Successful practices

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.

Summer interns often are put to work fetching coffee or making copies. But last year, UBT consultant Geoffrey Gamble wanted to create a more valuable experience for the teens of KP’s Summer Youth Employment Program at the Modesto Medical Center. So he trained a small army of performance improvement consultants to help support unit-based teams.

Despite initial skepticism from some team members and managers, the results were stunning. By the end of the summer, 12 of the 13 teams supported by the interns advanced at least one level on the Path to Performance. What’s more, four of the 19 projects carried out by the UBTs yielded savings or cost avoidance totaling $400,000. The program was such a success, it has returned to Modesto this summer and has spread to the Sacramento and San Jose medical centers. And in the process, the interns are gaining on-the-job training that translates to their studies and to the work world.

“I went in thinking we were going to do grunt work, but in reality it was like, ‘Wow, I’m actually doing something I can apply,’” says Nate Aguirre, who interned in Modesto’s Emergency Department last year. “It was a life-changing experience.”

The Community Benefit program has offered training and work experience to teenagers in underserved communities since 1968. In the past, that experience included clerical work or coaching on speaking in front of a large group. When Modesto’s internship coordinator retired in 2013, Gamble agreed to oversee the program as long as it supported his work developing UBTs.

Overcoming doubt with results

“When I first proposed the idea, directors were very skeptical,” Gamble recalls. “People would say, We’re struggling to do this with professionals—how do you expect to get momentum from a 16-year-old?’”

But Gamble saw the opportunity to offer teams a fresh perspective and the daily support many need to get started. He also wanted to show team members that performance improvement didn’t have to be complicated and could be incorporated in their daily work.

“I told managers that I was going to treat (interns) like adults and give them the skills I would give employees,” Gamble says. “If you hold them to that expectation, they will rise to the occasion.”

In the first few days of the eight-week program, Gamble trained the 16-year-old interns in basic performance improvement tools, including the Rapid Improvement Model, process mapping and Labor Management Partnership basics. By the second week, the youth were assigned to Level 1, 2 and 3 unit-based teams and started helping the teams launch projects and enter data into UBT Tracker.  

Rosemary Sanchez, Modesto’s Emergency Department supervisor, was one of the loudest doubters.

“At first I was like, ‘Ugh, one more thing to do.’ But then I thought, ‘OK, this could work and help us accomplish our goals and share our knowledge.’” 

Intern Nate Aguirre was crucial in helping the team on its project to streamline and standardize supplies in the treatment rooms.

“Nate was awesome,” Sanchez says. “He was so enthusiastic collecting data.”  

Getting the ball rolling

Aguirre also spent time talking to employees in the department to learn about their jobs and the challenges they face in their work.

Meghan Baker, an Emergency Department clerk and union co-lead for the UBT, says that sparked interest and support from UBT members—a shift from before, when they had struggled to get employees involved.

“People were into having their voice heard by someone,” says Baker, who's a member of SEIU-UHW. “Now people are talking and getting the ball rolling on things. And we’re making it known that people are being heard.”

At the start of the program, the Emergency Department UBT was ranked at Level 3. The team advanced to Level 4 after completing the work.

Michelle Smith, manager of Specialty Surgery Reception, appreciated the new perspective and support her team received from its intern for its project to reduce surgery no-shows and last-minute cancellations.

“It was nice to have someone get our project going,” she says, “because we were at a standstill.”

The team’s intern walked the UBT members through mapping out their process. New workflows emerged that included calling patients ahead of scheduled surgeries, which reduced no-shows and increased service scores.

When the teams were asked what they thought helped them advance, many said it was because of the interns coming to the departments every day to help push and support the work. 

“We would have eventually worked on the project, but having her come in and start us off in a positive way was great,” Smith says. “She taught us how to be a team, because we realized we all had to be part of the work.”

Want a safer workplace served up on a silver platter?

Then stop by the operating room at Kaiser Permanente’s West Los Angeles Medical Center in Southern California. Surgeons and the other health care workers there pass sharp instruments to one another on silver trays—rather than passing them hand to hand—which reduced injuries related to handling sharp instruments during procedures by 34 percent between September 2013 and May 2014.

“We can see the results,” says Lisa Duff, a surgical tech and workplace safety champion at the facility. This success is part of a new emphasis at the facility on task standardization—analyzing each step of an activity, identifying the potentially hazardous steps, coming up with a safer way of doing things and then ensuring everyone follows the new process the same way, every time.

How to reduce risk

“Injuries occur when there is not consistency,” says Tracy Fietz, chief administrative officer for Southern California Permanente Medical Group at West L.A.  “If you break [a task] apart on a fishbone diagram, you can identify where the risks are. It is about removing variation.”  

Standardizing practices also has helped several departments reduce—and in some cases eliminate—sharps-related injuries for up to 17 consecutive months. It’s also helped reduce injuries to EVS workers by 75 percent when they clean floors.

Another practice that is improving safety at West L.A. Medical Center is regular monthly meetings between senior leaders,  including Fietz, and the labor and management safety leaders of targeted departments. Departments that have special line-of-sight safety goals (see below) in the region’s Performance Sharing Program get special attention. The gatherings are a space to analyze processes, see what’s working—and what isn’t—and collect information to share with others.

How partnership helps

“I work with managers and the workplace safety champions, because it’s a partnership,” says Nor Jemjemian, the chief administrative officer for Kaiser Permanente Hospital/Health Plan at West L.A., who also leads those meetings. “I want the employees doing the tasks to be part of the solutions.”

Union-represented employees, for their part, appreciate the crystal-clear message top leadership is sending.

“You need management to back you up when you speak up,” says Duff, a member of SEIU-UHW. “Employees know that our managers will back them up 200 percent.”

Open communication, trust and partnership processes are the foundation of a safer workplace, says Jemjemian.

“When I was an employee, there were [hazardous] tasks I did that my manager didn’t know about,” he says. Today, in contrast, “UBTs create a venue and a forum to discuss the everyday work.”