Performance improvement

Colorado

When people go to school to learn how to perform X-rays or take blood pressure, they don’t generally expect they’ll be bonding with colleagues while getting their commercial driver’s licenses or that putting on snow chains will be part of their job. But members of the “mobile coach” unit-based team, who travel to clinics that do not offer mammograms on site and who are in charge of every aspect of running a mammography lab on wheels, took these tasks on and more. Their unusual assignment is improving the quality of care—they screen an average of 15 patients a day and performed 2,584 exams in 2012, finding 12 cancers.

Georgia

The Pharmacy team at the Cumberland Medical Offices cut labeling costs by more than 50 percent by improving accuracy in printing prescription labels. Techs now take a medication off the shelf before typing in the prescription or passing it off to a pharmacist. This helps them select the right code from the National Drug Code database—reducing the need to reprint labels and the associated medication information sheets that are given to patients. Within three months of the change, the number of incorrect codes on labels went from 13 a week to zero. Spending on labels dropped from $1,355 in November 2011 to $569 in March 2012, and monthly shredding costs dropped from $90 to $30. 

Hawaii

The Gerontology specialty team at the Honolulu clinic uses a distinctive combination of red and blue tape to keep its nursing staff free of accidental syringe needle sticks, which can lead to serious disease. More than a year ago, the team set a goal to have no more than three sticks a year—the number of incidents in the previous year. But telling busy caregivers not to rush was not enough. Today, a designated area blocked off by the tape signals to other staff that a nurse needs to concentrate fully on preparing an injection or disposing a needle. The UBT reinforces the warning with signs and a monthly safety message. There have been no needle sticks since October 2012.

Mid-Atlantic States

When busy patients kept canceling appointments, the Baltimore Behavioral Health unit-based team had to find a way to address the no-shows, which were having a negative impact on the clinic’s workflow. In June 2012, 32.7 percent of open slots for new referrals went unused. Then the team stepped in with personal reminder calls and letters, as well as in-person coaching during the after-visit summary review about—yes—how to cancel an appointment. Once patients learned how easy it is to use kp.org to cancel an appointment and understood how other members benefit from the newly opened slots, the no-show rate dropped to 25 percent in February 2013.

Northern California

When parcels arrive at the Fremont Medical Center, they are placed onto a conveyor that rolls them into a warehouse, where they are processed and staged for delivery. Before the conveyor was installed—a suggestion made by UBT member Pablo Raygoza, a storekeeper and SEIU UHW member—workers had to do a lot of bending and lifting to pick boxes up, handling each one multiple times. The improvement was part of a three-year effort to increase worker safety by redesigning and streamlining work processes. As of March 2013, the effort had kept the Supply Chain department injury free for more than 660 days and earned it this year’s regional President’s Workplace Safety Award.

Northwest

The Northwest welcomed 2013 with a recommitment to the region’s hospital’s unit-based teams at a three-day Value Compass Refresh meeting, attended by more than 300 UBT co-leads, subject matter experts and regional leaders. Groups explored subjects like overtime, process improvement and patient flow. In the end, hundreds of potential projects were identified by co-leads and subject matter experts to take back to their UBTs for discussion and next steps. Representatives from the Operating Room UBT discussed opportunities to improve communication with surgeons. On hand was Imelda Dacones, MD, the chief medical officer of the Westside Medical Center (slated to open this summer). She listened with an eager ear and asked questions of the teams to help understand the challenges. “All the physicians who have privileges at the new hospital,” she says, “will go through the Patient Safety University training.”

Ohio

Members regularly complained about long waits for prescriptions at the Parma Pharmacy, so the unit-based team decided to map the prescription-filling process using a spaghetti diagram. The tangled web of lines captured in the drawing told the story and pointed to the root cause of the problem: Pharmacists did a lot of unnecessary walking and backtracking. The primary culprit was walking to and from the technicians, who are located in the front of the pharmacy, to deliver prescriptions. The team decided to move pharmacists closer to the techs—a small change that gives pharmacists more time to dedicate to filling prescriptions and shaved wait times by 84 seconds, or 14 percent.

Southern California

The eight-person nephrology unit at the Stockdale Medical Offices has always exceeded regional goals for its discipline and prided itself on the care it provides its kidney transplant patients—but it got a rude awakening in January 2012, when it saw fresh data from the regional renal business group. The team was merely average. Team members got busy, analyzing the metrics and scouring patient records. To help flag the care each patient needs, they turned to the Proactive Office Encounter functions in KP HealthConnect™. They hosted a special short-term clinic just for transplant patients. Nurses made outreach calls. And the percent of patients getting five key services shot up—flu shots (up 50 percentage points), dermatology appointments (up 32 points), renal ultrasounds (up 22 points), annual follow-up visits (up 25.5 points) and lab work (up 26 points).

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.

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.

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.

Colorado

Spurred on by a Performance Sharing Program goal, UBTs in the region are focusing on affordability and efficiency by taking on improvement projects with identified cost savings or revenue capture. Teams are finding ways to work together. For example, the Stapleton Cytology and Molecular lab teams increased productivity by cross-training and solving problems together. As of August 2014, the teams are processing five times more HPV screenings a month than in 2012. The region also is celebrating strong membership growth.

Georgia

Clinicians know a lot about medicine and less about the health insurance benefits their patients have. Members of the unit-based team at the Douglasville Medical Office knew that frustrated patients. They set out in July 2013 to improve the staff’s understanding of member benefits through an ambitious 12-week training session. Before starting the weekly classes, staff members scored an average of 68.5 percent on a test about member benefits. By the end of October, their average score was 95 percent. The team credits its newfound business literacy for boosting service scores, which helped Kaiser Permanente retain a major city account and win a new one. 

Hawaii

More than 1,000 new health plan members joined Kaiser Permanente this summer, thanks to the collaboration between Kaiser Permanente and the Coalition of KP Unions to grow KP membership. The effort started in May with a strong presence at a conference of the Hawaii Government Employees Association—one of six unions covered by the state Employees’ Retirement System, KP Hawaii’s largest customer. Conference delegates visited the KP booth, took Body Mass Index (BMI) readings and participated in a KP-sponsored walk. KP followed up with mailers to prospective members, presentations to union retirees, invitations to tour KP facilities and more. Lynn Ching, labor liaison for the Labor Management Partnership in Hawaii, and Troy Tomita, a KP senior account manager, worked on the project together. “It’s a great headstart for open enrollment in October,” Ching says. 

Mid-Atlantic States

Members of the Ambulatory Surgery Center unit-based team in Gaithersburg, Md., not only are putting the patient at the center of every effort, but also bringing the patient’s family members and friends into the fold. The team created a perioperative liaison role, in which a staff person is assigned to a patient and acts as point person, updating a patient’s friends or family members throughout the patient’s journey through the surgery center. After creating the new role in February 2014, the surgery center’s service scores jumped from 75.8 percent in January 2014 to 88.8 percent in April 2014.

Northern California

Fremont Medical Center employees took all obstacles in stride when it came to adding physical activity to their workday as part of the KP-wide Instant Recess® week in early August. Nearly 200 Fremont workers Hula-Hooped, boxed, danced, hop-scotched and jump-roped as part of the facility’s Instant Recess obstacle course. Usually, Instant Recess is a 5- to 10-minute activity done to music, but it also can be any kind of fun activity that gets people moving. The San Francisco, Richmond and San Rafael medical centers were among the other Northern California locations that joined in the week of Instant Recess, which was organized by national and regional Workforce Wellness programs and the union coalition.

Northwest

Working through unit-based teams, the region has launched a new focus on affordability. The UBT Resource Team is leading the charge by providing such resources as a project template and performance improvement tools, including 6S and the Waste Walk, as it works with teams. In addition, teams can reach out to subject matter experts in finance, purchasing and other areas for assistance. The region’s UBT Data Team will calculate the return on investment of the efforts and enter that information into UBT Tracker. Some teams, such as the Rockwood Medical Office Patient Registration UBT, are working on reducing paper registration forms to cut down on waste and save money.

Southern California

Leaders at the South Bay Medical Center hosted a performance improvement fair for unit-based teams this summer, aimed at giving teams the tools they need to reach levels 4 and 5 on the Path to Performance. After grabbing some healthy snacks at the sign-in table, UBT co-lead pairs sat with an improvement advisor or UBT consultant and got customized advice on how to move their projects forward. For instance, the union co-lead from a medical-surgical unit reviewed data collection techniques at one table, while at another, food and nutrition team members filled out a fishbone diagram for their efforts to collect errant cafeteria trays. Co-leads got help entering their projects into UBT Tracker, then left with a packet of performance improvement tools.

Colorado

The Metabolic Surgical Weight Management unit-based team at the Franklin Medical Office is saving money and improving efficiency by reducing unnecessary lab tests for patients. The team researched current literature and discovered that its process was not adding value to patient care. As a result, the team went from 40 to 50 tests each day to 10 to 12 a day, saving more than $700,000 in one year. The project helped propel the team from a Level 1 to a Level 5 on the Path to Performance. The team won the UBT Value Compass Award for the first quarter of 2015.

Georgia

When the Georgia region sought to promote compliance initiatives while engaging frontline workers, it copied an idea from an existing regional program. “We already have workplace safety champions, so we mirrored what they did to birth this little baby,” says Kim King, fraud control, privacy and security officer. As of December 2014, each of Georgia’s 30 medical centers and its medical records facility boast a compliance champion on site. The goal is to increase under-standing of possible compliance lapses, such as an unlocked door or allowing an unknown person into restricted areas. “Frontline staff—and the majority are union representatives—raise awareness and do monthly walkthroughs of the facilities,” says King.

Hawaii

After she helped set up a network of safety champions at the Moanalua Medical Center and medical offices in the Hawaii region, registered nurse Christy Borton won the individual award for Creating a Safer Workplace at Kaiser Permanente’s Workplace Safety Summit in late February. Borton, the workplace safety co-lead and a member of HNA OPEIU Local 50, is mobilizing colleagues around the region’s renewed focus on safety conversations and safety walk-arounds. Frontline staff share safety tips via a weekly safety newsletter. She also is working with the Safe Patient Handling Committee to spread the use of HoverMatts, which help prevent injuries to both patients and employees.

Mid-Atlantic States

Workplace safety leaders in the Mid-Atlantic States region are committed to investigating incidents in partnership. Ensuring that a labor representative can meet soon after an employee injury was a key to the boost seen over the last several months. In January, 89 percent of incident investigations were performed in partnership, a 10 percent increase over December and significantly better than in October, when fewer than 70 percent were investigated in partnership. Another improvement is that incidents were reported in an average of four days in January compared to an average of eight days in December. “If we don’t keep ourselves and each other safe, we won’t be there for our patients to provide the care they deserve,” says Samantha D. Unkelbach, RN, the labor lead for Workplace Safety/Integrated Disability Management for the Baltimore area and a member of UFCW Local 27.

Northern California

Before moving to a new facility in San Leandro, members of the Pulmonary Sleep Services Center in Hayward took action to raise their patient satisfaction scores from the bottom third to upper third. They asked patients what needed to improve and even visited some members at home. By listening, the unit-based team identified nearly 50 points of confusion patients face from the moment they arrive for treatment to when they go home. From February to August 2014, the UBT began letting patients return diagnostic equipment at their own convenience and staggered lunch breaks to ensure that patients could receive respiratory therapy around the clock. These changes helped transform the team from a Level 1 to a Level 4 on the Path to Performance.

Northwest

Building on the region’s success in exceeding the goal of 75 percent completion of the Total Health Assessment in 2014, Total Health leaders are taking more steps to create a culture of wellness. Cynthia Beaulieu, the region’s Total Health labor lead and an OFNHP member, along with her management partner Lauren Whyte, employee wellness consultant, work with unit-based teams to celebrate team approaches to health. They round on teams with leaders to acknowledge and learn from team efforts. One fun project was collecting “healthy selfies” to showcase on the region’s internet site. Beaulieu and Whyte are encouraging the more than 300 employees who submitted photos to share them on social media using the hashtag #KPHealthie.

Southern California

The region is adding a new dimension to its popular and effective reward and recognition program for inpatient Medical/Surgical and Maternal Child Health unit-based teams: a special award for teams that sustain their strong service scores for an entire year. For the performance year that recently ended, winners were Anaheim Medical Center for Maternal Child Health and Woodland Hills 4 West for Med-Surg. After celebrating their achievements, the teams are expected to help spread their successful practices to their peers at their own facilities and region-wide. Strategies they are considering are a one-day conference with presentations by the winning teams, hosting visits from other UBT co-leads, and monthly webinars.