Service

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 new Lone Tree Specialty Care Medical Office, a 25-acre campus, boasts outdoor patios, picturesque mountain views and a walkway around the perimeter of the building. The facility, which opened in December 2013, was awarded a LEED (Leadership in Energy and Environmental Design) Silver certification by the United States Green Building Council. Lone Tree, which is near a light rail line, used recycled materials, water-wise fixtures and shading devices for balancing solar heat to win the LEED designation. The facility has nearly 350 employees and 45 physicians to take care of the 3,000 ambulatory surgeries and 3,000 minor procedures expected per year.

Georgia

What happens when two nurses from two different high-performing UBTs transfer to the same brand-new Level 1 team? That team zooms to a Level 4 in only 10 months. Jane Baxter and Ingrid Baillie, both RNs, had been UBT co-leads at the Crescent and Cumberland medical centers, respectively, and then joined the Ob/Gyn staff at Alpharetta. Drawing on their experience—at different times, they each have been UFCW Local 1996 members and members of management—they helped their new UBT move up through the Path to Performance. “We knew the steps in the process and what to expect,” says Baxter. Their advice to fledging teams: Start with small performance improvement projects in areas that clearly are Kaiser Permanente priorities and that already have lots of data collected.

Hawaii

Nurses on the 1-West Medical-Surgical unit-based team at Moanalua Medical Center vastly improved how well they educate patients about medications, moving from about 40 percent of surveyed patients saying they understood side effects and other aspects of their prescriptions to 96 percent reporting this awareness. Between April and December 2013, the RNs, who are members of the Hawaii Nurses’ Association (HNA), made notations on patient room whiteboards, rounded hourly and did daily teach-backs on every shift. The team members designed a three-day survey for a sampling of patients to report what they understood about side effects of their medicine. The survey provided speedier feedback than waiting more than three months for HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores.

Mid-Atlantic States

A Nephrology team at Tysons Corner Medical Center in Virginia helped patients prevent or manage chronic kidney disease by getting them into the classroom. Just 70 percent of the unit’s patients at risk of renal failure were enrolling in KP disease management classes in February 2013. But several successful tests of change boosted at-risk patient enrollment in March to 100 percent, where it has remained since. The team noted on individual patient charts if the member suffered chronic kidney disease, developed scripting for in-person coaching, mailed class invitations to patients’ homes and handed out class agendas with after-visit summaries.

Northern California

The Modesto Pediatrics UBT improved wait times for immunizations—and not only increased service scores but also reduced overtime costs, an example of how a change can affect an entire system. The team reduced patient waits for immunizations from 45 minutes to 15 minutes between June and August 2013 and maintained the improvement through the rest of the year. A workflow change was key to the dramatic reduction. When a patient is ready for an injection, physicians now copy the orders to a nursing in-box instead of searching for a licensed vocational nurse to give the shot. The half-hour reduction in wait times—which is credited with improving service scores from 86 percent to 95 percent—also reduced the need for LVN overtime by an hour a day, resulting in savings of more than $16,600 over six months. 

Northwest

The regional Employee Health and Safety department won KP’s “Engaging the Frontline” National Workplace Safety Award. Through the Northwest’s Safety Committee Challenge, facilities had to complete a rigorous set of tasks, including regularly scheduled safety meetings, joint planning with NW Permanente and Permanente Dental Associates, safety conversation training, awareness plans and a safety promotion event during the year. Of the 16 facilities that rose to the challenge, nine met all of the qualifications. The region ended the year with a 4 percent reduction in accepted claims compared with 2013. Leonard Hayes, regional EVS manager, won the individual award for his work, which contributed to the East service area’s EVS team going injury-free for the last four years.

Southern California

The regional LMP council has set a 2014 Performance Sharing Program (PSP) goal to power up unit-based teams’ achievements on improving affordability. When at least 50 percent of a medical center’s UBTs complete a project that saves money or improves revenue capture—and if the region meets its financial goals—eligible employees and managers there will get a boost in their bonus. “Imagine how powerful it will be to have a majority of unit-based teams achieving measurable cost-savings and revenue-capture improvements,” says Josh Rutkoff, a national coordinator for the Coalition of Kaiser Permanente Unions. “The idea is to take all the strong work on affordability at the front line to a whole new level.”

This time, I was the patient. I’m confident I received the right care at the right time. The removal of a suspicious polyp may have averted colon cancer a few decades hence. I’m grateful for that.

But I wouldn’t say I was “at the center” of my care team’s processes. My interaction brought home for me the theme of this issue of Hank, how we can improve care by asking members to participate in performance improvement. Previous patients could have told my team:

The instructions given to members on prepping for a colonoscopy don’t mention that the effects of the purgatives might take two hours to arrive—and then arrive so urgently you’d better be three steps from the toilet. The prep sheet should note what you can do to be ready.

In the clinic itself, the row of patients lined up on their gurneys don’t need to overhear nurses, somewhat frustrated, adapting to staffing changes. Problem solving is good, but save those discussions for staff areas.

In the procedure room, introduce yourselves—and keep pleasantries appropriate. In my case, one of two nurses remained anonymous. The doctor introduced himself but asked, “How are we doing today?” The “we” was a wrong note; he and I were having distinctly different days

Body and spirit are intertwined, and so, too, are quality and service. Our bodies need “best quality,” our spirits need “best service.” Best care addresses both. Patients know better than anyone what best service looks like. Find ways to invite their voices into your team’s work.

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.