Customer service

When discussing change, it’s a rare person who doesn’t have that question lurking at some level of consciousness. Since health care reform will bring change to just about every corner of Kaiser Permanente, it’s safe to assume a lot of people are wondering how their jobs will be affected.

The short answer is, no one exactly knows yet.

The better answer is, no one exactly knows and it doesn’t really matter.

Because the 130,000 frontline workers, managers and physicians who are engaged in the Labor Management Partnership already are on a path of continuous improvement, which means taking change in stride is becoming second nature to this crowd.

Doing better tomorrow what we did well today is the name of the game for unit-based teams. Team innovation, as this issue’s cover story notes, may result in a clinic making sure new members understand what they can do to ensure speedier service. It may result in new members getting the kind of attention on their first visit that impresses them and makes them want to stay with KP.

So the best answer to “what about me?” is: It doesn’t matter if a change arrives because a lab decided it wants to get results out faster or if change is a result of health care reform. Change is change. It isn’t out there waiting to roll over us, it’s already here. It arrived when UBTs began using the Value Compass as a guide to providing our members with the best service and quality of care at the best price, while creating the best place to work.

More members on their way because of health care reform? We’re already getting ready—it’s the same work we’re doing to serve our current members well.

The Family Practice unit-based team at the Sunset Medical Office in the Northwest was thrilled that its work to get members to sign up on kp.org was a success. But team members quickly grew dismayed when the onslaught of new signups had an adverse effect on patients’ experience.

The challenge began in 2014, when the team launched several projects to increase the number of Kaiser Permanente members signed up on kp.org, knowing that people who use kp.org usually give KP higher satisfaction scores. The office is located in Hillsboro, Oregon, near one of Intel’s campuses. Intel offers Kaiser Permanente as a health plan option, so the effort to get more people online made perfect sense.

But, on the flip side, the increased number of messages coming in through kp.org wound up increasing turnaround times for return emails and phone calls.

More than two-thirds on kp.org

The department now receives between 450 to 650 email messages per week. Seventy-one percent of its patients—29,000 members—are signed up on kp.org. The team sought to improve its turnaround time on messages by reducing the number of times staff members and physicians touched each message. Instead of multiple people working a message, each one is now triaged one time by either an LPN or RN. At the same time, the team decreased its time spent on messages per week from 13.6 hours to 10.9 hours.

Ed Vrooman, an improvement advisor and union partnership representative, coached team members on how to test and implement their improvements.

“We learned how to use process mapping, so we could identify where the holes were in how we were approaching the work,” says Eliseo Olvera, the assistant department administrator and the UBT’s management co-lead. “Ed knew where we could get the data we needed and help us understand it, so we could do the work.”

Vrooman also introduced the team to the 6S tool—sort, simplify, set in order, sweep, shine, standardize—to improve its work processes. The team broke into different workgroups and each group identified tests of change. Some of the ideas were abandoned, some were refined and adopted, and some still are being adapted.

Staying on track

“I tended to focus too much on the information and the numbers,” says Rikki Shene, a licensed practical nurse and SEIU Local 49 member who is the team’s union co-lead. “Ed helped keep us organized and simplified the data so that we could keep moving forward and accomplish something in our 45-minute UBT meetings.”

Vrooman’s role in the team has been critical for the team. He attends the co-lead planning sessions and UBT meetings. He stays in the background until needed—and then he speaks up.

“He’s part of our community,” says Olvera. “His expertise with data has been critical. It’s a gift.”

The Transportation department in the Northwest is coming out of a tumultuous time. A lack of trust between managers and employees created a barrier that affected morale—and made it difficult to focus on improving routes and processes.

The department uses a robust but complex process for optimizing its routes. For maximum efficiency, it has to integrate a variety of work streams and figure out where there are redundancies that can be eliminated. Because of the complexity of the process, however, it had been more than 15 years since the criteria and requirements for the transportation system from the customer’s point of view had been reviewed.

Eventually, the UBT worked out a thorough route-modernization plan based on data-driven service requirements and metrics that established parameters on how to revise and design its routes.

But before it got there, it had to fix its communication, which broke down so badly the team entered into an issue resolution. In the Northwest, the LMP Education and Training department is responsible for facilitating issue resolutions.

Blame-free solutions

“There was a lot of tension in the department, and people were nervous about losing their jobs as a result of our work around revamping routes. Poor communication was a problem,” says Greg Hardy, sponsor and manager of the department.

The issue resolution process uses interest-based problem solving, and that helped the team focus on a common goal: Serving its customers was the top priority and improving communication was a necessity. From there, other agreements came more easily, and the department was able to maintain staffing levels and improve processes as a result of its efforts.

Improved communication improves service

As a result of the improved communication, the team was able to improve service levels and achieve the efficiency and cost savings it had strived for.

“We have a group of dedicated workers who want things done the right way,” says logistics supervisor Chris Dirksen, the team’s management co-lead.

When it came to improving communication, the team members’ first step was to get a baseline measurement of what they were trying to improve. They created a survey that would measure not only communication but also morale and UBT effectiveness. Once they had that information, they created a SMART goal: to improve employee perception of communication, morale and UBT effectiveness by 15 percent within three months, raising the overall survey score from 2.55 to 2.93 by February 2014.

As the team began to investigate the issues, it discovered email was not a good form of communication. Fewer than 20 percent of the team members knew how to log on and use Lotus Notes. The team brainstormed ways get employees to use Lotus Notes email and frontline staffers began to instruct and coach one another.

Three months later, the team sent the survey out again and found it had met its goal. Perception of communication improved 48 percent, morale improved by 56 percent and UBT effectiveness improved by 21 percent. The team scored 3.4 on its survey, exceeding its stretch goal of 2.93, and anecdotal reports are that the communication success is continuing now that the team has successfully completely the issue resolution.

New ways to communicate

Team members use several means now for communicating with one another, including email. A communication board has been set up in the department’s headquarters, near dispatch, that includes information about the projects the team is working on, notes from UBT meetings and a copy of the department’s weekly e-newsletter, “Heads Up.”

In addition, the team has gone from a representative UBT to a general membership UBT and now has regularly scheduled meetings throughout the region, so that all employees are able to participate. “This has been our biggest success to share information,” says UBT union co-lead Nickolas Platt, a courier driver and member of SEIU Local 49.

“It’s cool to watch from meeting to meeting how more people show up each time,” Hardy says. “The engagement of the team has increased as we began to see improvement, and people could see change.”

If people understand why we’re asking them to do certain things, they are more likely to help find solutions. That’s why unit-based teams, and their sponsors, must understand the implications of the Affordable Care Act to lead meaningful change.

The ACA is producing unprecedented changes in the marketplace. It is opening up health care to people who had little or no access to routine care before, and giving them choices they never had before. But for many, the choice will come down to dollars and cents—which means Kaiser Permanente needs to do two things, in partnership:

First, to attract new members, we have to offer competitive rates. Then, we have to wow them when they call or visit—especially the first time they call or visit

Know your role

As UBT sponsors, we have to ask ourselves: How are we going to do an awesome job of caring for patients and being the most affordable if our team doesn’t understand the impact it can have and isn’t involved in helping find solutions?

We need to understand what our role is in helping teams improve service and efficiency. If we, as sponsors, recognize that unit-based teams give Kaiser Permanente a competitive advantage and a way to drive change, and we provide the support for that work, we’ll largely have succeeded in our role.

Work with your team

When a manager or sponsor comes to me with an issue or area for improvement, one of the first things I ask is: Are you working with your UBT on this? If not, I ask them to try again—because becoming more efficient, cost-effective and member-centered doesn’t happen just in the administrative suite. It happens with the frontline staff and physicians. If sponsors, leaders and managers look to UBTs and their expertise, it will lead to solutions.

Sponsors and leaders also need to ask themselves: Have we figured out what resources the UBTs need to get the work done? Do they need the time, the meeting space, and a facilitator?

UBTs are only as good as the leaders who invest in them. We have more compelling reasons now than ever to leverage the partnership. If team members understand those reasons and are given direction and support by their sponsors, there is no limit to what we can do to help Kaiser Permanente continue to lead in this time of change.