Member services

It's a simple set of five letters, but it can pay big dividends when you're interacting with patients.

Let's spell it out and communicate our best.

Acknowledge—The first letter of the AIDET acronym reminds each staff member or care provider along the patient’s path to acknowledge his or her presence. Making eye contact with a patient or giving the member a smile is all that’s needed.

Introduce—When you identify yourself by name, you change the patient’s visit from an anonymous interaction into a personalized experience.

Duration—A little information goes a long way. Letting patients know how long a visit is expected to take lets them know their time is valued. If a doctor is running late or the lab is behind, letting patients know about the delay and keeping them updated shows respect.

Explanation—Whose body is it? No one likes it when a caregiver starts doing something without telling a patient what they’re doing and why.

Thank you—The last step wraps up the visit by thanking the patient for coming in or for providing the information needed to provide them with excellent care.

For nearly a year now, the Neonatal Intensive Care unit at the Fontana Medical Center has welcomed parents 24 hours a day, thanks to a unit-based team that put the patients’ needs first.

Since April 5, 2011, parents have been able to stay on the unit with the newest member of the family regardless of the hour and even during shift changes and rounding.

“The belief in family-centered care is put into action here,” says management co-lead Annette Adams, RN. “Nothing should come between parents and babies.”

Team members put themselves in the shoes of the parents whose children are treated on the unit: The distress of having a newborn baby staying anywhere other than right by your side, of having to leave your baby in the hands of strangers, and being told when you could come and see your own child.

Making it better for parents

Keeping the service point on the Value Compass in mind, the team looked inward to tackle the problem of concerned parents lacking 24-hour access to the unit.

The UBT began by researching what it takes to have successful open visitation in the NICU and what the benefits are for members and patients. The team found that many NICUs were not truly open to parents 24 hours a day, as parents were asked to leave during change-of-shift reports and physician rounds.

The UBT concentrated on how to make sure parents could remain, despite the concerns.

Shift reports are done at the bedside. But the NICU is one big room where anyone can hear anything. Team members researched how to solve this problem by asking how other Los Angeles-area NICUs, such as Cedars-Sinai Medical Center, handle shift reports without compromising privacy.

Involved in shift hand-offs

Not only do parents now get to see their babies whenever they desire, they are also asked to participate when the physicians round and during the change of shift hand-off, which gives them the opportunity to meet the nurse assuming care of their baby.

“The belief that family-centered care is an essential part of each family’s experience was the driving philosophy behind the progressive move in visiting policy,” says Sheila Casteel, RN, the NICU team’s labor co-lead and UNAC/UHCP member.  

The representative team members enlisted help from the rest of the unit by introducing the concept through the monthly staff newsletter and giving presentations at staff meetings.

Unit staff members were asked for their ideas about how to overcome barriers—real and perceived. Some of the practices adopted included:

• moving the staff hand-off huddle outside the unit to the conference room
• making the relief and admitting nurse available to answer parent questions during hand-offs

When discussing change, it’s a rare person who doesn’t have that question lurking at some level of consciousness. Since health care reform will bring change to just about every corner of Kaiser Permanente, it’s safe to assume a lot of people are wondering how their jobs will be affected.

The short answer is, no one exactly knows yet.

The better answer is, no one exactly knows and it doesn’t really matter.

Because the 130,000 frontline workers, managers and physicians who are engaged in the Labor Management Partnership already are on a path of continuous improvement, which means taking change in stride is becoming second nature to this crowd.

Doing better tomorrow what we did well today is the name of the game for unit-based teams. Team innovation, as this issue’s cover story notes, may result in a clinic making sure new members understand what they can do to ensure speedier service. It may result in new members getting the kind of attention on their first visit that impresses them and makes them want to stay with KP.

So the best answer to “what about me?” is: It doesn’t matter if a change arrives because a lab decided it wants to get results out faster or if change is a result of health care reform. Change is change. It isn’t out there waiting to roll over us, it’s already here. It arrived when UBTs began using the Value Compass as a guide to providing our members with the best service and quality of care at the best price, while creating the best place to work.

More members on their way because of health care reform? We’re already getting ready—it’s the same work we’re doing to serve our current members well.

The Family Practice unit-based team at the Sunset Medical Office in the Northwest was thrilled that its work to get members to sign up on kp.org was a success. But team members quickly grew dismayed when the onslaught of new signups had an adverse effect on patients’ experience.

The challenge began in 2014, when the team launched several projects to increase the number of Kaiser Permanente members signed up on kp.org, knowing that people who use kp.org usually give KP higher satisfaction scores. The office is located in Hillsboro, Oregon, near one of Intel’s campuses. Intel offers Kaiser Permanente as a health plan option, so the effort to get more people online made perfect sense.

But, on the flip side, the increased number of messages coming in through kp.org wound up increasing turnaround times for return emails and phone calls.

More than two-thirds on kp.org

The department now receives between 450 to 650 email messages per week. Seventy-one percent of its patients—29,000 members—are signed up on kp.org. The team sought to improve its turnaround time on messages by reducing the number of times staff members and physicians touched each message. Instead of multiple people working a message, each one is now triaged one time by either an LPN or RN. At the same time, the team decreased its time spent on messages per week from 13.6 hours to 10.9 hours.

Ed Vrooman, an improvement advisor and union partnership representative, coached team members on how to test and implement their improvements.

“We learned how to use process mapping, so we could identify where the holes were in how we were approaching the work,” says Eliseo Olvera, the assistant department administrator and the UBT’s management co-lead. “Ed knew where we could get the data we needed and help us understand it, so we could do the work.”

Vrooman also introduced the team to the 6S tool—sort, simplify, set in order, sweep, shine, standardize—to improve its work processes. The team broke into different workgroups and each group identified tests of change. Some of the ideas were abandoned, some were refined and adopted, and some still are being adapted.

Staying on track

“I tended to focus too much on the information and the numbers,” says Rikki Shene, a licensed practical nurse and SEIU Local 49 member who is the team’s union co-lead. “Ed helped keep us organized and simplified the data so that we could keep moving forward and accomplish something in our 45-minute UBT meetings.”

Vrooman’s role in the team has been critical for the team. He attends the co-lead planning sessions and UBT meetings. He stays in the background until needed—and then he speaks up.

“He’s part of our community,” says Olvera. “His expertise with data has been critical. It’s a gift.”

The Transportation department in the Northwest is coming out of a tumultuous time. A lack of trust between managers and employees created a barrier that affected morale—and made it difficult to focus on improving routes and processes.

The department uses a robust but complex process for optimizing its routes. For maximum efficiency, it has to integrate a variety of work streams and figure out where there are redundancies that can be eliminated. Because of the complexity of the process, however, it had been more than 15 years since the criteria and requirements for the transportation system from the customer’s point of view had been reviewed.

Eventually, the UBT worked out a thorough route-modernization plan based on data-driven service requirements and metrics that established parameters on how to revise and design its routes.

But before it got there, it had to fix its communication, which broke down so badly the team entered into an issue resolution. In the Northwest, the LMP Education and Training department is responsible for facilitating issue resolutions.

Blame-free solutions

“There was a lot of tension in the department, and people were nervous about losing their jobs as a result of our work around revamping routes. Poor communication was a problem,” says Greg Hardy, sponsor and manager of the department.

The issue resolution process uses interest-based problem solving, and that helped the team focus on a common goal: Serving its customers was the top priority and improving communication was a necessity. From there, other agreements came more easily, and the department was able to maintain staffing levels and improve processes as a result of its efforts.

Improved communication improves service

As a result of the improved communication, the team was able to improve service levels and achieve the efficiency and cost savings it had strived for.

“We have a group of dedicated workers who want things done the right way,” says logistics supervisor Chris Dirksen, the team’s management co-lead.

When it came to improving communication, the team members’ first step was to get a baseline measurement of what they were trying to improve. They created a survey that would measure not only communication but also morale and UBT effectiveness. Once they had that information, they created a SMART goal: to improve employee perception of communication, morale and UBT effectiveness by 15 percent within three months, raising the overall survey score from 2.55 to 2.93 by February 2014.

As the team began to investigate the issues, it discovered email was not a good form of communication. Fewer than 20 percent of the team members knew how to log on and use Lotus Notes. The team brainstormed ways get employees to use Lotus Notes email and frontline staffers began to instruct and coach one another.

Three months later, the team sent the survey out again and found it had met its goal. Perception of communication improved 48 percent, morale improved by 56 percent and UBT effectiveness improved by 21 percent. The team scored 3.4 on its survey, exceeding its stretch goal of 2.93, and anecdotal reports are that the communication success is continuing now that the team has successfully completely the issue resolution.

New ways to communicate

Team members use several means now for communicating with one another, including email. A communication board has been set up in the department’s headquarters, near dispatch, that includes information about the projects the team is working on, notes from UBT meetings and a copy of the department’s weekly e-newsletter, “Heads Up.”

In addition, the team has gone from a representative UBT to a general membership UBT and now has regularly scheduled meetings throughout the region, so that all employees are able to participate. “This has been our biggest success to share information,” says UBT union co-lead Nickolas Platt, a courier driver and member of SEIU Local 49.

“It’s cool to watch from meeting to meeting how more people show up each time,” Hardy says. “The engagement of the team has increased as we began to see improvement, and people could see change.”