Departments

Emile Pinera, MD, a second-generation Kaiser Permanente employee, came to the company five years ago and immediately became co-lead of an adult medicine unit-based team in the Georgia region.

“I had the clinical part down,” says Pinera, who is now lead physician for diversity and inclusion in Georgia and an adviser on the region’s transgender task force. But being a co-lead and working in a UBT were unfamiliar. “I had to implement my medical knowledge in a team, as opposed to a top-down approach where the doctor tells everyone what to do.” 

He wasn’t convinced at first—but the partnership approach and physician participation helped elevate the team’s performance, and it posted some of the region’s highest quality scores for managing diabetes and blood pressure. 

“We achieved it through hard work and collaboration,” Pinera says. “I loved working with my management and labor co-leads. We were respectfully honest about what was achievable. Working in the UBT gave us the tools to effectively communicate, track, adjust and improve.”

Pinera currently guides and supports co-leads as a UBT sponsor for three teams and is lead physician for three adult medicine offices. His enthusiasm helps his teams, the members and the Georgia region. 

“I was skeptical at first about UBTs’ relevance, but we couldn’t achieve our success with hypertension and diabetes management without each other’s help. I’m a believer,” he says. “My tip for fellow providers is to be engaged as much as possible, because it will help us achieve better outcomes and help our patients thrive.”

Northern California: Staff laptops make life easier 

Even in a fast-paced Emergency Department, change doesn’t always come swiftly.

“I’m old school,” says Jacinta Laupua, a clerk and SEIU-UHW member, who was one of the last holdouts when her team decided to try using laptop computers to gather member signatures. 

“I thought of every excuse in the book. But now I love it,” she continues. “If I don’t have a laptop assigned to me, I ask other clerks if they are using theirs, because I want one. In fact, we need more.”

The laptops, provided through a regional initiative, are at the heart of a successful unit-based team project to reduce paper and copying costs in the Emergency Department at the South Sacramento Medical Center. The total savings came to more than $88,000 in 2016. 

The Level 5 UBT’s project got under way in late 2015, when clerks and the team’s co-leads—Bianca Ruff, a clerk and SEIU-UHW member, and managers Susan Velasquez, administrative services manager, and Neeta Kumar, administrative clerical supervisor—brainstormed ways to improve cost savings and efficiency. Their first goal was to save $27,820 over four months. 

Soon team members were trying out the use of laptops with signature capture pads. The technology makes it possible for clerks to register patients at their bedside and record their information and signature electronically. Not only does this eliminate the need for paper registration forms, it also increases the clerks’ mobility and efficiency.

There were many small tests of change needed before everything was working smoothly, but the project has been so successful the department has invested in nine laptops on wheels. And all Emergency Department clerks are trained on
the computers. 

“It’s almost too painful to remember how we used to process forms,” jokes Ruff.

—Tracy Lee Silveria

Northwest: Pharmacy team ‘owns’ its inventory, saves thousands

When team members at the Community Care Pharmacy in the Northwest region did a routine inventory, they were astounded at the value of their expired medications that no longer could be returned. 

“We took a $70,000 loss,” says Rob Yancey, the pharmacy’s manager. The pharmacy serves patients in extended care facilities and often fills prescriptions for costly and uncommon drugs.

Susan Luu, an inventory technician and member of UFCW Local 555, spearheaded a successful project that drew on the free-to-speak culture and collaborative spirit that helps make this a Level 5 team. 

“I knew it was too much to do by myself,” Luu says. “I felt comfortable talking with my manager, and his response was, ‘Let me see how can I can help.’” 

Different staff members “owned” a section of the pharmacy to check for outdated or slow-moving medications. By the time the team did its next inventory, losses had dropped to $7,000.

—Jennifer Gladwell

Mid-Atlantic States: Tackling unwanted side effect of a computer upgrade

When the South Baltimore County Medical Center laboratory in the Mid-Atlantic States region upgraded its computer system in December 2015, it inadvertently increased lab costs. 

The problem? While the new system has many great features, it doesn't have a way to alert staff when providers add a new test to an existing order. In May 2016, the lab missed 32 percent of these “add-ons,” a total of 30 tests, says Samuel Endalew, the lab’s lead technician, a UFCW Local 27 member and the team’s labor co-lead. 

The mistake inconveniences members, who must return to the lab to provide a new specimen. Each missed add-on costs Kaiser Permanente about $35 in extra supplies and employee time. 

The solution: a system to check the lab’s inbox for add-on tests and a team binder to track their progress. By February 2017, the team was missing only 2 percent of add-ons and saving about $1,050 a month.

Leaders from other area labs are considering adopting the process.

—Otesa Miles

When the Ridgeline Behavioral Health team members in Colorado decided to tackle outside medical costs, even they were surprised at how their small touch on a huge issue could result in such significant savings.

Team members identified two ways they thought they could have an impact—including finding out which of their patients were being seen frequently in the Emergency Department—while helping their patients get appropriate care. 

“We know from evidence-based medicine that if patients are seeking care in the Emergency Department for mental health issues, it’s unlikely to provide a long-term improvement in symptoms,” explains Amy Martin, manager of Ridgeline Behavioral Health. 

Team members began the project by researching which outside hospitals Kaiser Permanente prefers to have members and patients use. Armed with the new information, they created a flier explaining the options and shared it with the rest of the staff, who then shared it with patients. This way, when patients did access care, they were more likely to go to a facility that KP has a contract with and thus, cut costs.

The results were remarkable. The team’s patients’ visits to emergency departments decreased by 8.25 percent, which in turn reduced ED costs by 26 percent. The total impact for 2016: $1 million in soft-dollar savings. 

Management and union representatives in Southern California were at odds when they gathered in March 2015 to settle a UNAC/UHCP grievance over the working conditions of registered nurses in Home Health, Hospice and Palliative Care. 

Because of the dispute’s complexity and scope, involving nurses regionwide, it was moved from the grievance process into issue resolution.

“When they started, it was the Mason-Dixon Line. It was management on one side and labor on the other side,” recalls Marcia Meredith, who works as a neutral facilitator in Southern California. She gets called on when “sticky and contentious” issues come up involving the Labor Management Partnership, which is celebrating its 20th anniversary this year. “It was pretty tense.”

Months later, managers and union representatives were working side by side, forging consensus on key issues. 

Key to their success was the issue resolution (IR) process spelled out as part of the partnership between the Coalition of Kaiser Permanente Unions and Kaiser Permanente. It incorporates interest-based problem solving (IBPS) and consensus decision making (CDM) to provide a framework for settling disagreements collaboratively—providing a modern-day take on Henry J. Kaiser's line, “Problems are only opportunities in work clothes.” 

Bringing order to chaos

They also benefited from the fact that Southern California—after watching people struggle for months and sometimes years without resolving their problems—recently had clarified how the process was to be used and had added a clear path for escalating issues.  

“Issue resolution helps you focus on what the problem is and the possible solutions,” says Meredith.

The nurses and managers eventually agreed to make changes to assignment workflows, improve communication and enhance training opportunities for frontline workers. “They came up with good things that they’re still using,” says Meredith. 

Crafting Southern California's appeals process took months of hard work. Key stakeholders included regional LMP Council members, coalition union leaders and Human Resources administrators.

Before escalation changes took effect on Jan. 1, 2015, the issue resolution process had tended to spin out of control. 

‘It was like the Wild West’

“It was like the Wild West. Everybody did their own thing,” recalls Ilda Luna, an SEIU-UHW service representative for Glendale Medical Offices in Southern California. 

Alex Espinoza, the Coalition of Kaiser Permanente Union’s national coordinator for Southern California, agrees.

“People would email whomever they thought would resolve the issue,” he says, citing examples of individuals who leapfrogged layers of union and management intervention to appeal directly to leaders at the national level.

During national bargaining in 2015, Southern California representatives shared the region’s appeals process, and the subgroup working on the issue recommended a similar process be created in every region.

The approach calls for resolving issues at the lowest possible level. For stubborn disagreements, there is now a standardized process for escalation the aggrieved parties can turn to, with 30-day deadlines for resolution at every step of the way.

In Southern California, for issues that can’t be resolved at the facility level, a nine-member regional SWAT team made up of management and union representatives serves as a court of last resort before the matter heads to national leaders. 

But since the process was adopted two years ago and local LMP Councils and union leaders were educated about how to use it, no issue has been referred to the regional team. 

That’s good news, says Maryanne Malzone Miller, senior director of Human Resources in Southern California and a SWAT team member. 

“I like to believe we’re pushing it to the level where it should be resolved,” Miller says. 

“It’s a success,” agrees Espinoza, also a SWAT team member. “Folks are engaged and are talking to each other.”