LMP Concepts

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Teams are juggling constantly, trying to meet their own objectives, move forward on initiatives related to facility, regional and national goals, and comply with regulatory requirements—all in a competitive economic environment.

When the curve ball comes sliding in, it can be one thing too many, derailing a strong team or keeping a struggling team at ground level. So a host of unit-based team supporters are turning their attention to strategies to help unit-based teams prioritize competing demands—from personalized mentoring to intensive workshops for co-leads.

“I see my role as taking away the noise and the chaos…to help them figure out, ‘Realistically, how many things can we work on at once?’” says Denise Johnson, San Jose Medical Center continuum of care administrator and a UBT sponsor. “I have to help them not be crazy, because we don’t want a lot of projects that don’t make a difference.”

Here are four strategies for helping teams.

Strategy #1: Planning pays off

Every year, labor and management sponsors at the San Jose Medical Center sit down with their UBT co-leads to develop an operating plan. The plan flows from Kaiser Permanente’s organizational goals as well as from regional goals, facility priorities, and the needs of the department. Each sit-down includes the service area’s UBT consultant and its union partnership representative. Projects emerge naturally from that plan, with teams turning to the Value Compass and a tool called a PICK chart to fine-tune their priorities.

“They have to figure out what’s in their sphere of influence,” says Eric Abbott, the area’s union partnership representative. “What are the things they can change, and of those things, how much time do they have?”

When Johnson became sponsor of one San Jose team, it was immediately clear to her the UBT had too much on its plate. She worked with the team to winnow eight projects down to two.

“In my experience, people get bogged down with the to-do list and sometimes don’t stop and think about what’s really on that list and what effort does it serve,” she says. “They thought I was crazy. They came from a mentality where ‘more is better.’”

Strategy #2: Urgency can be a tool

Two years ago, San Diego’s interventional anesthesia unit-based team was humming along in its performance improvement work when it got hit with the news that co-pays for patients who suffer from chronic pain would be increasing sharply.

The 14-member team responded with a new service project, a multiphase communication plan to help members understand the new co-pay and their options. And then the next wave broke: The team learned it had a matter of days to move into a new specialty services building. It suspended the co-pay project to plan for and complete the move.

One key performance improvement tool—a process map—proved instrumental. The team created a detailed map that laid out every piece of work that needed to be done in preparation for the transition, from changing procedures to adapting to a new phone system to altering workflows based on the new floor plan.

“They simply became a single-issue team,” says their UBT consultant, Sylvia Wallace, of the 2011 move.

With the process map in hand, the team spotted an opportunity to weave communication about the new co-pays together with communication about the move. As a result, it didn’t miss a beat in providing its members with critical information about available financial assistance.

The comprehensive plan helped the unit’s service scores hold steady through the transition—and then increase at the new facility. The moving plan became a template for other departments, which are still moving into the Garfield Specialty Center.

“Everyone participated. All types of ideas were solicited and implemented,” says Grace Francisco, the assistant department administrator and the management co-lead at the time. “Everyone has a role and accountability for each step.”

Strategy #3: Take time to train

Teams stand a better chance of weathering competing demands when they have a solid understanding of partnership principles and processes as well as performance improvement tools and methods.

In Colorado, the UBT consultants used LMP Innovation grant funds to host a two-day workshop centered on two regional priorities. Co-lead pairs from throughout the region learned how best to serve new members and improve the affordability of KP care by reducing waste and inefficient practices. They walked away with a variety of team improvement tools and resources.

“We are trying to set the teams up to be successful by giving them the time to focus on topics that could have a huge impact in the region in the next few years,” says Linda Focht, a UBT consultant and UFCW Local 7 member.

In San Diego, regular UBT summits bring co-leads together for intensive sessions on given topics. Service area and local union leaders play a major role in structuring the agenda, so the team development matches up with high-level strategy. The joint planning creates a full picture, one that resonates better at the front line and sets up teams to work on projects that make a difference to KP’s reputation.

“Leaders see a lot more than what we see,” says Jenny Button, director of Business Strategy and Performance Improvement in San Diego. “Leaders see what is going on with the competition. They see across all of the different metrics we are working toward. They see at a broad level where our biggest gaps are.”

Strategy #4: One-on-one attention counts

At San Jose Medical Center, sponsors like Johnson and Hollie Parker-Winzenread, an assistant medical group administrator, are coaching UBTs one on one in performance improvement tools to help them set priorities.

 “Teams like to jump to the solution,” says Parker-Winzenread. “But they struggle with the process….The gain falls apart, because the process is not strong.”

San Jose’s clinical laboratory UBT is a success story, jumping from a Level 1 to a Level 4 in less than a year after new co-leads worked together to reach joint agreement on the department’s priorities. The team started with tests of change that made strides in attendance. Today, it has moved on to complex projects that require shifting schedules to accommodate demands for getting lab results earlier in the day.

Guidance from their sponsors has helped keep team members on track.

“We’d come up with all of these ideas and projects, and they made suggestions and really helped prioritize what we worked on so we didn’t bite off more than we could chew,” says Antoinette Sandez, a phlebotomist, the team’s union co-lead and an SEIU UHW member.

“You have to help teams to believe in the process,” Johnson says. “As a sponsor I can’t rush the process and say harder, faster, move, move, move. That won’t get us what we want in the long run. Because we’re looking for sustainability.”

When Donna Fraser sees something that needs doing, “I like to get it done,” she says. Twenty-one years ago, she joined Kaiser Permanente as a clinical assistant, one of the first in the Mid-Atlantic States region in the urgent care setting. After a few years, Fraser led a couple of her colleagues in approaching their supervisor at the Camp Springs, Md., facility about moving beyond registration and clerical duties to assisting nurses with patients’ health care needs.

“I said, ‘We believe you can utilize us.’ I knew I could do so much more to help out when the nurses were busy.”

She found a training program that ran from 8 a.m. to 2 p.m. five days a week. Meanwhile, she worked 3 p.m. to midnight shifts, mainly on weekends, and completed her courses in about three months. After struggling mostly on her own to pay for certifications in performing EKGs, phlebotomy and other tests and specimen collections, Fraser joined the facility’s fledgling class of urgent care technicians.

Hard work, good support

Today she is the lead RN at the Urgent Care/Clinical Decision units at the Largo Medical Center Hub, one of the newest facilities in the region. Fraser, a member of UFCW Local 400, says she owes much of her success to one of the Labor Management Partnership’s scholarship and wage replacement programs.

“I grew up here,” says Fraser. “It’s a great company if you work hard. You have to show up to win, do the best job.”

Trying to get an education while working full time is not easy, even for someone as motivated as Donna Fraser. That’s why LMP’s Ben Hudnall Memorial Trust was created, to support lifelong learning for union coalition-represented employees.

Wage replacement allowed her to take time off from her regular work schedule to attend classes, continue her employment, and keep up her clinical skills and knowledge. She’s taken advantage of the program twice since her first promotion, becoming an LPN in 2009, an RN in 2011. Fraser became a lead RN in 2013.

Click to enlarge.

Taking ownership

Jennifer Walker, the Mid-Atlantic States region improvement specialist who works with Fraser’s unit-based team, has seen greater benefit to the training. “Donna has become the person who organizes her group, serves as a support to all and keeps the team motivated,” Walker says. "And she has done this while working a full-time job and raising a family.”

But Fraser credits the Ben Hudnall Memorial Trust program with giving her a sense of ownership and responsibility for her education and her career. “We did the scheduling,” she says. “The big difference was the empowerment our manager gave us. As long as we could find the backfill, we went to our classes.”

The keys, says Fraser, are a supportive supervisor who “believes in the partnership” and a willingness to look to the union as a positive force: “Sometimes when you are an employee, you think you just use unions for when you are in trouble.”

The greatest challenge is helping people see that if they are involved in the process, it will be easier to move up.

“You can always find places within KP that need your expertise,” she says.

Kaiser Permanente’s chief executive officer, Bernard Tyson, recently sat down with the New York Times to talk about leadership for a regular business column featuring corporate leaders called the “Corner Office.” Tyson recalled the standards for integrity his father, a carpenter and minister, set for him as a child. He also discussed how those early lessons have affected the kind of feedback he looks for today as the leader of one of the country’s largest nonprofit health care organizations.

Q. What were some early leadership lessons for you?

A. I grew up in a large family, with two brothers and four sisters….

Read the full interview on the New York Times website.

A year ago, Susan Miles bid farewell to her diabetes medication—five insulin injections a day, one at each meal and two at bedtime—and cut her dosage of cholesterol-lowering statins in half. And she was only partway down the road toward improving her health.

“I know all about excuses. I’ve used the best of them,” says Miles, the ambulatory nursing director at the Ontario Medical Center in Southern California. Miles, 60, who's been with Kaiser Permanente for 34 years, tapped into the company’s tools and support systems—and her own willpower—to change her life for good. Despite her bad back, herniated disc and an arthritic knee, she has lost 94 pounds, changed her relationship with food and grown closer to family and co-workers.

“That’s really me,” she says, pointing to a picture on her desk of a much heavier woman.

Fat summer, skinny summer

Miles, an RN, always had a weight problem: “I’d have a fat summer, then a skinny summer.” She earned her bachelor’s and master’s degrees in nursing and moved up the career ladder at Kaiser Permanente. But the married mother of two children found it increasingly hard to take care of herself.

“I just didn’t feel good,” she says. “I loved my job, but it was getting harder to do. I had lost my mojo.”

More than two years ago, she tried taking the total health assessment (THA) but raced through it: Yes, her body mass index, or BMI, was almost 38, and of course, she had high cholesterol.

But when the statins got added to her medication regimen, she decided “it was my time to do something.” In February 2012, Miles enrolled in the weekly weight loss class offered at the Ontario facility. She retook the THA, slower, and “entered each and every line.”

“It puts a spotlight on all of your health issues,” says Miles, who used her THA statistics to help monitor her progress. In 16 weeks, she had shed 38 pounds. Her husband lost a few pounds, too, as he mirrored her eating. And the couple began taking weekday bike rides, breaking the cycle of “dinner, chores, bed”—with the bonus that they “rediscovered” each other.

Taking advantage of what’s available

Kaiser Permanente stands out in the field for focusing members on preventive health care and healthy eating, says Miles, who is quick to recommend KP programs—which helped her “reframe how I think about food”—to colleagues who marvel at her transformation.

“I haven’t stopped living, or eating,” she says. “We forget we are members too, not just employees. We need to take advantage of the programs we have. I really appreciate having KP physicians and dietitians at your fingertips to help you when you need it.”

From Miles’ perspective as a manager and an administrator, a healthy workforce is a happy and productive workforce.

“We depend on everyone being healthy and present,” she says. “We need to be models of that for our members.”

Maureen “Moe” Fox, RN, is a member of the UBT Resource Team in the Northwest region, helping teams with process improvement, and also teaches regional LMP classes. She credits her exercise routine with giving her the energy to keep up with her busy life as a working woman, wife and mother of three boys. She was interviewed by LMP communications consultant Jennifer Gladwell.

Q. Moe, you have a ton of energy. Where does that come from?

A. Like most working moms, my life is busy. I try to eat foods that will fuel me, drink lots of water and exercise. I’m a Jazzercise instructor two days a week, and the other days I run. Exercise helps me keep up my energy level as well as maintain strength and balance. I think I’d be less optimistic and more stressed out if it weren’t for my daily exercise routine.

Q. I notice you have a lot of ribbons and medals—what are those from?  

A. I always wanted to run but thought my size would be a problem. As I began my weight-loss journey a few years ago, I added running as an extra way to burn calories. A new friend and fellow novice runner convinced me to sign up for my first 5K (3.1 miles). Finishing that race was such a huge accomplishment. It took months to train for and required a lot, both physically and mentally. I was hooked. Since then, I’ve done multiple 5K to 15K races, 16 half-marathons (13.1 miles) and finished my first marathon (26.2 miles) on Dec. 31, 2012. The problem with running is that it’s addictive!

Q. What started you on your wellness journey?

A. I’ve been active my whole life, lettering in high school sports and playing on teams as an adult. I’ve also been “bigger” my whole life. I started doing Jazzercise in 1999 and became an instructor seven years ago. Despite my best efforts, it seemed that the weight I gained with my last son was not going to budge. I had actually come to accept it—the whole “as long as I can buy cute clothes, I’ll be fine” thing.

About five years ago, I found that I couldn’t keep up with the students in my Jazzercise class. I would get to the most intense part of the workout and feel like I was dying. I knew something had to change. I made a plan and set a date to start. I started counting calories and recording everything I ate with an online journal. I also took the total health assessment and that prompted me to get my labs done, which is how I found out about my elevated cholesterol level.

We are at an advantage at Kaiser Permanente because the labor unions and the health plan are willing to put their money where their mouth is—pun intended. I joined a Mix It Up team in the spring, and the weekly emails are full of helpful and positive tips. If the total health assessment and accompanying healthy living programs can help an employee get interested in getting healthy, it’s a step in the right direction.

Q. What was it like to lead the flash mob at the 2012 Union Delegate Conference in Hollywood?

A. Oh my goodness, that was the best thing ever! I was so in my element. I love dancing and I love getting other people to dance. It was a bit of a game changer for me, because up to that point, I hadn’t ever thought of myself as a leader for physical fitness and healthy living. I had people coming up to me by the end of the conference who were vowing to make life changes. I spoke with some of them at this year’s conference and some have stayed true.

Q. What advice would you give someone who is trying to get healthy?

A. Get help and support. If you have a friend who understands and your family’s on board, it really helps, even if they aren’t changing anything. Make a (food) plan. Know what you’ll do for weekends, family events, parties and nights out. If you bite it, write it—all of it—even on a bad day. Also, I have to have something sweet every day—just a little something sweet. Know when you’ll exercise and what you’ll do and for how long. It’s important to move every day, even if only for a few minutes. You need to have an exercise plan that is realistic and fun. If you love to dance, dance. If you love to ride a bike, ride a bike. Cheat a little. I don’t count calories on the weekends or for special occasion meals. Reward yourself for reaching milestones. Lastly, find ways to de-stress and be kind to yourself. You’re not ready for the journey if you’re going to punish yourself through it. It’s hard enough on its own. Don’t make it harder by not rooting for your own team.

See what other teams are doing to find success in Total Health.