Roles

Bernie Nadel is director of customer service and call center operations at Patient Financial Services in Southern California. He co-chairs the Regional Operations LMP Council, bringing together 27 business units, including the regional laboratory, central refill pharmacy and optical services.   

None of us was born into a unit-based team. Partnership is learned. Teams and their leaders need guidance and a playbook.

I tell other managers partnership makes my job easier. I have 10 other people helping to come up with solutions. I know some managers are uncomfortable with that approach. They act as though they can opt out of the Labor Management Partnership. It’s as if they said, “I know we have KP HealthConnect™, but I want to use this other computer program.” I say, if you don’t want the LMP, don’t work at Kaiser Permanente. You don’t get to opt out of the company’s policy.

Owning the work

Recently, our UBT went through a list of issues to work on. Call volume is up 30 percent, and we’re figuring out how to deal with that. We are going to do several tests of change. UBT members are gung ho about it. If I were to try to make those changes myself, I’d miss things. I would not get the insights of the people who interact with our members every day. And the people doing the work wouldn’t have the ownership and energy that comes with having a voice. Employees know I believe in partnership—and I give them the time to do it. That is a challenge. But you can’t solve the problems if you don’t invest.  

Not that long ago this call center was a toxic environment. There was low trust and low morale. All that has switched 180 degrees. A big step was my predecessor attending a sponsorship training class, which led her to involving UBTs more in day-to-day operations. I wanted to build on that.  

Taking the first step

LMP is a dance between labor and management, and management has to take the first step. When labor sees that management is serious, that’s when it changes. We’ve shown that you can change the culture.

Recently, we had a meeting with top executives about improving the consumer financial experience. Our UBT representative group prepared a report, and it gave our executives insights they couldn’t get any other way. It was not slick, it was real. I’m grateful to the group for the experience, commitment and knowledge they bring to this work every day.

For more than 10 years, Kaiser Permanente’s Child Health Program has been veiled in relative obscurity despite the extraordinary service it offers.

Even more unknown is the role KP enrollment processors in Northern California, who are represented by OPEIU Local 29, are playing in helping the charitable health program fulfill KP’s mission of serving our communities.

“I like to say that we’re the best-kept secret of KP,” says Sharlene Jones, an enrollment processor who screens applicants for eligibility and guides them through the sign-up process. The community benefit program provides comprehensive medical, dental and optical coverage at little or no cost to children ages 19 and younger whose family income falls below the federal poverty level and who have no other coverage options.

Since August, the Oakland-based enrollment processors have attended more than 40 health coverage enrollment or outreach events across Northern California, from informational sessions at small medical clinics to large events like the “We Connect Health Care” enrollment and resource fair in Fresno, which drew thousands of people. The processors answer any question thrown at them about the Child Health Program and help enroll those who qualify.

“Our processors are able to help families right on the spot,” says Sara Hurd, a former employee who until recently led outreach for the program. “They know what challenges are and how to work through them.”

Long-lasting value

The Child Health Program has a goal of enrolling 80,000 qualified children across Northern and Southern California. The work the Local 29 members are doing to help meet that goal fits within the framework of Labor Management Partnership efforts to grow the number of Kaiser Permanente members—and to establish positive member relationships that can last a lifetime.

As outreach coordinator, Hurd’s priority was getting the word out about the program and forging relationships with community organizations. She also served as the sole contact for prospective applicants at outreach events—but she didn’t have the detailed enrollment knowledge the Local 29 processors have.

Maury Rosas, manager of Charitable Health Coverage operations, reached out to enlist the processors’ help. Including them in the work, Hurd says, “has been invaluable”—and as of May 2014, more than 77,000 children were enrolled.

“We needed people who really understood what the applications are about and could help people with eligibility,” Rosas says. Before he requested their help in the field, the enrollment processors’ interactions with potential qualifying applicants were by phone or letter.

“We’re able to answer their questions,” Jones says. “It allows us to put a face on KP.”

Many of the processers who attend the events have bilingual certification and are skilled in walking applicants through enrollment in Spanish.

“It’s important to show (the public) that we’re not just sitting behind a desk, pushing papers,” says Miriam Garcia, an enrollment processor. “We’re the labor force behind it all….We’re here to work with the community and are proud of KP.”

Demonstrating a commitment

The effort has been an unqualified success, Rosas says, from community agencies asking for repeat visits to the response of the children’s parents.

“They took me by the hand and walked me through the process of completing the application and made me feel comfortable with the process,” says Rufina Garcia, speaking through a Spanish interpreter. Garcia enrolled her three children in the program at an outreach event in March. “This has been the first time when I could walk in and give my information and be signed up right there.”

Delivering on KP’s mission in partnership between labor and management also helps build relationships with potential union-oriented purchasers of health care, says Katy McKenzie, a consultant to LMP and its membership growth work.

“It goes a long way when you’re talking to unions that represent low-wage workers,” McKenzie says. “They see that we actually do care about caring for people and our communities. It’s not just about selling something to them.”

McKenzie and others involved in the growth work helped promote the Child Health Program to unions representing low-wage or part-time workers, such as laundry or home care workers—people who don’t get dependent health care coverage as part of their job benefits or who can’t afford what is offered to them.

 “It’s a great opportunity to see that management is working with labor as a team,” Miriam Garcia says. “We’re not only supporting KP, but we’re supporting our own labor force.  We’re showing that we can work together and make a change. We’re helping make a change that carries over into the community.”

That kind of caring makes an impression. Rufina Garcia, who only has catastrophic medical coverage for herself, says she would choose Kaiser Permanente for her whole family given the chance.

“It has been a wonderful experience,” she says. “The way they treat my children is incredible. (The doctors and nurses) are very caring—they have more patience and actually listen to the kids….I believe they take better care of my children.”

Marcella Austin spent her first six years at Kaiser Permanente as a medical assistant. Three years ago, she became a licensed vocational nurse through a partnership between KP, the Ben Hudnall Memorial Trust, Chaffey College and the San Bernardino County Workforce Investment Board that funded a Pathway to LVN project. That gave her the support she needed to advance her career—tuition, books, tutoring and wages. She was one of the first of nearly 50 KP employees to graduate. She was interviewed by LMP Senior Communications Consultant Anjetta McQueen.

Q. What started you on your journey?

A. My father, who is diabetic, had a heart attack when I was in college. My mom and I were the first ones at the ER with him. It was scary, but I remember those nurses and how they took care of him and us. One of the nurses took an orange from her lunch and taught me how to do an insulin injection. I fell in love with nursing. Six months later, I became a medical assistant. I thought that was as close as I would get.

Q. How did you manage school after years of working?

A. I went to school full time and worked in Urgent Care from 5 to 9, getting my 20 hours a week. The Ben Hudnall trust covered the other 20 hours. I never lost a paycheck. It’s not like I could say I didn’t have the funds—the funds were there.

Q. What about the responsibilities at home?

A. I have two kids, a 16-year-old daughter and a son who is 13. I had a husband, mother and mother-in-law all helping me out. I used to be the one who cooked, cleaned and picked up after everyone. All of this helped my kids become more responsible.

Q. College nursing slots are hard to come by. How did Chaffey College help?

A. I have taken one course or another since graduation from high school. I also took time to get married, have children. Chaffey pulled all of my transcripts from everywhere and offered the prerequisite classes I still needed.

Q. Your wages and tuition were covered, but how did you manage all those other costs?

A. We owe a lot of thanks to the county’s Workforce Investment Board. They saw a need for educating people in the community. We didn’t have to worry about transportation, uniforms or supplies during our clinicals. All of that can really add up.

Q. How did the cooperation of your labor management partners help you?

A. Managers and labor leads stayed with us every step of the way. They had meetings with us. They kept asking us how they could help. If there was a barrier, if a schedule needed changing, they would work together to see that it got done. I especially appreciate the help from Susan Rainey, the department administrator for staffing at Ontario; career counselor Michele DeRosa with the Hudnall trust; Margaret Winningham, a senior Human Resources consultant for Fontana/Ontario; and Valerie Robinson, a Local 7600 representative.

Q. What is different about your work now?

A. In the LVN training, you get the basics—biology, anatomy, psychology—but you also learn about nursing care plans, sterile processing, wound care and get hands-on training all while attending school. I can assist RNs in several procedures, do minor surgical assists, order and co-sign documents in KP HealthConnect®.

Q. What is different about you?

A. My confidence has gone through the roof. I was selected to go to the KP Quality Conference, and I was invited to speak in a leadership meeting about my experience. The girls on the unit tease me now, saying they want my autograph.

Improve service scores. Reduce waste. Retain members. Gain new members. Cut wait times. Work safer. Perfect patient safety. Innovate care.

Teams are juggling constantly, trying to meet their own objectives, move forward on initiatives related to facility, regional and national goals, and comply with regulatory requirements—all in a competitive economic environment.

When the curve ball comes sliding in, it can be one thing too many, derailing a strong team or keeping a struggling team at ground level. So a host of unit-based team supporters are turning their attention to strategies to help unit-based teams prioritize competing demands—from personalized mentoring to intensive workshops for co-leads.

“I see my role as taking away the noise and the chaos…to help them figure out, ‘Realistically, how many things can we work on at once?’” says Denise Johnson, San Jose Medical Center continuum of care administrator and a UBT sponsor. “I have to help them not be crazy, because we don’t want a lot of projects that don’t make a difference.”

Here are four strategies for helping teams.

Strategy #1: Planning pays off

Every year, labor and management sponsors at the San Jose Medical Center sit down with their UBT co-leads to develop an operating plan. The plan flows from Kaiser Permanente’s organizational goals as well as from regional goals, facility priorities, and the needs of the department. Each sit-down includes the service area’s UBT consultant and its union partnership representative. Projects emerge naturally from that plan, with teams turning to the Value Compass and a tool called a PICK chart to fine-tune their priorities.

“They have to figure out what’s in their sphere of influence,” says Eric Abbott, the area’s union partnership representative. “What are the things they can change, and of those things, how much time do they have?”

When Johnson became sponsor of one San Jose team, it was immediately clear to her the UBT had too much on its plate. She worked with the team to winnow eight projects down to two.

“In my experience, people get bogged down with the to-do list and sometimes don’t stop and think about what’s really on that list and what effort does it serve,” she says. “They thought I was crazy. They came from a mentality where ‘more is better.’”

Strategy #2: Urgency can be a tool

Two years ago, San Diego’s interventional anesthesia unit-based team was humming along in its performance improvement work when it got hit with the news that co-pays for patients who suffer from chronic pain would be increasing sharply.

The 14-member team responded with a new service project, a multiphase communication plan to help members understand the new co-pay and their options. And then the next wave broke: The team learned it had a matter of days to move into a new specialty services building. It suspended the co-pay project to plan for and complete the move.

One key performance improvement tool—a process map—proved instrumental. The team created a detailed map that laid out every piece of work that needed to be done in preparation for the transition, from changing procedures to adapting to a new phone system to altering workflows based on the new floor plan.

“They simply became a single-issue team,” says their UBT consultant, Sylvia Wallace, of the 2011 move.

With the process map in hand, the team spotted an opportunity to weave communication about the new co-pays together with communication about the move. As a result, it didn’t miss a beat in providing its members with critical information about available financial assistance.

The comprehensive plan helped the unit’s service scores hold steady through the transition—and then increase at the new facility. The moving plan became a template for other departments, which are still moving into the Garfield Specialty Center.

“Everyone participated. All types of ideas were solicited and implemented,” says Grace Francisco, the assistant department administrator and the management co-lead at the time. “Everyone has a role and accountability for each step.”

Strategy #3: Take time to train

Teams stand a better chance of weathering competing demands when they have a solid understanding of partnership principles and processes as well as performance improvement tools and methods.

In Colorado, the UBT consultants used LMP Innovation grant funds to host a two-day workshop centered on two regional priorities. Co-lead pairs from throughout the region learned how best to serve new members and improve the affordability of KP care by reducing waste and inefficient practices. They walked away with a variety of team improvement tools and resources.

“We are trying to set the teams up to be successful by giving them the time to focus on topics that could have a huge impact in the region in the next few years,” says Linda Focht, a UBT consultant and UFCW Local 7 member.

In San Diego, regular UBT summits bring co-leads together for intensive sessions on given topics. Service area and local union leaders play a major role in structuring the agenda, so the team development matches up with high-level strategy. The joint planning creates a full picture, one that resonates better at the front line and sets up teams to work on projects that make a difference to KP’s reputation.

“Leaders see a lot more than what we see,” says Jenny Button, director of Business Strategy and Performance Improvement in San Diego. “Leaders see what is going on with the competition. They see across all of the different metrics we are working toward. They see at a broad level where our biggest gaps are.”

Strategy #4: One-on-one attention counts

At San Jose Medical Center, sponsors like Johnson and Hollie Parker-Winzenread, an assistant medical group administrator, are coaching UBTs one on one in performance improvement tools to help them set priorities.

 “Teams like to jump to the solution,” says Parker-Winzenread. “But they struggle with the process….The gain falls apart, because the process is not strong.”

San Jose’s clinical laboratory UBT is a success story, jumping from a Level 1 to a Level 4 in less than a year after new co-leads worked together to reach joint agreement on the department’s priorities. The team started with tests of change that made strides in attendance. Today, it has moved on to complex projects that require shifting schedules to accommodate demands for getting lab results earlier in the day.

Guidance from their sponsors has helped keep team members on track.

“We’d come up with all of these ideas and projects, and they made suggestions and really helped prioritize what we worked on so we didn’t bite off more than we could chew,” says Antoinette Sandez, a phlebotomist, the team’s union co-lead and an SEIU UHW member.

“You have to help teams to believe in the process,” Johnson says. “As a sponsor I can’t rush the process and say harder, faster, move, move, move. That won’t get us what we want in the long run. Because we’re looking for sustainability.”