Nurse communication

The new goal was dramatic: Reduce hospital stays to 23 hours for total joint patients.

Renee Portillo, RN, was worried.

“It was a shocker. Our staff was used to patients going home in two to three days,” says Portillo, former assistant clinical director and management co-lead of the 7 South medical-surgical team at Fontana Medical Center in Southern California.

The accelerated time frame meant that the unit’s nurses, who care for total joint patients following surgery, would have less time to prepare them for discharge. They’d also need to help choreograph care across multiple departments—Orthopedics, the operating room, Physical Therapy, Home Health—from pre-admission to discharge.

Who best to help the team through this change? The team itself.  

“We used our UBT to help change the culture,” Portillo says.

Wave of the future

“We helped our nurses be successful by having them anticipate patients’ needs and prepare them for discharge,” says Enrique Rivero, RN, a surgical nurse and UNAC/UHCP member who is the team’s union co-lead.  

Fontana is among a growing number of hospitals across the United States to offer a combination of shorter hospital stays and more outpatient care for hip and knee replacement patients. The trend is driven by less-invasive surgical techniques, improved pain management and rehabilitation practices, and patients’ desire to return home as soon as possible.

“There were a lot of challenges. A lot of it had to do with bringing people together,” says Mary Hurley, MD, chief of Orthopedics, who championed the new approach. “They all had to buy in and be willing to support this in order to have a successful program.”   

The new approach, which Fontana introduced in January 2014 after months of researching best practices, gets patients walking within hours of surgery and enables them to recover within the comfort of their own homes. The initiative takes advantage of Kaiser Permanente’s integrated model of care and is designed to improve clinical outcomes and reduce costly hospital stays.

The dread is familiar: You have a question or a problem, and you need to call a service center to get the matter cleared up. Will the issue be fixed quickly? Or will the call be transferred from one person to the next—to the next—to the next?

As the second open enrollment period under the Affordable Care Act approached, Kaiser Permanente’s Customer & Member Services team knew that it didn’t want the thousands of new members joining KP to have that sort of frustrating experience. Just the year before, C&MS’ Member Service Contact Centers (MSCC) had been swamped by three times as many calls as expected. That had led to many handoffs to Membership Administration, which works with the MSCC customer service representatives to get questions answered. 

And so the first-ever “super unit-based team” sprang into action in September 2014. Its mission: To combat long wait times and better handle the anticipated surge in calls that would come with open enrollment.

What made it “super” was that it transcended locations and time zones, bringing together on a single team representatives from across the country—from the MSCCs in Denver, Colorado; Fulton, Maryland; and Corona, California, and from Membership Administration in Denver and San Diego. In the past, an individual UBT at one of the centers might develop a good practice, but it was left largely to chance that other centers would learn of it and follow suit. But under the umbrella of the Open Enrollment 2015 Readiness Initiative, 29 frontline and managers, supported by regional and national leaders, took a fresh approach to testing initiatives and spreading best practices.

Unifying approach

The combined team helps everyone operate as one team instead of separate entities, says Deashimikia Williams, a customer service representative at MSCC-Fulton and an OPEIU Local 2 member.

The collaborative effort was important because members don’t distinguish between different centers or different divisions. “They see us as One KP,” says Marie Monrad, vice president of strategy and operations for the Office of Labor Management Partnership, “and with this, we are doing performance improvement as One KP.”

The Super UBT’s biggest success so far is known as “one and done”—meaning that the member’s question is taken care of by the representative who picks up the phone. Before, a member’s request to stop an online payment, for example, might have taken up to a half-dozen calls. But with the introduction of the one and done process, the MSCCs were able to reduce the number of handoffs by 60 percent from January 2014 to January 2015.

The secret to success was looking to the customer service representatives for answers, says Jerry Coy, senior vice president of Customer & Member Services. “We asked the people who actually take the calls, ‘What questions are members asking?’ and ‘What would make your job easier?’” he says. “We are the front door to KP. We welcome the members and want them to be a member for life.”

“All of this work is in line with the Labor Management Partnership’s commitment to grow and maintain membership for KP,” notes Janelle Williams, consultant specialist for frontline engagement and growth. 

Answering calls from all over

The call centers that participate in the Super UBT answer the majority of KP member calls from the entire organization, fielding questions on a range of topics from billing to details of the health plan to helping members who haven’t received their membership cards.

Super UBT members received additional education and created a rapid resolution team within Membership Administration. While the representative stays on the phone with the member, he or she can consult with specialists via Lotus Notes SameTime chats or by opening another line. From mid-January through early March, the MSCCS handled nearly 5,400 calls—and more than 5,000 of them were successful rapid resolution calls, with the members helped in a single interaction. In addition, through staffing changes, operational improvements, and the implementation of the rapid resolution team, Membership Administration has reduced mean processing time for member issues from 26 days in January 2014 to three days in January 2015.

While Kaiser Permanente members benefit from the work, the frontline staff members benefit, too.

“We have a better understanding about the changes in different regions,” says Deashimikia Williams, who is the Fulton UBT’s labor co-lead. “Before the Super UBT, it was hard to get everybody engaged. Being engulfed in this work motivated us.”

LaDondra Hancock, senior account administration representative for Membership Administration in San Diego, also says the initiatives started by the Super UBT have improved the way she and her teammates work. “It has lessened the calls we get in from the different Member Services Contact Centers,” says Hancock, who serves as her local team’s labor co-lead and is a member of OPEIU Local 30.

Model practices

The success of this collective effort provides a model for other teams and departments looking to share and spread best practices, and underscores the importance of reaching out to other teams doing the same or similar work.

“Not only is this work of the Super UBT critically important for improving the member experience,” Monrad says, “but it also shows that it is critically important to test, model and explore new ways to bring improvement through our partnership that cuts across not only multiple regions, but multiple unions and multiple functions.”

With changes this fall promising to bring more health care coverage to millions of Americans—and many more members to Kaiser Permanente—unit-based teams are helping to get member services in top shape.

Managing diseases, slashing wait times and cutting out the high cost of waste are naturally on the radar for caregivers’ UBTs. But operations teams also are working behind the scenes to make sure our services are seamless.

For instance, one team at the California Service Center in San Diego is working to make sure new members have a good “onboarding” experience. Its project aims to make sure that what an employer purchases for its employees is what those workers get when they show up at a medical center for the first time, ID cards in hand. No one wants a new member arriving at a Kaiser Permanente facility and being asked to fork out an unexpected copayment or, worse, being denied a service outright.

“This is the kind of solution that is—and should be—generated from the front line,” says Demetria Williams, a service center manager and the Contract team’s management co-lead.

KP's dual role

Kaiser Permanente is unusual in that we provide both insurance coverage and health care, and so how administrative services are handled affect a member’s overall impression of the organization. The Contracts team enrolls employer groups, entering the details of the lengthy contracts—copay amounts, covered medicines, vision care allowances and so on—that will apply to every employee covered by that particular contract. That sets the stage for the individual employee’s enrollment with Kaiser Permanente. If it’s all done correctly, everything goes smoothly when the new member arrives at one of our facilities.

The job is tough. About 18 account administration representatives refer to the signed contracts they’ve received from Sales and Account managers as they enroll a new employer group—or update an existing one—so the employees will get the right services. The account administration representatives contact the sales people when they find inconsistencies—when, say, the plan that was selected doesn’t include vision coverage, even though the associated contract calls for it.

“We would pick up the phone, but we were not connecting,” Williams says. “We were speaking different languages. We didn’t know what they wanted; they didn’t see what we saw.”

Despite the meticulous work, the team faced a 65 percent discrepancy rate—entries that are likely to cause problems for members when they seek care. So the Contracts UBT used the plan, do, study, act steps to track where the data was misaligned and trace it to specific parts of the process—and team members decided on a small test of change, hosting a “Day in the Life of a Contract” with members of the Sales and Marketing team.

Part of the difficulty was that sales managers and service reps work on different computer systems, with no connection between them. The competing systems were a swamp of alphabet stew: CIDARS, LOB, PA. Since merging the two systems into one isn’t in the offing, staff members found a solution at the unit-based team level.

Cutting through jargon

During two days of face-to-face meetings, the two sides cut through the sea of baffling acronyms and buzzwords and created a cheat sheet of common, acceptable codes.

Jeannie Athey, the Contract team’s union co-lead, an account administration representative for nine years and an OPEIU Local 30 member, said the UBT project was like a foreign student exchange. “We hadn’t seen their system before,” she says—and it was eye opening.

It’s too soon to have updated metrics, but Athey says anecdotal reports indicate the reps need fewer phone consults with sales managers and there has been less frustration between the two groups.

“Members can’t be enrolled until we’ve done our job of setting up the group contract,” says Sherri Saunders, the service center’s operations manager and the team’s sponsor. “If they’re not enrolled, they can’t get services. The contracts are legal documents. We have to get them right the first time, for our members.”