Performance improvement projects

Do you or your teammates want to shrink wait times? Save money on supplies? Reduce time wasters or roadblocks? Once you’ve identified a problem to solve, you may wonder where to start. No need to invent an improvement project from scratch. Visit the Team-Tested Practices section and see what’s worked for others. We’ve got short summaries of successes from every region and every type of work environment to give your team a kickstart.

1. What’s here? 

When you visit LMPartnership.org/team-tested-practices, you’ll find the first several “tiles” of the dozens you can choose from as you scroll through this section. Each tile will have a photo and short preview about a specific, measurable improvement a team has made.

2. Sharpen your search 

Want to narrow down what you see? Use the filters on the left side of the page. There are several to try, including:

• Topic. Choices include affordability, patient safety, service and more.
• Department. See what departments like yours have done.
• Region. Check out the projects done in your region.

Selecting more than one filter at a time works, too. And remember that you can get great ideas from departments very different from yours and regions other than your own. You’ll notice these filters throughout the website to help you focus your searches. 

3. Intrigued? 

See something your team might want to try? Click on the tile to get a more complete description of the challenge the team was facing — and the main tests of change that helped the team achieve its goal. And the measurable result: “Saved $40,000,” “decreased wait times by 11 minutes,” “69 percent drop in costs.”

4. No dead ends! 

So, maybe the practice you clicked on isn’t right for your team. Before you move on, check out the related tools and stories in the colorful columns farther down this page. Throughout the site, the color orange means, “Here are tools to get your team started on work like this.” Blue is, “Get inspired by stories and videos about teams working on similar efforts!” And, “Just for fun” — green will take you to puzzles, games and other light-hearted resources to kick off your improvement campaign on an upbeat note.

Colorado

The nurses in the Primary Care department at the Englewood Medical Office were short-staffed due to medical leaves and feeling overwhelmed. Messages from patients were piling up in the electronic inbox in KP HealthConnect. So the team brainstormed ideas, and the physicians offered to help clear the backlog. After testing a couple of time blocks, the doctors began setting aside 30 minutes every morning and afternoon to triage messages and call patients back directly without involving the nurses. As a result, the team consistently closes encounters within an hour more than 40 percent of the time—and, with more problems resolved by phone, access for patients needing in-person appointments has improved. Morale in the department is up, too—and the team recently won the region’s quarterly “Value Compass” award.

Georgia

At the Crescent Centre Medical Office Building in Tucker, the Adult Medicine unit-based team is closing care gaps, managing chronic conditions better and improving screening rates for colon cancer—all key elements that differentiate Kaiser Permanente from its competitors. For example, the team increased the percentage of patients with diabetes getting the recommended blood sugar control and cholesterol tests by enlisting licensed practical nurses who help review, print and process pending test orders. To increase colon cancer screening rates, the team began tracking the number of take-home screening kits handed out by providers and made outreach calls to patients who didn’t return them. Starting from scratch, the team ramped up rapidly and handed out 173 kits between September and December 2012 and achieved an impressive return rate of more than 76 percent.

Hawaii

At the Moanalua Medical Center’s 1 East unit, patients are learning more about their medications,  thanks to a successful test of change by the medical-surgical nurses. Two significant steps helped the Honolulu unit-based team achieve its goal of increasing patients’ medication awareness: Nurses took the time to review a single prescription and its common side effects with each patient, and then they reinforced the information at subsequent office visits. A follow-up survey showed that the percentage of patients saying they understood their medications and the possible side effects increased from 36 percent to 50 percent in just three weeks in May.

Mid-Atlantic States

Several UBTs have joined the region-wide Member Demographic Data Collection Initiative, gathering crucial information about race, ethnicity and language preference. The data is needed to fulfill accreditation and contractual requirements—and, even more importantly, to eliminate health disparities and provide culturally competent care. In Springfield, Va., the Pediatrics team increased data collection from 46.8 percent of patients to 95 percent in less than two months by changing its workflow. In addition to nurses surveying patients in exam rooms, the team’s receptionists start data collection at check-in. Using laminated cards to describe ethnicity choices helped the Reston, Va., Pediatrics team improve by 10 percentage points. Region-wide rates improved 31 percentage points since May 2011, says Tracy S. Vang, the region’s senior diversity consultant.

Northern California

The benefits of performance improvement work aren’t just in the results. Sometimes the work helps teams discover the crucial role they play in providing quality care. That’s what happened when the Richmond Medical Center’s patient care technician team set out to improve its workflow. The technicians, who help hospital patients get up and moving, had been meeting only 45 percent of physicians’ mobility orders. Their goal was to reach 75 percent by October 2012. By September, the team was fulfilling 95 percent of daily mobility orders. Communication with nurses and physicians improved, and the work had an added benefit: By helping patients get up more regularly, hospital stays were shortened, which is estimated to have avoided $600,000 in costs over five months.

Northwest

By eliminating variation and wasted time, the regional lab’s Histology unit-based team improved slide turnaround time by 11.8 percentage points from its starting point in 2011 to April 2013. The team has reduced delays by tracking its slide volumes every hour, implementing huddles and adding additional equipment to minimize downtime due to lack of equipment. These improvements also helped improve employee morale: People Pulse scores for the department Work Unit Index increased by 30 points from 2011 to 2012.

Ohio

The Labor Management Partnership is supporting frontline employees as the region transitions to become part of Catholic Health Partners. Once the process is complete, employees, physicians and operations and administrative personnel who are currently part of the Ohio Permanente Medical Group and Kaiser Foundation Health Plan-Ohio will become part of Catholic Health Partners. They will continue to work in the existing medical offices in Northeast Ohio.

Southern California

Being accurate 98.9 percent of the time sounds pretty great. But the Central Processing department at the West Los Angeles Medical Center sterilizes almost 4,000 trays a month, so even a tiny drop in accuracy can disturb Operating Room efficiency. But with managers and employees working together to analyze the department’s data, the unit-based team was able to reach its goal of 99 percent accuracy between June and August 2012. It continues to maintain that level of precision by using a buddy system to audit instrument trays, involving lead techs in quality assurance spot-checks, posting tray accuracy reports in break rooms and holding weekly meetings with the Operating Room department administrator.

Yes, I’d be happy to. Yes, I can do that. Yes, of course, yes.

Stepping up to the plate, being engaged, working hard—in a workplace that fosters continuous learning and improvement, these are qualities we prize in our colleagues and cultivate in ourselves.

And, in a sprawling, complex organization like ours, with myriad initiatives and projects, these traits can be our undoing. If we say yes to everything, we wind up spread too thin. Spread too thin, we lose effectiveness. Trying to regain the ground we think we should already have covered, we go faster and faster, start to spin our wheels and—burn ourselves out.

We do it as individuals, and we do it in our unit-based teams, too: Yes, we can do that. Yes, we’ll take that on. And then there’s too much to do and an effort to improve sputters out.

There are lots of techniques for individuals to manage competing demands. As UBTs mature, they and their mentors are getting savvy about the importance of having teams set priorities, too.

Developing teams don’t always have the confidence it takes to say no. In “From Frenzied to Focused,” Denise Johnson, the continuum of care administrator at San Jose Medical Center, notes that we have a tendency to think more is better. She and other UBT supporters are helping their teams map out the path forward, teaching them to discriminate (in all the best senses of that word)—to know when to say “yes” and when “no, not now” is in order.

Fewer, well-chosen projects have a greater impact on Kaiser Permanente’s quality of care, service and affordability. And not being constantly frazzled certainly helps create a better place to work, too.

When it comes to metrics, even the best teams can get muddled.

At such times, a good team realizes it needs help—that it’s time to ask for assistance from someone with specialized skills. In the Northwest region, teams can turn to Ed Vrooman.

His enviable strength? An ability to crunch numbers, connect the dots and break down the complexity of the data so that unit-based teams get the information they need to do their work.

“It’s easy for teams to fall into analysis paralysis, where they dissect every data point. I work with them to know the why and the what,” says Vrooman, who started as a part-time phlebotomist 18 years ago at Portland’s now-long-gone Bess Kaiser Hospital. Today, he does double duty as a union partnership representative (UPR) for the Coalition of Kaiser Permanente Unions—he’s a member of SEIU Local 49—and as an improvement advisor.

A broad perspective

His atypical career path has given him an unusual outlook. In 2003, Vrooman took an extended leave of absence to work for Local 49, helping organize KP employees and other health care workers. After returning to KP, he became a labor partner and brought the coalition’s interests to the building of the new Westside hospital and other major regional projects.

“Partnership has allowed me to touch nearly every function within this organization,” Vrooman says. Working on the large initiatives got him more intrigued with the data side of the house—and led to his current position, which gives him an opportunity to use his skill with data and analytics. 

When he heard from the region’s UBT consultants that teams didn’t have the data they needed to work on projects, Vrooman became—along with the data analytics department and health plan leaders—a driving force in the creation of the region’s scorecards for teams. The STATIT scorecards (named after the electronic system that hosts them) enable teams to see their goals online and how they line up with the regional and PSP goals.

Co-leads’ gathering

Every year, Vrooman, along with the other two UPRs in the region—Bruce Corkum, RN, an OFNHP/ONA member, and Mariah Rouse of UFCW Local 555—present information on regional goals and budgets in one of the quarterly Steward Councils, which bring together the region’s UBT union co-leads and representatives from its four partnership unions. For the meeting on regional goals, the management co-leads are invited as well, providing a chance for team leaders to learn together how their teams can have an impact.

When he’s working directly with a team, Vrooman mentors and coaches its members on using improvement tools, from understanding the fundamentals such as SMART goals and entering projects into UBT Tracker to more advanced tools like process mapping. He asks his team members what they need to be successful.

“You don’t need a title to be a leader,” Vrooman tells them. “You lead from where you stand.”

You say your unit-based team has reached Level 5 on the Path to Performance? Great, everyone take the rest of the week off!

Your UBT is stuck at Level 1 and has been for years? Just hide in a dark corner and hope no one notices.

Not so fast.

Teams soar. Teams stumble. And we need them all to stay in the game.

Unit-based teams are Kaiser Permanente’s platform for improving performance. They’re also the union coalition’s instrument for amplifying workers’ voices in the workplace. All of which has paid off for KP members and patients, through UBTs’ efforts to improve quality, service and affordability. None of which is easy for teams to pull off.

Enter union partnership representatives and UBT consultants. They are recruited from frontline positions in union and management, so they know firsthand what it takes to deliver high-quality health care. They also receive special training that enables them to coach and mentor unit-based teams.

Our leaders knew teams would need such support. But it’s a balancing act. The tightrope for these folks is to gradually build the skills and confidence among team members, then step back at the right time so teams can fly on their own.

Few of us can truly go it alone. We all benefit from coaching—someone to hold up a mirror and offer frank advice (diplomatically delivered!) on how to improve in our jobs. A consultant’s most important skills are listening and observing. Those are skills we’d all do well to improve.