Engagement

Summer interns often are put to work fetching coffee or making copies. But last year, UBT consultant Geoffrey Gamble wanted to create a more valuable experience for the teens of KP’s Summer Youth Employment Program at the Modesto Medical Center. So he trained a small army of performance improvement consultants to help support unit-based teams.

Despite initial skepticism from some team members and managers, the results were stunning. By the end of the summer, 12 of the 13 teams supported by the interns advanced at least one level on the Path to Performance. What’s more, four of the 19 projects carried out by the UBTs yielded savings or cost avoidance totaling $400,000. The program was such a success, it has returned to Modesto this summer and has spread to the Sacramento and San Jose medical centers. And in the process, the interns are gaining on-the-job training that translates to their studies and to the work world.

“I went in thinking we were going to do grunt work, but in reality it was like, ‘Wow, I’m actually doing something I can apply,’” says Nate Aguirre, who interned in Modesto’s Emergency Department last year. “It was a life-changing experience.”

The Community Benefit program has offered training and work experience to teenagers in underserved communities since 1968. In the past, that experience included clerical work or coaching on speaking in front of a large group. When Modesto’s internship coordinator retired in 2013, Gamble agreed to oversee the program as long as it supported his work developing UBTs.

Overcoming doubt with results

“When I first proposed the idea, directors were very skeptical,” Gamble recalls. “People would say, We’re struggling to do this with professionals—how do you expect to get momentum from a 16-year-old?’”

But Gamble saw the opportunity to offer teams a fresh perspective and the daily support many need to get started. He also wanted to show team members that performance improvement didn’t have to be complicated and could be incorporated in their daily work.

“I told managers that I was going to treat (interns) like adults and give them the skills I would give employees,” Gamble says. “If you hold them to that expectation, they will rise to the occasion.”

In the first few days of the eight-week program, Gamble trained the 16-year-old interns in basic performance improvement tools, including the Rapid Improvement Model, process mapping and Labor Management Partnership basics. By the second week, the youth were assigned to Level 1, 2 and 3 unit-based teams and started helping the teams launch projects and enter data into UBT Tracker.  

Rosemary Sanchez, Modesto’s Emergency Department supervisor, was one of the loudest doubters.

“At first I was like, ‘Ugh, one more thing to do.’ But then I thought, ‘OK, this could work and help us accomplish our goals and share our knowledge.’” 

Intern Nate Aguirre was crucial in helping the team on its project to streamline and standardize supplies in the treatment rooms.

“Nate was awesome,” Sanchez says. “He was so enthusiastic collecting data.”  

Getting the ball rolling

Aguirre also spent time talking to employees in the department to learn about their jobs and the challenges they face in their work.

Meghan Baker, an Emergency Department clerk and union co-lead for the UBT, says that sparked interest and support from UBT members—a shift from before, when they had struggled to get employees involved.

“People were into having their voice heard by someone,” says Baker, who's a member of SEIU-UHW. “Now people are talking and getting the ball rolling on things. And we’re making it known that people are being heard.”

At the start of the program, the Emergency Department UBT was ranked at Level 3. The team advanced to Level 4 after completing the work.

Michelle Smith, manager of Specialty Surgery Reception, appreciated the new perspective and support her team received from its intern for its project to reduce surgery no-shows and last-minute cancellations.

“It was nice to have someone get our project going,” she says, “because we were at a standstill.”

The team’s intern walked the UBT members through mapping out their process. New workflows emerged that included calling patients ahead of scheduled surgeries, which reduced no-shows and increased service scores.

When the teams were asked what they thought helped them advance, many said it was because of the interns coming to the departments every day to help push and support the work. 

“We would have eventually worked on the project, but having her come in and start us off in a positive way was great,” Smith says. “She taught us how to be a team, because we realized we all had to be part of the work.”

Sometimes the best way to spread effective practices is to spread experienced people. That’s what happened when the Alpharetta Ob-Gyn UBT in Georgia zoomed from Level 1 to Level 4 in just 10 months after two nurses from two different high-performing UBTs transferred there at the same time.

Jane Baxter and Ingrid Baillie had been UBT co-leads at two different clinics when they each got a new job with the Alpharetta Ob-Gyn department. They both drew on their experiences to guide their new team when they became co-leads at Alpharetta. “We knew the steps in the process and what to expect,” says Baxter, the department’s charge nurse.

Fledgling teams should begin with small performance improvement projects, they say. “We started with the low-hanging fruit,” says Baillie, RN, a member of UFCW Local 1996. “You don’t need to reach for the stars right out of the box.”

Pick your projects wisely

And, says Baillie, there’s no need to look any further than Kaiser Permanente’s organization-wide and regional priorities to find plenty of ideas for performance improvement projects—and a wealth of data that is being collected regularly.

“KP makes no secret about what is important to it,” says Baillie. “From that alone, you have all the data you need.”

For instance, the Alpharetta team’s first efforts were to improve clinic start time and get a second blood pressure test for patients with high initial readings. “These are important to KP, and they helped us gel as a team,” says Baillie.

“Small wins help develop confidence,” says Baxter. Now the team is taking on more complex cross-departmental initiatives, such as trying to make available online the big packet of paperwork patients need to complete before a first Ob-Gyn visit.

Getting physicians involved also has been part of this UBT’s success. You won’t find doctors who think UBTs are just for clinic staff on this team, says Baxter.

“Our providers are very invested,” she says. “They take minutes at meetings. We are all on an equal playing field.”

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.