coffee and eat doughnuts and solve problems for everyone else. Your team needs you contributing ideas; our members and patients need you.

Angela Chandler and Nee Tang, Pharm.D., didn’t like what they were seeing.

The team co-leads for the West Los Angeles Ambulatory Care Pharmacy crouched beside Camille Wong, scrutinizing her posture as the pharmacist and UNAC/UHCP member sat typing at her computer.

After a quick huddle, the pair worked together to adjust Wong’s chair until she was sitting in the ideal position to protect her from pain—and a potential injury.

“I didn’t know I could adjust my chair this way. It feels good,” Wong said appreciatively, her feet resting flat on the floor and her legs bent at the appropriate 90-degree angle.

Shift in culture

Such peer safety rounds are one of the hallmarks of a dramatic shift in culture for the team, a shift that has built engagement and created a workplace where frontline workers feel confident speaking up. The department went 3½ years without injuries and earned a national workplace safety award earlier this year.

“We’re all in it together, and we’re all here for each other,” says Chakana Mayo, a pharmacy technician and UFCW Local 770 member who is the team’s workplace safety champion.  

But the situation was not always so bright.

In 2011 and 2012, the department experienced a spate of workplace injuries. Employees, who spend most of their time on phones and computers, were sometimes reluctant to report pain—including one who suffered a repetitive motion injury so severe that it required two surgeries and time off from work.

“It was really a wake-up call,” says Tang, a pharmacy supervisor and the team’s management co-lead. “We needed to make sure that everyone feels comfortable enough to speak up when they have a problem.”

Fairy Mills, a pharmacy technician and member of UFCW Local 555, has worked for Kaiser Permanente for 29 years. Not long ago, however, there were days she left the Mt. Scott Pharmacy ready to cry, exhausted. Wait times were up and service scores had plummeted. She thought about retiring but decided to tough it out—and was voted in as the union co-lead for the department’s unit-based team.

About the same time, Linh Chau arrived as the new supervisor. He wasn’t sure what he’d stepped into. “It was the perfect storm,” he says. “The team was stressed out, members were unhappy, membership was up, and in the midst of it all, we were implementing a new software system.”

Pharmacies in the Northwest region were in a tough spot a year or so ago—and that was especially true for the Mt. Scott Pharmacy. Part of the Sunnyside campus, it’s the second busiest pharmacy in the region, seeing an average of 500 patients a day and filling nearly 1,000 prescriptions.

Although other regions had already made the transition to ePIMS, a software system that syncs up with KP HealthConnect®, the migration process hadn’t been easy.

“We had to reenergize the team,” Chau says.

Chau and Mills’ first strategy was to give staff members confidence that things would improve. The two co-leads began rounding, checking in with UBT members regularly and making sure everyone had a chance to offer suggestions for improvement— giving them the power to shape how things are done, one of the key elements for beating back burnout.

Katie Richardson, MD, is a master juggler: She’s a pediatrician at Highlands Ranch Medical Office in Colorado two days a week and the director of Physician Experience for the Colorado Permanente Group (CPMG) the rest of the week; she’s a sponsor of the CPMG Physician Wellness Committee; and at home, she’s the mom of an 11-year-old daughter. Dr. Richardson recently talked about the pressures of practicing medicine and what the Colorado region is doing to help its doctors sidestep stress and burnout.

Q: Why do so many doctors suffer from stress and burnout?

A: As physicians, in general we are not as good at taking care of ourselves as we are at taking care of others. We don’t tend to ask for help—and we need to change that culture. There are a lot of clinicians out there who are suffering and they don’t recognize the signs of burnout or know what to do.

Q: What happens when physicians are burned out?  

A: We are the leaders of the health care team. We’re trained to solve diagnostic dilemmas and do what is best for our patients. If we’re burned out, we may not think through our decisions as well. Healthy, happy physicians take better care of their patients. We want to make sure that we take care of our physicians.

Q: How do you help doctors deal with stress?

A: We know this is a high-pressure environment and look for resiliency in our physician hiring process, which helps us identify candidates who have experience managing stress. In addition, our yearly physician survey includes questions around burnout and resilience. We use that information to identify strategies to improve the physician experience.

We are trying to foster conversations around stress and burnout. We’re encouraging physician chiefs to meet with their physicians regularly and ask, “How are you doing?” Educating providers to look for signs that they might be experiencing stress, as well as providing education about available resources, will help. The first step is letting people know we are aware there is an issue.