Departments

Fremont’s Operating Room team loved taking the first parts of Northern California’s business literacy training—so much so, it immediately requested the last two sessions, when teams pull out their budgets to review line-item expenses for the department. The review of payroll and non-payroll budgets has caused controversy and concern in some quarters, but the Fremont OR team not only took it in stride, it rode the momentum of the training by developing several performance improvement projects to reduce waste. One of those, streamlining its ready-made surgical supply packs, is projected to save roughly $34,000 a year. The Northern California training began rolling out in 2011. The first three sessions are a tutorial on the basics of Kaiser Permanente business, explaining such things as our integrated business model (how the various KP entities do business together), key sources of revenue, and business concepts like margin goals. The rubber meets the road in the final two sessions, with their look at the department’s financial realities. Team co-leads Yolanda Gho, Operating Room nurse manager, and Gus Garcia, a surgical technologist and SEIU UHW steward, talked with communications consultant Cassandra Braun about the training, its benefits and how it inspired their team to do better.

Q & A

Q. Were you concerned about sharing the department’s payroll and non-payroll budget with staff?

Gho: Not really. I thought, “Why don’t we highlight the areas where we have opportunities to improve, like sutures—ones we can improve on and have control over.” With payroll, my one concern was showing someone’s salary. But it was explained that they didn’t show individuals’ salaries. So I was totally on board.

Q. What was the staff’s reaction to the training?

Gho: The response was quite eye-opening. There was an audible gasp. When they saw [the red lines], they were like, “Oooh, I thought we were doing great. Why do we have all that red on the screen?” What’s great about this group is their minds immediately started running, thinking about what they could do.

Garcia: To me, it’s like: We can fix that, or come up with ideas (for fixing it). That is what melds it all together.

Q. Talk about your project to streamline surgical packs and how it was influenced by the business literacy training.

Garcia: Surgical packs have draping and supplies for each particular procedure. They’re ready-made. So you always had to add things or throw away things that you didn’t want, depending on the procedure. I was trying to see what we need or don’t need. I worked with the supplier and our teams, like general surgery, and I asked their opinion—“What do you need in this thing and what do you not need?” We streamlined the packs to have the bare minimum. So everyone uses everything in the pack.

Gho: After the training, Garcia wanted to revisit this issue, because he had brought this up before.

Garcia: The wheels were turning in my head. If we’re not using it, we’re wasting money.

Q. You also started work on reducing waste of sutures and other supplies?

Gho: Yeah, it was a culture change. In the past, as a nurse or tech, you were trained to always be ready. You were trained that the surgeons shouldn’t have to ask for something. Some people think that if they’re able to do that, they’re seen as efficient and anticipating the needs. But the world is different, the economy is different. Now we have to ask ourselves, “Do we need to have this open to look good or just in case a surgeon asks for it? Or is it OK not to open it, but to have it in the room and ready?” Before, we were all trained that way—anticipate, anticipate, anticipate. We now give ourselves a centering moment before we open sutures or supplies that are not needed immediately for a case.

Q. What advice would you give to other teams thinking about taking business literacy training?

Gho: My advice is to help educate your staff members by being transparent about information that affects them and the team. As a manager, I want to create awareness and understanding of the issues with my staff. It bridges the information and knowledge gap. The more we’re armed with information, the better decisions we make.

Garcia: If it was up to me, I’d have everyone take the class. I think it just gives you a different perspective. It breaks it down and gives you an overall view that staff members don’t get to see all the time. It keeps them informed.

Gho: People tend to complain about things but do nothing about it. In our UBT, you bring solutions. We’re doers. It’s our chance to do something.

Cutting waste and saving money for Kaiser Permanente members and patients is good. But 350 Environmental Service workers in Southern California are taking that mission a step further by tending to Mother Earth as well.

Kaiser Permanente and two Labor Management Partnership-funded workforce development trusts are among the health care partners nationwide that are training frontline workers and managers in improved recycling, waste disposal, energy conservation and other green practices. The U.S. Department of Labor and the Healthcare Career Advancement Program, a national partnership of unions and hospitals, are leading the effort.

“‘Carbon footprint’ is a phrase that’s thrown around a lot,” says Milford “Leroy” Alaman, EVS operations manager at the Los Angeles Medical Center. “Now our staff is able to understand that when you are talking about conserving energy, water and electricity, you are talking about looking at the resources we have in our facility and holding on to just what we need instead of creating more waste for us and the planet.”

Leading change at work

Along the way, these “green teams” also are reducing operating costs, enhancing employee skills and morale, and improving patient and workplace safety. 

For example, the EVS department is now using environmentally friendly microfiber mops to clean a single patient room. This has the benefit of not spreading infections between rooms and preventing lifting and straining injuries caused by wringing traditional mops and hauling buckets of water.

The department also has started a project that is reducing the cost and trouble of replacing the 500 D-cell batteries used in the hospital restrooms’ automatic towel dispensers. The traditional batteries wore out in a matter of weeks—costing about $3,000 a year to replace and adding some 6,000 batteries a year to local waste or reprocessing streams. Starting in February 2012, workers installed new rechargeable batteries. Overall, EVS' green projects, including the use of rechargeable batteries, are saving an estimated $12,000 a year.

Enhancing skills, raising sights

“I feel better having conversations with anyone…doctors, nurses, I can tell them how to be green,” says EVS attendant Jose Velasco, an SEIU UHW member and a recent graduate of a green certification course offered at West Los Angeles Community College.

The program also was piloted at KP Riverside Medical Center, where the EVS unit-based team is reaching out to others with its newfound expertise. Now an EVS member is embedded with the Operating Room UBT—with others to follow—to help tackle waste and hygiene problems there.

The SEIU UHW-West & Joint Employer Education Fund and the Ben Hudnall Memorial Trust have helped underwrite the cost of the training for Kaiser Permanente’s LMP-represented workers. Eventually, frontline workers may be able to use their certifications for higher pay and promotions as medical center “green leads,” a program that would be negotiated between KP and the unions.

But the training already is making a difference to workers as well as to KP and the community. “They have more tools, more knowledge, so they are able to catch things,” says Angel Pacheco, management co-lead of the EVS UBT at Riverside. “We talked about saving the environment for future generations.”

In 2011, the Medical Records unit-based team in the Northwest received 1,222,361 pages of outside records that required indexing into patients’ electronic medical records—a staggering 725,000 more pages than it received in 2010.

Yet team members met and mastered the challenges facing them, whittling down an enormous backlog and reducing the turnaround time for processing from 62 days in December 2010 to three days by December 2011—benefiting both their internal customers and KP’s members and patients. And they’re sustaining that success.

The steady increase had been debilitating. Overtime hours went through the roof, with more than 2,450 hours logged in 2010. The 37 team members work 24 hours a day, seven days a week and have seven different work classifications. Staff members were worn out. Piles of paperwork were stacked high, waiting for processing. Morale was at an all-time low.

The case illustrates vividly that service is not just a bedside issue at Kaiser Permanente. For a variety of reasons, many KP members see outside providers—and when those providers submit paper or electronic records with the patient’s medical information to Kaiser Permanente, the records have to get indexed into KP HealthConnect. If there’s a delay, the patient’s regular physician may be missing important information the next time the member is seen at KP.

“When the clinician needs medical information on their patients in order to treat their current medical condition, we’re able to provide updated and accurate records,” says the team’s union co-lead, Kathleen Boland, a data quality clerk and SEIU Local 49 member. And, she notes, members aren’t having to repeat critical tests and procedures, saving them time and money.

Things started to change when, through unit-based team training, team members learned such skills as process mapping and how to understand data. They created SMART goals (specific, measurable, attainable, realistic/relevant, time-bound), started huddling and developed a greater understanding of roles and responsibilities.

The team receives more than 700 different types of documents, so variation was rampant. Team members developed cheat sheets to standardize how documents should be prepped for indexing and to get everyone to use the same process for each task. They also cross-trained and helped each other out when someone was on vacation or ill.

“In the beginning,” says Bruce Corkum, RN, a UBT resource team specialist, “they didn’t share the work. Then they started understanding how they could help each other work toward the same goal.”

Not only did the backlog disappear, but the need for overtime is nonexistent now, they’ve improved attendance and “morale has improved,” says Burgandy Muzzy, a health records clerk and member of SEIU Local 49. People are happy to be at work.

“People are talking about us in a positive way now,” says manager Debbie Lang, “instead of as ‘those people who lose everything.’ ”