Plan, do, study, act

As we move toward the “next normal,” the Labor Management Partnership has played a key part in supporting COVID-19 vaccinations.

Frontline workers, doctors and managers have come together to get shots in arms. These fruitful collaborations point the way forward as Kaiser Permanente and the Partnership unions work to transform fear into confidence, confusion into clarity, and hesitancy into bold action.

Look at the data

A joint effort between SEIU-UHW and physicians pushed vaccination rates of the union’s members from less than 50% all the way up to 64% within 3 months. It began when union leaders crunched the numbers — and didn’t like what they saw.

At the beginning of February, less than half of SEIU-UHW members at Kaiser Permanente were vaccinated against COVID-19. For instance, only 40% of union employees were vaccinated in the Emergency Department at Downey Medical Center in Southern California, where Gabriel Montoya works as an emergency medical technician.

Montoya and his fellow union members — working with physicians and managers — wanted to raise those rates, so they pulled together labor-doctor huddles. Union members were scared, confused and hesitant.

Building trust

At first, they considered joint physician-labor rounding. But they realized being in patient areas wouldn’t support those conversations, so they pivoted to huddles — short, informal team meetings.

Carol Ishimatsu, MD, a pediatrician with the Southern California Permanente Medical Group, was one of the first doctors to join a huddle in Downey.

“Vaccines are our most important intervention,” says Dr. Ishimatsu, who participated in the clinical trials for the shots when they were being tested.

To build trust, Dr. Ishimatsu emphasized her shared experience with SEIU-UHW members as warriors on the front line. “I told the employees: I do the same thing you do after work,” she says, describing her ritual of removing her clothes in the garage and putting them directly in the washing machine before entering the house. “We are in different professions, doing the same thing.”

Joel Valenciano, an Environmental Services manager at Downey, helped organize huddles at outlying clinics.

“I encouraged the staff to be honest, relate their fears and doubts, anything holding them back,” he says. “And they really opened up.”

“We did it in partnership,” says Montoya, the emergency medical technician. “The labor partners led the huddles and introduced the doctors.

I can’t imagine that happening in a nonunion hospital, or even a non-Partnership hospital.”

Amy Edmondson says innovation depends on a culture of focused chaos.

Those words sound like opposites. They are. Don’t worry. It’s not a mistake.

In fact, innovation depends on four pairs of seeming opposites. As unit-based teams ramp up, involving frontline managers, physicians and employees in finding new ways to improve performance and transform health care, they can benefit from creating a culture of innovation. This is how Edmonson, a professor at Harvard Business School, defines the four cultural contradictions of innovation:

• Chaotic/focused
• Playful/disciplined
• Deep expertise/broad thinking
• Promotes high standards/tolerates failure

Let's take a more detailed look.

Chaotic/focused

“An innovation culture is focused,” says Edmondson. “It is really intent on improving a process or inventing a new business model or coming up with a new product.” At the same time, it is chaotic. “Any idea is welcome and possible—at least until we sort it out. No idea is a bad idea—at least early in the process.”Chaos, says Edmondson, “is about welcoming all ideas, even ‘wacky’ ideas.” Only in a psychologically safe learning environment will employees feel open enough to offer these “wacky” ideas, she adds.

Playful/disciplined

The Labor Management Partnership offers a disciplined process for innovation in the form of the Rapid Improvement Model (RIM) and the plan, do, study, act cycle. But, Edmondson emphasizes, teams use these tools “without knowing in advance what the answer is.” There is a careful and well-managed process, but the content of the conversations about improving performance must be open and inclusive. As teams begin a performance improvement project, UBT leaders need to be very clear about what aspect of performance they are trying to address—not on how the team is going to do it.

Deep expertise/broad thinking

An innovative team is one that values those who bring deep expertise (in a specific topic, subject area or clinical specialty, for instance) and people who are broad, general thinkers who span boundaries. “Both of those skill sets are absolutely essential at the same time,” says Edmondson.

Promotes high standards/tolerates failure

In an innovative work culture, “We hold very high standards but we are also very tolerant of failure,” says Edmondson. “That sounds ‘wrong,’ at first,” she admits, “but it is essential because, in innovation, you will never get it right the first time. You try something, test it out, it’s not going to work quite right and then you either tweak it or throw it out altogether and try something else.”

Spreading new ideas that get results throughout a large organization such as Kaiser Permanente, says Edmondson, requires finding ways to “shine a very quiet spotlight”—another seeming contradiction!—on innovators so others become aware of what they are doing and are drawn to try it too. 

“In today’s world, there are two ways to get the word out,” she says. The first is face-to-face communication, “positive buzz that starts locally and spreads.” The other is internal online social networks as “a way to listen, motivate and share practices that are potentially better.”

“It can catch on,” says Edmondson. “When there are pockets of effectiveness, other people see them, and they want to play too.”