Departments

Many Small UBTs Do What One Large One Can’t

Submitted by Andrea Buffa on Wed, 11/17/2010 - 15:20
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sty_NCAL_charitablehealth
Long Teaser

When Charitable Health Coverage switched from having one large UBT to having several smaller ones, it struck upon a formula for success. For the first time, the department processed every application in time for insurance coverage to begin on the first of the following month.

Communicator (reporters)
Non-LMP
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Tyra Ferlatte
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I will find a photo from the photo library.
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Many small UBTs do what one large one can’t
Deck
The Charitable Health Coverage Operations department reorganizes—and achieves a goal that had eluded it for years
Story body part 1

The employees in Charitable Health Coverage Operations (CHCO) felt good about their Northern California department’s mission—but not so good about how long it took sometimes to help the thousands of low-income children who benefit from KP-subsidized health care.

The department handles the eligibility paperwork for a KP program that provides health coverage to people who don’t qualify for employer-based health coverage or public programs like Medicaid. At the team’s low point in 2005, it had a six-month applications backlog.

“Our primary customers are children,” said Nancy Waring, CHCO customer care manager. “We have over 80,000 children, most of them low income. About 50 percent of our population is Spanish speaking. And the program is completely subsidized by Kaiser.”

Too large a group

In the past, one representative unit-based team encompassed the whole department.  Because employees within the same department were doing very different types of work—processing mail, entering data, processing enrollments, providing customer service, and servicing the regions outside of California—they didn’t share a single set of problems. So the UBT tended to work on departmentwide problems like attendance.

But the single UBT struggled.

 “We basically failed from 2006 to 2009 to do anything,” says Suber Corley, the department’s director, “simply because we were looking at too large a group trying to solve too large a problem.”

So they reorganized. The department now has five UBTs that correspond with employees’ functions.

Setting priorities

The smaller teams set their sites on a number of changes, but they also coordinated with each other on one common goal: to process every application by the 20th of the month.

In their UBT, the mail-room employees decided to look at priorities differently.

“We identified that what we really needed to do was to have a prioritization scheme for every week of the month,” says Victor Romero, CHCO operations manager. He explains that during the first week of January, a recertification application that’s due on April 1 would be low priority in the mail room, whereas a new application—which would need to be processed by January 20 for insurance coverage to begin on February 1—would be high priority. After the 20th, attention moves to the low-priority documents.

The data entry, scanning and enrollment UBTs came up with other solutions, too.

“We instituted several changes in how the application is handled,” says Carl Artis, an enrollment processor team lead and OPEIU Local 29 shop steward. “If we couldn’t process an application, the application was sent back to the customers very early so they could make necessary corrections. We also streamlined our process—there were some things we were doing twice, which wasn’t necessary.”

Artis emphasizes that the changes were developed jointly by frontline workers and managers.

“I have to admit they (the managers) have some really great ideas,” he says, “and they were really able to listen to some great ideas.”

It worked. In October, for the first time in the department’s history, the team was able to process all its new applications by the 20th, so coverage for those applicants could start in November.

“The end result is that poor children did not go without health coverage,” Romero says.

Addressing burnout

In addition to the project to reduce the amount of time it takes to process new applications, the smaller teams have taken on other projects, like reducing burnout among customer service agents who spend all day answering phone calls. They’ve also done charity work together, raising funds to provide school supplies for low-income students at a local high school.

Artis passes on the story of his department’s flourishing UBTs to other members of Local 29.

“I’ve heard some people say, ‘Oh, that’s too much work to take on,’ or, ‘We don’t have the resources we need to address the issue’ or ‘Management would never go for that,’ ” Artis says. “But what I’ve learned is—just try it, and don’t be afraid to fail.”

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Poster: Going Green With Blue Wrap Recycling Kellie Applen Tue, 11/02/2010 - 11:21
poster
PDF
Southern California
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Content Section

Format:
PDF (color and black and white)

Size:
8.5” x 11”

Intended audience:
Frontline workers and managers

Best used:
Use this to encourage your surgery team colleagues to help make Kaiser Permanente more affordable and at the same time, preserve the environment. Post it on bulletin boards, in break rooms and other staff areas. 

 

bb_irvine_goingreen

This poster features a surgery team that is helping to make KP more affordable and at the same time, preserving the environment.

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Game Changer: Putting the Patient First

Submitted by tyra.l.ferlatte on Mon, 10/18/2010 - 16:21
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sty_gamechanger_hankcoverstory_fall2010
Long Teaser

A team in South San Francisco that improved the surgery-scheduling process for patients and teams in San Diego that took a hard look at their service scores demonstrate what things look like when teams truly consider what's best for the patient as they make decisions.

Communicator (reporters)
Non-LMP
Notes (as needed)
note: there are links in "highlighted stories and tools" section.

caption for second photo (hank25_coverstory3):
Streamlining the process: The new pre-surgery checklist developed by a South San Francisco UBT has helped patients and improved communication for everyone involved. Dr. Brian Tzeng (center) helped lead the work.

caption for third photo (hank25_coverstory6):
Improving service: Terry Caballero, a surgery scheduler and SEIU UHW member, helped spark the work that led to a streamlined surgery-scheduling process.
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Making things easier: Members of a San Diego Medical Center turn team help KP patient Deborah Allen shift in her bed.
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Benefits to teamwork

In South San Francisco, Dr. Brian Tzeng, who’s an anesthesiologist, and others on the team say that working on the project through the unit-based team allowed them to understand each others’ roles and responsibilities better—and also gave them an opportunity to hear and contribute an opinion from that perspective.

“One of the great benefits of this group was it was an outlet for multiple providers at different levels to voice their concerns and actually be heard,” Dr. Tzeng explains. “The greatest frustration for many individuals is we all had great ideas but didn’t know how to make that happen. We realized through this group we had a means to make those changes.”

Dr. Tzeng is certain the team’s accomplishments are the result of every team member’s commitment to working out the best solution in the patient’s best interest. There were no politics, just concern for the member.

“To us, this is not a job,” says Debbie Taylor. “We come here to serve a patient.”

And what about Caballero’s initial concern, that patients weren’t getting enough advance notice about when they have to be at the hospital? The team has been slowly chipping away on that as well. In October, they expect to start giving patients two days’ advance notice of their arrival time at the hospital.

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Game changer: Putting the patient first
Deck
Teams in South San Francisco and San Diego work to keep patients front and center
Story body part 1

What happens when teams truly walk a mile in their patients’ shoes? They often discover their own actions are making that mile a rocky one for patients—and as a result make huge breakthroughs in the way they deliver care.

In the case of South San Francisco’s multidepartmental pre-admission team, observing their processes from the other side of the gurney spurred them to dramatically streamline the pre-surgery and admitting process for patients. With the member at the forefront of their thinking, the team members turned a two-inch-thick packet of confusing, redundant information into a streamlined, one-page checklist. And a funny thing happened—while redesigning the process to help patients, the team improved the way it works.

“Patients would often get confused and weren’t sure what the next step in the process was,” says Brian Tzeng, MD, the Peri-operative Medicine director. “We realized we didn’t have a clear path for the patient to follow.”

Other teams throughout Kaiser Permanente are making similar realizations, framing their performance improvement work by asking the question, “What’s best for the patient?” If a possible solution doesn’t work well for the member and patient, then there’s more brainstorming to be done. These teams are taking the Value Compass to heart—organizing their work not just around the four points but examining what they’re doing from the patient’s perspective.

What does that mean for frontline teams? At the San Diego Medical Center, the Emergency Department sees up to 300 patients every 24 hours. Physicians and staff members are always on the go, delivering on the ultimate bottom line—saved lives. What could be more important? Clinical quality is high; patients are seen in a timely manner and the rate of unscheduled return visits is good.

Yet the results of a recent patient satisfaction survey bothered the team. The department scored well overall, but their patients gave it only 63 percent approval on one question: While you were in the Emergency Department, were you kept informed about how long the treatment would take?

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Poster: "Care Cards" Give Patients a Voice

Submitted by Kellie Applen on Mon, 09/27/2010 - 12:28
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Content Section
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bb_care_cards

This poster reveals how 'Care cards' helped a Med-Surg team in Irvine improve patient satisfaction scores.

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Poster: 'Care Cards' Give Patients a Voice

Format:
PDF (color and black and white)

Size:
8.5” x 11”

Intended audience:
Union coalition-represented employees and frontline managers

Best used:
Posted on bulletin boards or in break rooms and other staff areas to inspire your team to discuss ways to boost patient satisfaction.
 

 

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Preparing You for Surgery

Submitted by cassandra.braun on Wed, 09/22/2010 - 18:16
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tips_presurgerychecklist

A South San Francisco pre-admissions team developed this one-page, easy-to-use checklist to help prepare their patients for surgery.

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Team develops surgery prep checklist.

Format:
PDF and Word DOC

Size:
1 page, 8½” x 11”

Intended Audience:
Teams working on improving the pre-surgery process for patients.

Best used:
Use this document as a model to consider how your facility might revamp the presurgery process and create your own one-page checklist for patients. 
This checklist was developed by a multidepartmental team in South San Francisco that wanted to streamline the presurgery process for patients. As a result of using it, 80 percent of patients are now being confirmed as pre-admitted 24 hours before surgery and the completeness and accuracy of admissions rate has hit 99.4 percent.

Read more about the process in the Fall 2010 Hank.

 

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Sand Canyon Goes Green With Blue Wrap Recycling Shawn Masten Mon, 09/13/2010 - 12:18
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Southern California
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Irvine goes geen with blue wrap reycling project
Deck
Project saves money and helps the environment--and assists local disabled adults, too
Request Number
sty_sandcanyon_blue wrap recycling
Long Teaser

New blue wrap recycling project at Sand Canyon Surgicenter saves money and the environment and helps the disabled.

Story body part 1

Looking for ways to make the Sand Canyon Surgicenter in Irvine more efficient, Albert Olmeda wound up learning a lot about blue wrap—like the fact that it makes up nearly 20 percent of the waste generated by hospital surgical services. 

The lead Central Services technician and SEIU UHW member also learned that this heavily used hospital product, an industrial strength plastic used to maintain the sterility of medical and surgical instruments until opened, is not biodegradable and persists in the environment. 

But recycled blue wrap can be sold as raw material for use in the production of other plastic products. Today, the surgicenter’s unit-based team has gone green with a blue wrap recycling project that is not only saving money and protecting the environment, but also aiding the community. 

“The biggest problem with the blue wrap is when we throw it in the landfill, it’s there forever,” says Olmeda. “That’s a big concern especially considering how much blue wrap we use.” 

How recycling works

About 600 pounds of blue wrap is collected every week from the center’s six operating rooms. It is picked up free of charge and sorted by Goodwill of Orange County, which sells it to a Houston recycling services company. The company reprocesses the plastic into beads that are used in various products, including railroad ties, pallets and artificial siding for decks, docks and houses. 

The surgicenter has been recycling its blue wrap and plastic bottles since September 2009, reducing the facility’s solid waste disposal fee by 10 percent annually. The savings amount to a modest $5,880—but there’s a greater payoff. Proceeds from the sale of blue wrap and other recyclable products enable Goodwill to provide education and training programs for developmentally and physically disabled adults, including a state-of-the-art fitness center. 

Peter Bares, business development manager for Goodwill of Orange County, says the relationship with Kaiser Permanente has gone beyond expectations. “It is kind of the perfect storm because of the nature of what we do and why we do it and the materials that the hospital generates,” he says. 

Getting buy-in

As the frontline staff person responsible for the surgery center’s blue wrap disposal, Olmeda—and his fellow UBT members—championed the recycling cause, educating the staff at weekly in-services and UBT huddles.  The team got the rest of the department on board by integrating the blue wrap recycling process without creating additional tasks. 

“We figured if we changed workflows, staff wouldn’t want to do it.” says UBT co-lead Nicole Etchegoyen, a surgery scheduler and SEIU UHW steward. “But if we asked them, ‘How would this work best for you?’ then everyone would get involved, and they did.” 

The team members designated a single container for blue wrap in each operating room. They also placed a larger bin for collecting multiple bags of discarded blue wrap near the soiled utility room, where the trash is taken on its way out of the surgery center. 

“It’s not a big deal,” EVS worker and SEIU UHW member George Sollars said, hoisting bags. “We just carry it over here on our way out this door. It’s one of the easiest jobs. And it’s for a really good cause.” 

No trash, just recycling 

The hardest part was making make sure that other trash didn’t make it into the blue wrap recycling containers accidentally. Labeling the containers with signs reading ‘Recycling Blue Wrap Only’ helped, as did regular reminders by UBT members. 

Now, everyone in the operating rooms—from doctors, nurses and surgical techs to nursing assistants and EVS workers—makes sure that the blue wrap containers aren’t contaminated with other trash, Etchegoyen says. 

Olmeda does periodic spot checks. “Everybody who plays a role in the operating room has to look out to make sure no trash is going inside the containers,” he says. “It’s a team-building thing.” 

“If it wasn’t for the UBT, this wouldn’t be happening,” said Ramin Zolfagar, MD, department head and UBT member. “We are helping the environment by ‘going blue,’ so to speak, and the end result is gym equipment for the disabled—which makes it all the more worthwhile.” 

After learning about the project at a recent Orange County UBT fair, other departments are thinking about emulating it. 

Visit the Goodwill of Orange County website to find out more about their work.

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Non-LMP
Notes (as needed)
link to related slideshow and psda when available. (Highlighted resources box)
For more information about this team's work contact Nicole.M.Etchegoyen@kp.org
Paul go ahead and publish when finished.
Blue wrap recycling in the operating room at the Sand Canyon Surgicenter
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Keep It Clean

Submitted by Laureen Lazarovici on Fri, 06/04/2010 - 08:59
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sty_EVS_WPS
Long Teaser

EVS workers and managers are tasked with keeping KP's facilities clean and germ free, but these departments are prone to lots of injuries. Find out in this story from the Summer 2010 issue of Hank how some of these departments are doing what it takes improve workplace safety.

Communicator (reporters)
Laureen Lazarovici
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Panorama EVS attendant Rosemary Mercado, an SEIU UHW steward, says the department’s unit-based team helped reduce the number of needlestick injuries.
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Keeping It Clean
Deck
How EVS departments are building a culture of safety with partnership—and cutting injury rates
Story body part 1

The lady who talks to you from inside your GPS has found a new home, it seems, in the robotic carts deployed in the newly rebuilt Los Angeles Medical Center.

Instead of guiding you to your destination, she’s moving linen and trash along the long hallways and underground tunnels. By herself. Her gentle yet firm computerized voice tells workers in a docking room when the cart is ready to be filled, and sensors ensure she doesn’t run anyone over. She even can detect whether there are passengers in the staff elevators and patiently waits for the next empty one.

The robotic carts reduce wear and tear on the muscles and joints of the medical center’s Environmental Services (EVS) attendants. They are just one example of how managers and union members at this Southern California hospital are taking the lead in improving workplace safety for EVS departments.

Historically, EVS is a high-injury department because the job involves a lot of bending, lifting and moving equipment—not to mention working with hazardous chemicals. But the EVS department at Los Angeles Medical Center made such remarkable progress in reducing workplace injuries in 2009, its members earned a special bonus as part of the Performance Sharing Program (PSP). So did the EVS departments in Riverside and in Panorama City, which boasts the lowest injury rate in the region.

“Everyone wants to beat Panorama City,” laughs Manuel Covarrubias, the building services manager there. “It’s a friendly competition.”

But more important than the good-humored rivalry is the confidence these teams inspire in their counterparts. “They know it can be done,” Covarrubias says.

Even Kaiser Permanente’s oft-stated goal of a workplace free of injuries isn’t as far off as might be thought: The EVS department at the Eastside Service area in the Northwest region hasn’t had a single injury for two straight years. Regionwide, the EVS departments improved their collective injury rate by a remarkable 65 percent for the reporting year ending Sept. 30, 2009.

Management and union co-leads on these successful unit-based teams credit specific safety techniques, such as pre-shift stretching, and better equipment, such as microfiber mops and motorized carts. But they also say the communication and team-building skills they use by working in partnership are crucial to building not only systems of safety, but a culture of safety.

What works

Based on the experiences of successful EVS departments in Southern California and the Northwest, here’s what’s working to improve workplace safety.

Conduct safety observations: At Riverside Medical Center in Southern California, the management and labor co-leads of the EVS unit-based team conduct safety observations together. “We walk the units and look for safety hazards,” explains Cora McCarthy, EVS manager.

Evidence from Sunnyside hospital in the Northwest shows the effect this kind of effort can have. After the injury rate jumped up in the first half of 2009, Curtis Daniels, the medical safety coordinator, challenged UBT members to see how many safety conversations they could have to raise awareness of potential hazards. More than 6,000 conversations were reported in one month alone—and during the second half of 2009, the inpatient teams had only two workplace injuries.

By the numbers: The successful teams collect, track and—most importantly—share data, information and tips about workplace safety.

In Southern California, for instance, where there has been a 33 percent reduction of accepted workers’ compensation claims since 2005, the regional Workplace Safety department has built a customized incident investigation database, harnessing data that helps teams spot trends and come up with solutions. The database is only useful because employees are willing to report the injuries they suffer.

“At first, people were afraid,” says Eva Gonzalez, an EVS attendant at Panorama City and an SEIU UHW-West steward. “We assure them there is not going to be a backlash. Incident investigations helped, because people would show us how they got hurt and we let them say what happened. We ask, ‘What do you think we should do differently?’ ”

Ofelia Leon, the day shift supervisor who has worked at Kaiser Permanente for about three years, notes the fear of reporting was not unfounded: “At other (non-KP) hospitals, if you got injured, you got a caution or discipline, so people were afraid to report them.”

Employees also get regular updates about their progress toward their workplace safety goal. “We share information and let our members know where we’re at and where we need to be,” says Edwin Pierre, a 26-year EVS worker at LAMC. A huddle at the beginning of each shift includes a safety tip shared by an employee —creating a climate where workers get accustomed to speaking up and gain confidence that their voices are being heard.

Floor it, safely: To reduce injuries from lifting bulky mop buckets, EVS departments are buying more efficient microfiber mops that don’t require as many trips to empty, are wringerless, and use less water and cleaning solution. To keep those long hallways at LAMC clean while keeping workers safe, the EVS department replaced autoscrubbers with “chariots” that workers ride. “They have improved quality and morale, as well as safety,” says Abraham Villalobos, the hospital’s director of Environmental Services.

Maximize the micro: Microfiber is not just for mops. EVS departments in the Northwest now are using microfiber dusters with extendable handles proven to reduce worker strain. The new dusters also clean 45 percent faster than traditional methods and reduce chemical and water consumption up to 90 percent.

Tamper with hampers: The lids on trash cans and hampers were falling on workers’ arms and causing injuries—so the Panorama City EVS department bought new bins with hydraulic lids. They also put signs above hampers asking staff members not to overload the bins, because too-heavy loads were causing lifting injuries.

In a similar vein, “when needlestick injuries were up, we brought it to the table,” says Rosemary Mercado, an EVS attendant at Panorama City. The unit-based team decided to coach workers to hold the bags away from their bodies when taking them out of the laundry hampers. And they borrowed an idea from colleagues at nearby Woodland Hills Medical Center: They moved the hampers away from the sharps containers.

Take your time, take time off: “Be careful and take your time,” is the advice from Rebeca MacLoughlin, a housekeeper in the Northwest for seven years. Mindful of the link between fagtigue, morale and injuries, building services manager Manuel Covarrubias in Panorama City encourages employees to take time off when they seem to be getting sluggish. “I look for ways to cover people during summer to ensure people with less seniority can get some time off when they really want it,” he says.

Starting with stretching: Without exception, every EVS department that’s been successful at reducing the injury rate starts every shift with stretching. “Sometimes we dance and make it fun,” says Ofelia Leon, the day shift supervisor at Panorama City. The dance music of choice at LAMC is Michael Jackson. “I mean, who can’t dance to Michael Jackson?” wonders Pierre, the Pierre, the LAMC EVS attendant.

The bottom line: Investigating incidents, sharing safety tips, having on-the-spot conversations about working safely: These things are possible in large part because of the communication and team-building foundation fostered by the Labor Management Partnership.

'Our opinons matter'

Before, “It was just coming to work, doing whatever, and then leaving,” says Sandra Pena, the EVS labor co-lead at Riverside and United Steelworkers Local 7600 member.

“Now, it’s like there’s feedback back and forth all the time. It’s more of a team.”

“It makes you feel good as an employee to make improvements,” says Eva Gonzalez of Panorama City. “We know our opinions matter. We know we are not talking to the wall.”

Dilcie Parker, the labor co-lead at the LAMC EVS department, recalls how things were in 1999, when partnership started taking hold at her facility. “When we first began meeting, it was, ‘You sit on that side of the table, I sit on this side.’ I once arrived at a meeting and said, ‘I don’t sit next to management.’ You could feel the hate in the room.”

Management co-lead Villalobos doesn’t disagree. “Before, we couldn’t stand each other,” he says. “There was screaming.”

The turnaround, both say, came as a result of the LMP training the whole team received—from mapping root causes to issue resolution—and persistence.

“We started seeing the benefits in better quality and better attendance,” says Abraham Villalobos. “The reduction in injuries didn’t just happen this year. It’s about understanding the things we need. If we don’t get along, we can’t come up with projects to work on.”

This doesn’t mean everyone is holding hands and singing “Kumbaya.”

“There are still issues we disagree about,” says Parker. “But before, we used to get nothing solved. Now, issues get solved and they are off the table.” Recently, Parker, Villalobos and the team were in a meeting, crammed together in a tiny conference. The woman who once refused to even sit next to a manager found herself saying, “Look, Abraham, we’re actually touching.”

For information about EVS teams in Southern California, contact Dave Greenwood, workplace safety program director, at Dave.B.Greenwood@kp.org; for more information about workplace safety for EVS teams in the Northwest, contact Lori Beth Bliss, regional EVS manager, at Lori.B.Bliss@kp.org.

 

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Tip Sheet: A-HEART Service Recovery

Submitted by Kristi on Mon, 05/31/2010 - 21:33
Tool Type
Format
Running Your Team
Topics
Taxonomy upgrade extras
ED-2078

This tip sheet guides you through the important steps in performing service recovery, using the "A-HEART" mnemonic, when a member/patient expresses a problem or concern.

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Laureen Lazarovici
Tool landing page copy (reporters)
Tip Sheet: A-HEART Service Recovery

Format:
PDF

Size:
8.5" x 11"

Intended Audience:
Frontline managers, UBT sponsors and UBT co-leads

Best Used:
This tip sheet guides you through the important steps in performing service recovery, using the "A-HEART" mnemonic, when a member/patient expresses a problem or concern.

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