Performance improvement

After their letters to members went unanswered, the members of the Burke Primary Care team changed their approach.

Instead, clinical assistants called patients with the message, “Your doctor is concerned that your blood pressure is not being controlled,” says Angela N. Williams-Edwards, RN, a member of UFCW Local 400, the team’s lead nurse and former labor co-lead. “It worked better because it was more personal.”

This was in 2011, when the team had challenged itself to get more patients’ blood pressure under control and reduce their risk of a wide range of diseases. They succeeded—and their success mushroomed, with the other centers in Northern Virginia adopting it. All Primary Care teams share the goal of having more patients with blood pressure in a healthy range, and there was no reason for the other teams to start at square one since Burke had demonstrated its way worked—and worked well.

Four years ago, to entice members to come in more frequently to better manage their hypertension, the Burke team also made changes to make the visits for blood pressure checks as appealing as possible:

• Patients could pop in almost any time for the mini-checks, so they could stop when they were at the medical center for other reasons. There was no copay for the quickie visits.
• The members don’t have to wait long. “If they wait too long,” Williams-Edwards says, “their blood pressure will go up.”
• If a member’s blood pressure reading was too high, the doctor came in during that same visit to discuss options—possibly making medication changes—and to urge the member to return for a follow-up within 10 to 14 days.

All of these factors helped the Burke unit-based team increase the percentage of patients whose blood pressure is under control from 75 percent in January of 2011 to 85 percent by August of 2011. Today, the team has not only maintained that improvement but surpassed it. As of November 2014, the team boasts that 90 percent of its patients with hypertension have their blood pressure under control.

“Burke worked so hard to have the results sustained,” says Eileen Chiama, who has been the team’s management co-lead and clinical operations manager for about three years. “We achieved these gains through the huddling process and by keeping focused on it. It became part of our normal workflow.”

Moreover, Chiama says, “The workflow process was shared with other medical centers. The way you spread is to find a champion—someone on the team who is so passionate about the goal.” She says Edwards-Williams is that champion at Burke. “Never underestimate the power of one to generate enthusiasm in the rest of the team.”

Marianne Henson, RN, who was the team’s manager when the project first started, says she met regularly with the area’s other internal medicine clinical operations managers. “We share best practices that way,” she says. Now, several Northern Virginia teams—including Henson’s current teams at Falls Church and Tysons Corner—have improved their rate of blood pressure control, too.

When Marianne Henson, RN, left her position as clinical operations manager of the Burke Primary Care team in Virginia, she took something with her—a plan.

In 2011, Henson helped launch a project at the Burke Medical Center that boosted the percentage of patients with their blood pressure under control. Instead of creating a brand-new plan to solve the same problem at her new facility in Falls Church, Virginia, she became a copycat.

“Why reinvent the wheel?” Henson says. “We already knew what worked.”

When Henson was in her role at Burke, other clinical operations managers and physicians from the 10 Northern Virginia medical centers held regular area-wide meetings that allowed teams faced with similar issues to learn from one another. As a result, other facilities began adopting Burke’s practice of having clinical assistants call members with hypertension to ask them to come in for more frequent blood pressure checks. Burke had already discovered that members ignored requests sent via mass mail, so the other centers didn’t waste time or money repeating that experiment.

“We have members waiting only five to 10 minutes,” says Andrea Brown, a clinical assistant at Falls Church and member of OPEIU Local 2. “We let them know over the phone that this will be a quick visit and they will be on their way.”

Brown and the other clinical assistants try to call at least five members each day to see if they can pop in for a check while at the pharmacy or when they have an appointment with a specialist. And each day, depending on the weather, between three and five patients take advantage of the mini-blood pressure appointments. “This brief visit is cost effective, saves time and helps us make sure the member is on the right track,” Brown says.

Brown says members have given her positive feedback because of the convenience.

“It made sense because the whole region was expected to bring hypertension control up to better levels,” Henson says. “We standardized what we do.”

Our Value Compass puts the patient at the center. But—which patient do we mean?

If you are, say, a registered nurse on a telemetry unit, do you mean just your specific patient? Or all the patients in your department? Or at your whole facility? In your region?

What would happen if you took the One KP strategy to heart and considered every patient at every Kaiser Permanente facility your patient?

In this issue of Hank, you’ll find ways to do just that. How? By sharing your own department’s successful practices—and by learning from your colleagues’ triumphs in improving care.

Let’s face it: As at every large organization, there are silos and turf at KP, with attendant rivalries among departments, facilities and regions. That sense of competition on everything from service scores to attendance to membership growth can make it seem like quality is a zero-sum game—that my improvement must come at your expense.

As at other institutions, there’s also a bias against anything “not invented here.” How many times have you heard, “But that won’t work here. We’re—different.” Really? Is the birth of a baby so different in Oakland than in Portland? Is filling a prescription for statins so different in Atlanta than in Denver? Or could the same approaches to improving service and quality work regardless of location?

As an antidote to “not invented here,” try “proudly found elsewhere.” Open your mind, eyes, heart and—yes—ego to improvements from outside your home base. When you view every KP patient as yours, you won’t hesitate to spread what you’ve learned to others and to learn from them in turn.