Performance improvement

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.

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.”

Although Rahul Nayak, MD, calls himself “fundamentally lazy,” it might be more accurate to call him lazy like a fox. Instead of starting from scratch to create Georgia’s centralized Outpatient Safety Net Program, his team started with a recipe provided by Southern California.

“Someone has already done something that works. Why not start there?” says Dr. Nayak, who was physician program director of patient safety for Georgia when the program launched.

Dr. Nayak’s outlook serves as the guiding force behind spread—the art of adopting a practice, workflow or project from another team, medical center or even an entire region. The benefits? As the Georgia team learned, new initiatives often get off the ground faster if they’re modeled on an already proven concept. The Southern California safety net system had already won a 2012 David M. Lawrence Patient Safety Award for its work.

“The foundation was laid,” says safety net team member Eula Maddox, LPN, a member of UFCW Local 1996. Maddox makes up to 60 calls a day, phoning members who have had abnormal lab results and scheduling follow-up appointments. “These calls reduce stress for patients and costs for Kaiser Permanente,” she says. But, she notes, the team had to adapt the program for it to work well for Georgia members, including changing the hours that calls were made.

For its work, the team won the 2014 David M. Lawrence Patient Safety Award in the transfer category—an award for a region that successfully implements a project from an earlier award winner. The award recognizes the importance of spreading best practices, which ensures that members receive the same high level of care regardless of which medical center they visit. That’s a primary principle of One KP, which sets the goal of providing every health plan member with “the best experience, everywhere, every time.”

“Our members and customers believe—rightfully so—that we know how to operate as one organization,” says Bernard J. Tyson, KP’s chairman and CEO, “and that whatever we learn about the best ways to care for people in one geographic area…is available to all of our 9.6 million members.”

Best practices occur at all levels and in all departments. In Colorado, for example, the Regional Lab unit-based team tackled the issue of standardizing labels. Even a simple mistake—putting a label on crooked—can adversely affect patient care. The team is creating visual aids and tip sheets that will spread to 28 locations by this fall.

“This is a problem people have had to deal with for years and are passionate about fixing,” says Beth Fisher, a medical technologist, member of UFCW Local 7 and sponsor for the regional lab team.

Spreading practices takes effort from both sides. At Virginia’s Burke Medical Center, a project launched by the Primary Care team four years ago has sustained its success in helping patients with hypertension get their blood pressure under control—and the team has helped other facilities in Northern Virginia adopt the practice.

“If it works for us, it will work for other people,” says the Burke team’s lead nurse, Angela N. Williams-Edwards, RN, a UFCW Local 400 member. “Other teams saw it was easy and ran with it.”