Innovation

Forty percent of U.S. marriages end in divorce after an average of eight years. Most business partnerships fail to meet expectations. And most campaigns end when they achieve their goals or the world moves on.

But the Labor Management Partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions has beaten the odds: October 2017 marks the 20th anniversary of the partnership’s founding, making it by far the largest, longest-running and most sweeping such partnership in the country.

We’ve accomplished a lot together. And in a world of change, sustaining a healthy long-term relationship is an achievement in itself. A key to our success has been the willingess to honestly reflect on our successes, failures, and opportunities to improve. 

By working in partnership, says Kaiser Permanente Chairman and CEO Bernard Tyson, “We have tapped into the potential of smart people all over the organization coming here every single day trying to figure out, ‘How do I improve quality, how do I improve service, how do I improve affordability?’ That’s an incredible competitive advantage for the organization.”

Marking a milestone

This fall Kaiser Permanente and the union coalition will be celebrating those achievements with special events and employee outreach. It won’t be all cake and balloons, however. LMP regional councils, unit-based team sponsors and co-leads, and others will host reflection sessions where workers, managers and physicians can share their experiences, pain points and suggestions for the future of partnership. Participants will consider three questions:

• What is different since we created partnership? (Or, what do you see as the top accomplishments of partnership?)
• What are the greatest challenges it faces today?
• How might we address those challenges, to strengthen partnership now and in the future?

Getting results

Partnership is not easy, and the parties don’t always agree on things. So what’s kept it going?

“It’s nice if we can all get along,” says Tyson. “But most important, we’re here to get results.” Here are some of the results achieved in partnership:

• Performance improvement: More than 50,000 team-led improvement projects since 2007, with measurable gains in quality, service, the work environment—and cost savings exceeding $48 million in 2016.
• Best place to work: Industry-leading wages and benefits, a voice in decision making, and an Employment and Income Security Agreement providing retraining and redeployment for displaced workers.
• Joint marketing: Strategic engagement brought strong gains in KP membership, union coalition membership, and more than $108 million in revenue for Kaiser Permanente in 2016.
• Job training and career advancement: More than 300,000 professional, academic and skill-enhancement courses taken by 104,000 coalition-represented employees since 2007.
• Systems collaboration: Joint implemention of multiple complex programs and systems, including KP HealthConnect, Claims Connect, ICD-10 and call center reorganization.

Lessons for success

All of the above have garnered attention from business, union and academic leaders over the years.

“The Labor Management Partnership is a shining example of how you bring labor and management together to produce results,” said Liz Shuler, secretary-treasurer of the AFL-CIO. “What I love about this model is the notion that, no matter where you work in the system, you have a place at the table and your voice is heard.”

Working in partnership also holds lessons that apply outside of work—including lessons that might have saved some of those failed marriages.

“If you are going to be a good partner and have a successful relationship, with a partner, kids, friends,” says a facilitator from 2015 national bargaining, “you have to have your partner’s needs in mind as well as your own.”

To learn more about LMP anniversary activities, visit the 20th Anniversary How-to Guide.

Colorado

Unit-based teams are hitting their stride, with 190 out of 261 teams reaching a Level 4 or 5 on the five-point Path to Performance. Teams are engaged in several types of projects, including those that save the organization money. The region will see a financial savings of $1.85 million this year through the 175 affordability projects of UBTs. The five UBT consultants in the region are coaching teams impacted by regional restructuring and helping those teams rebound quickly. Teams also are focusing on workplace safety, patient safety and HEDIS measures (Healthcare Effectiveness Data and Information Set).

Georgia

Starting in May and running through December 2015, Georgia medical centers are conducting an experiment. This region-wide test involves using greeters to usher in members. During the trial period, 15 greeters will make the member feel welcomed and convey the message they are important to Kaiser Permanente. Greeters also will answer questions, escort members to their appointments, maintain waiting rooms, ensure wheelchairs are available and welcome members with a smile. “They will provide a concierge-type member experience,” says Elizabeth Ramsey, the Georgia region’s senior manager of loyalty and retention.

Hawaii

The Hawaii region recently re-set its 57 unit-based teams’ scores on the Path to Performance to Level 1. Three consultants—two also are registered nurses and one is a project manager—will help teams quickly advance as they meet such core requirements as sponsor training. The region is unique in that, for now, one union (Hawaii Nurses Association/OPEIU Local 50) is in the Coalition of Kaiser Permanente Unions, while other unions are not. Although that can be challenging, consultants say teams still focus on the patient and want to do improvement work. “We help each other work through obstacles with our teams and understand the data,” says Lisa Kane, UBT consultant and project manager.

Mid-Atlantic States

In February, when home health orders came in to Health Information Management Services Northern Virginia, the average turnaround time was 4.4 days. By creating red folders for the orders, adding a cover sheet that says “stat” and date stamping the order as soon as it arrives, the team cut turnaround time to three days by April 2015—even as the number of orders went up from 673 in February to 747 in April. “This was important to the workflow, because when home health agencies called to follow up on the orders it interrupted our work,” says LaShawnda Powell, a senior health information management assistant in Woodbridge, Virginia, and member of OPEIU Local 2. “We have determined that our new process is successful and we’ve adopted it.” 

Northern California

Last year, unit-based team consultants and union partnership representatives formed a regional UBT to work on issues related to consistency and accountability for Northern California’s 1,300 frontline teams. Now the group has established three subgroups to review the 2015 National Agreement, which includes new provisions for UBTs. Each subgroup has a distinct focus area: sponsorship, UBT validation and assessment, and tools to support contract expectations. The subgroups will develop recommendations for review by a committee of labor members and management representatives. The regional co-leads will submit final recommendations to the regional LMP Leadership Council by year’s end.

Northwest

UBT Resource Team members have been busy refining the region’s new process for assessing teams on the Path to Performance. Co-leads and sponsors of 415 unit-based teams in the Northwest work with their consultant to ensure each team advances or sustains high performance throughout the year. Improvement Advisors help co-leads create action plans and provide direct training to move teams along or refer them to the appropriate subject matter experts. A majority of teams at Levels 2 and 3 will advance to high performance within the next 90 days due in large part to the work of the UBT Resource Team.

Southern California

Playing games at work usually is considered taboo. But that’s exactly how a group of regional UBT staff members spent a recent afternoon when they learned to play the “Leading Innovation Game.” Created by Kaiser Permanente’s Innovation and Advanced Technology team, the board game is designed to help employees overcome challenges that can doom the best ideas. Starting this fall, regional UBT staff will train team co-leads and sponsors, who will share the game with unit-based teams at their facilities. “Most teams come up with great ideas but they aren’t always aware of potential pitfalls,” says Rosalyn Evans, UBT practice leader for Southern California. “This board game gives them hands-on experience to develop innovation in a risk-free environment.”

Want to supercharge efforts to improve performance and help reach Kaiser Permanente’s strategic goals? Then bring unit-based team leaders together for a summit.

UBT consultants at several facilities in Southern California have organized summits that focused on Performance Sharing Program (PSP) goals, performance improvement strategies and affordability projects. All say they are seeing results in the forms of more robust UBT projects, clearer SMART goals, and stronger alignment between top medical center leadership and the work of UBTs.

After seeing teams improve service scores, reduce workplace injuries and save more than $160,000 in just four months in the San Diego service area, Sue Smith, a senior UBT consultant, concludes, “The overall experience was wonderful. Many teams had an exciting opportunity to network with other teams and learn new skills in a fun way.”

This spring, San Diego Medical Center hosted a UBT affordability summit, which brought together co-leads for a half-day to build the skills to tackle a new PSP goal for 2014 in the region: to increase the percentage of UBTs that successfully complete a project with hard dollar savings or improved revenue capture. (The projects are reviewed by finance departments to ensure they could lead to cost savings.)

Seated around large tables, UBT co-leads played a spirited game of “KP-opoly,” which offered a crash course in the organization’s finances. They heard from a UBT whose work resulted in cost savings. And they had time to work on driver diagrams and process maps for their own team’s affordability projects.

Co-leads gain PI skills

The year before, San Diego leaders—inspired by an event at the Riverside Medical Center—had held a more general, daylong UBT summit. That event brought UBT co-leads together for intensive training on performance improvement tools and created a space for them to refine their existing projects. Deadlines were set for finalizing driver diagrams and process maps, beginning tests of change and formulating sustainability plans.

The effort culminated in a UBT fair that showcased the projects that had begun as mere inklings at the summit: The ultrasound UBT demonstrated how it had gone injury-free for six months (it had been having at least one injury per month); the diagnostic imaging department boosted patient satisfaction scores from 87 percent in May 2013 to 93 percent in December.  

Leaders at the Woodland Hills Medical Center followed the same playbook, hosting an LMP summit in April that launched an array of of affordability projects to be showcased at a UBT fair scheduled for mid-July.

Mobilizing on PSP

At Fontana and Ontario medical centers, UBT staff used the summit model to mobilize the workforce around all of the region’s PSP goals. Top leaders from both management and the unions kicked off the day, then gave subject matter experts each 10 minutes to discuss the goal (whether it be service, workplace safety, attendance, etc.) and challenge co-leads to take on a performance improvement project to tackle it. A highlight was an impassioned and dramatic account from Roy Wiles, president of Steelworkers Local 7600, about a union member who did such a good job of saving up unused sick time that he recently retired with a five-figure nest egg in his Health Reimbursement Account.

The key to attracting co-leads to the summits, the consultants say, is to plan well in advance and to enlist top leadership to encourage participation. That lets managers and employees make plans for attending while ensuring their departments’ operational needs are met.

“This is part of their work,” says Priscilla Kania, senior UBT consultant at Ontario. “Your leaders are inviting you. People are excited to be in the room with top leaders.”

The Imagining Care Anywhere exhibit, created by Kaiser Permanente’s Innovation and Advanced Technology team and the Garfield Innovation Center, illustrates how current and emerging technology makes it possible to bring health care directly to a patient’s home—or wherever a member may be—and can transform the way care is delivered at the doctor’s office and in the hospital. Dan Weberg is director of nursing innovation at the Garfield center and has been traveling to Kaiser Permanente facilities, conferences and union meetings to talk with people at all levels of the organization about the exhibit. He was interviewed by LMP Communications Director Andrea Buffa.

Q. As director of nursing innovation, what kind of work do you do?

A. I have a really great job. I’m supposed to help envision the future about three to five years from now and figure out what technologies, what trends, what changes in nursing practices and what changes in health care might occur. And then help guide pilot projects and strategy and brainstorming sessions to move the organization toward that future.

Q. What is the Imagining Care Anywhere exhibit about?

A. Imagining Care Anywhere is the start of a conversation with everyone at Kaiser Permanente to create a vision of what it might look like in the future as we engage members no matter where they are. How can we seamlessly integrate their home life, their school life, their work life and their health interactions with Kaiser all together? How can we help people have a more healthy lifestyle or healthy work-life balance? It’s a tour that’s supposed to provoke people to think about and imagine what that care will look like.

Q. How are emerging technologies changing the future of health care?

A. One example is the smartphone. Many of us use it for everything from tracking our fitness goals to shopping lists to emails to Facebook. But the data and the information behind that can be integrated in with goals for your health life. We’re working on a project now called Profile and Preferences. You might be able to set personal health goals and then use the data you collect already—whether it’s through a fitness app or diet tracking—and upload that into your kp.org profile so you can see how you’re moving along with your goals. And then, when you meet with your care team, we have a better picture of who you are as a person, and we can help you facilitate your goals. Remote diagnostics and remote monitoring are a big deal now, too.

Q. What do you think virtual visits will look like?

A. There are several organizations now that do tele-visits, including Kaiser. I think the future is going to hold more of these as our TVs and our cable providers get faster and faster internet and smarter devices. It may not be a full visit, but it may be a way to engage with a care provider—whether it’s a nurse, a physician, some sort of navigator or a health coach. Keeping people from having to drive into one of our facilities for simple things is going to be key.

Q. How are things going to be different when people are in the hospital?

A. In the exhibit, there’s a “journey home” board, which allows members to know exactly what has to happen before they get discharged. They don’t have to continue asking the nurse or the doctor or the care team by clicking the call light—they can see it right there and they’re able to access it.

The board is also about answering their questions conveniently and in a way they can understand. The exhibit has the idea of using an avatar. After a nurse or teacher comes in to do some kind of education, the member still has some questions. Instead of having to ask the same questions over and over and feeling a little uncomfortable, they’re able to use a virtual person to answer them.

Q. How can KP support its employees and help them advance their careers as these changes begin to take place?

A. I think as an institution we need to keep thinking about how we evolve our roles, what are the things we need to do differently. The technology is coming whether we want it or not, so it’s about continuing to imagine how specific roles might change and coming up with strategies to train our workforce to be able to evolve with the technology.

Q. What role are the labor unions that represent KP’s employees playing?

A. We’re really excited about the engagement with the unions. I think it’s great that they’re using Imagining Care Anywhere as a springboard to talk to their constituents about how the future of health care is going to evolve and also work to create that future with us.

The front line should be driving this because they know what’s broken. And they can help us address that early, before we get too far down the road with a solution that may not meet the real need.

A January UNAC/UHCP steward meeting in Southern California included a traveling version of the Imagining Care Anywhere exhibit, and nurses across Southern California weighed in with their thoughts about the emerging technologies.

Gracie Johnstone, RN
Kern County

Our dermatologist left and we didn’t have one for a while. We did “tele-derm” with a doctor in Orange County. We trained the medical office assistants on how to set up the technology. We could do the biopsies, if needed, at Kern. It evolved really nicely. It saves a visit for the patient. I don’t think all this technology will take jobs from nurses because we still need the human touch. Nurses will become more techno-savvy.

Pam Brodersen, NP
Downey Medical Center

It’s great, but we have to slow down a bit. We don’t want to become an app. We still need that human connection.

Yoshini Perera, RN
Downey Medical Center

I love change, but I’m a little concerned we might get out of touch with the patient. As long as we can listen to and touch and feel the patient, that’s OK.

Nelly Garcia, RN
Panorama City Medical Center

I am concerned about the ability of computer systems to communicate with each other. We need to get the systems to connect in order to provide the best service.

Gerard Corros, RN
Irvine Medical Center

It’s like having a Ferrari all of a sudden. You can drive really fast, but you need speed limits.

“Team” is a noun. “Teaming” is a verb, defined by the woman who coined it as teamwork on the fly, coordinating and collaborating across boundaries, without the luxury of stable team structures.

That woman, Harvard Business School Professor Amy Edmondson, talked to the 2012 Union Delegates Conference about why teaming is such a crucial skill, especially for those in health care settings where work is complex and unpredictable.

“In health care, many times people are interacting with each other in an emergency room, for instance, now, for five minutes, but they don’t know each other,” says Edmondson. “The catch is we have to act as if we trust each other…because we often don’t have the luxury of having a lot of time to get to know each other.”

A “team” is a static, stable entity. But, says Edmondson, “In health care, if we wait until we have the perfectly designed ‘team,’ the moment has passed. We have to get together quickly, do what needs to be done, and then disband and do other things.”

In the absence of long-term work relationships, Edmondson says allegiance to an organization with a compelling vision can be the glue that holds these teams-on-the-fly together. “There is the pride in working for KP,” for instance, she says. “That is a real bond.”

Looking at the performance improvement work of unit-based teams at Kaiser Permanente, the principles of teaming still apply. While not as fluid as an emergency room, UBTs still see plenty of flux. Just think about the manager that gets promoted or retires, or the labor co-lead who rotates out of that role. The team has to be able to keep focused on improving performance even as the cast of characters changes.

UBTs can be stable teams that do great work. They are a very powerful tool,” Edmondson says. “And yet, I also want people to be able to quickly get up to speed, do what needs to be done with other people in the absence of those stable structures.”

A UBT needs to be a scaffold that is strong enough to withstand the flux, says Edmondson.

“If there is clarity about what the structure looks like—independent of the people who are in that structure—you are better off,” says Edmondson, a point explored in research she’s conducted with Harvard colleague Melissa Valentine. “We won’t always have the same human beings in those roles, but the roles are reasonably static.”

Amy Edmondson says innovation depends on a culture of focused chaos.

Those words sound like opposites. They are. Don’t worry. It’s not a mistake.

In fact, innovation depends on four pairs of seeming opposites. As unit-based teams ramp up, involving frontline managers, physicians and employees in finding new ways to improve performance and transform health care, they can benefit from creating a culture of innovation. This is how Edmonson, a professor at Harvard Business School, defines the four cultural contradictions of innovation:

• Chaotic/focused
• Playful/disciplined
• Deep expertise/broad thinking
• Promotes high standards/tolerates failure

Let's take a more detailed look.

Chaotic/focused

“An innovation culture is focused,” says Edmondson. “It is really intent on improving a process or inventing a new business model or coming up with a new product.” At the same time, it is chaotic. “Any idea is welcome and possible—at least until we sort it out. No idea is a bad idea—at least early in the process.”Chaos, says Edmondson, “is about welcoming all ideas, even ‘wacky’ ideas.” Only in a psychologically safe learning environment will employees feel open enough to offer these “wacky” ideas, she adds.

Playful/disciplined

The Labor Management Partnership offers a disciplined process for innovation in the form of the Rapid Improvement Model (RIM) and the plan, do, study, act cycle. But, Edmondson emphasizes, teams use these tools “without knowing in advance what the answer is.” There is a careful and well-managed process, but the content of the conversations about improving performance must be open and inclusive. As teams begin a performance improvement project, UBT leaders need to be very clear about what aspect of performance they are trying to address—not on how the team is going to do it.

Deep expertise/broad thinking

An innovative team is one that values those who bring deep expertise (in a specific topic, subject area or clinical specialty, for instance) and people who are broad, general thinkers who span boundaries. “Both of those skill sets are absolutely essential at the same time,” says Edmondson.

Promotes high standards/tolerates failure

In an innovative work culture, “We hold very high standards but we are also very tolerant of failure,” says Edmondson. “That sounds ‘wrong,’ at first,” she admits, “but it is essential because, in innovation, you will never get it right the first time. You try something, test it out, it’s not going to work quite right and then you either tweak it or throw it out altogether and try something else.”

Spreading new ideas that get results throughout a large organization such as Kaiser Permanente, says Edmondson, requires finding ways to “shine a very quiet spotlight”—another seeming contradiction!—on innovators so others become aware of what they are doing and are drawn to try it too. 

“In today’s world, there are two ways to get the word out,” she says. The first is face-to-face communication, “positive buzz that starts locally and spreads.” The other is internal online social networks as “a way to listen, motivate and share practices that are potentially better.”

“It can catch on,” says Edmondson. “When there are pockets of effectiveness, other people see them, and they want to play too.”

The theme of the 2012 Union Delegates Conference was “You Gotta Move”—and Amy Edmondson’s advice for the delegates was “you gotta learn.”

The Harvard Business School professor studies what she calls “learning environments.” To support innovation and teamwork, it’s essential the Labor Management Partnership and unit-based teams foster learning environments throughout Kaiser Permanente.

Imagine the ideal learning environment: People feel free to take risks. They feel psychologically safe. They believe they won’t be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. “Without that kind of psychological safety, it’s very hard for an organization to learn,” says Edmondson.

Now imagine the opposite of a learning environment, one where no one speaks up. “Nobody ever got fired for being silent,” says Edmondson. “And yet many bad things happen as a result of silence. Silence is a strategy for individuals to stay safe, but not necessarily for patients to stay safe or for organizations to stay vibrant.”

Creating a learning environment is up to leaders—to those people with influence, whether or not they have a formal leadership role.

“Leaders have to go first,” Edmondson says. They “have to be willing to ask questions themselves, invite participation, acknowledge their own fallibility, and to explicitly state we don’t know everything yet.” These behaviors help an environment where others can take the risks of learning.

But, she cautions, “The learning environment doesn’t live at the ‘organization’ level. For the most part, there are pockets of learning environments.…In a large, complex system, answers don’t come from central headquarters or the CEO. The answers come from the people at the front line doing the work.”

A labor management partnership like the one at Kaiser Permanente “is an important foundation” for building a learning environment, says Edmondson. “A true partnership is completely consistent with the context for mutual learning.”

Both management and union UBT co-leads can help create a learning environment by articulating the unit’s or department’s purpose and goals “in a meaningful way that touches hearts and minds, that motivates and encourages,” she says.

They can—and must—also reduce the fear people experience that makes them reluctant to speak up. The LMP helps develop and support people, helping them be their best and most courageous, Edmondson says.