Culture

David Jones, MD, works in the Georgia region with the Southeast Permanente Medical Group. He has been with the medical group for more than 11 years, and currently works in the Panola Medical Office. He spoke with LMP senior communications consultant Julie Light.

Q. What is your partnership role?

A. My role with the Labor Management Partnership in Georgia is assistant to the medical director for unit-based teams. I serve as the physician regional co-lead for all the UBTs for the region. I’m excited about this role and how it can help engage our physicians.In this role, I work closely with all of the teams, with a particular focus around supporting the physicians and helping them understand the value of UBTs and how UBTs really can improve what we do day to day in the offices and how they can improve the care for patients. It also means removing any potential barriers that the physicians may face, or anticipate, to allow them to be more engaged with the UBT process.  Another part of my role is working with our unit-based team’s resource team. In that capacity, I bring more of a clinical perspective to UBTs.

Q. How do teams improve care?

A. A project I had personal involvement with was the pediatric team at our Panola office, which addressed ADHD (Attention Deficit Hyperactivity Disorder) medication management. Before our UBT project, we were meeting the goal of having a follow-up visit within 30 days approximately 25 percent of the time. Through our UBT work, we increased those results to reaching and sustaining a rate above 90 percent after three months.

Q. Why haven’t more physicians embraced partnership?

A. The first thing I tell physicians about the UBTs is that it is about improving the work that we’re already doing. It’s not about adding more work, it’s about looking at the work that you're doing and figuring out how to do it better.

I think one of the barriers physicians face has been just lack of understanding. It wasn’t clear to physicians the value that UBTs can bring to the team. So it’s taking the UBT process and putting that into terms that are meaningful to physicians. Time is always a barrier for most people, and particularly for physicians. That’s why it’s important to have them understand that it’s not about doing more or working harder, it’s about working better. This is a very new way of thinking about teamwork. It’s about the physician being engaged and involved and still having a leadership role, but also embracing the value and the input, perspectives, talents and skills of the whole team, and understanding how everybody can share the same goal and work together and improve the accountability across the board.

What it really takes is physicians and teams going through the process. I can talk with them all I want, and tell them how it is in theory, but once they start to go through the process and see the results, and see how morale and efficiency improves—that’s when they become believers.

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.”