Trust

COVID-19 is testing partnership as never before.

Management and labor have had to work together quickly to retool the delivery system to support rapidly changing needs. Employees’ and physicians’ skills and talents are needed in new ways and in new places — so leaders from Kaiser Permanente and unions created labor pools to get KP employees to where they were needed.  

It’s one of dozens of innovations made to provide top-quality care at a time when every day is bringing new challenges. The swift work was possible in part because of the foundation provided by the relationships and values of the Labor Management Partnership.

In Southern California's Riverside service area, “It’s all-hands on deck,” says Jiji Abraham, area chief financial officer. “Even physicians are in the labor pool.”

As physician assistant Larry Rick, PA-C, made his rounds of the South Bay Medical Center one recent morning, staff stood at the hospital’s main entrance and screened members, patients, and employees for signs of cold- and flu-like symptoms. Like Kaiser Permanente facilities enterprise-wide, the Southern California hospital adopted the new procedure to protect patients and staff from COVID-19, the respiratory illness caused by the novel coronavirus.

A well-established approach is also helping: Frontline workers here say years of working collaboratively with managers as part of the Labor Management Partnership has better prepared them to fight the pandemic. The Partnership has saved money, improved care, and led to better service – and now will literally be saving more lives because frontline workers, managers, and physicians are working together.

An opportunity to speak up

“Partnership is a fantastic tool,” says Rick, a member of UNAC/UHCP, who has 34 years of experience fighting infectious diseases including H1N1, HIV, and sexually transmitted diseases to prevent the spread of HIV. “Every Kaiser Permanente senior leader has been responsive to our requests and has heard us. We’re working together and everybody is leaning in” to treat more patients now, while preparing for an expected surge. In response to unit-based team members’ concerns, for example, tape was placed in 6-foot intervals on pharmacy floors to help members and patients maintain social distancing while standing in line.

“We’re able to speak up as labor and help figure out the solution,” says Alejandra Navarro, a registered nurse in Maternal Child Health and a member of UNAC/UHCP.

Working in partnership together has also built trust between management and labor. That’s been key to maintaining open lines of communication now and helping counter misconceptions spread by social media, say frontline workers.

Education and support

“They’re educating us and giving us a lot of support,” said Lizz Burnett, a licensed vocational nurse in Geriatrics and a member of SEIU-UHW. “If I can help educate someone and they can tell their family, then maybe we can stop this.”

Tynikko Snyder, a registered nurse in Family Medicine at the Gardena Medical Offices, has 2 children with asthma and her mother suffers from chronic obstructive pulmonary disease. She is worried about the impact of her work on her family. “I am afraid, but I know that I need to step up to the plate and do what needs to be done,” says Snyder, who is a member of UNAC/UHCP. Rick says that can-do spirit is needed to combat the spread of the disease: “If we all do our jobs, we will save lives.”

When one of her teams is able to leap over the roadblocks in its path with the grace of an Olympic hurdler, Charisse Lewis finds herself out of a job.

As a UBT consultant for the Baldwin Park Medical Center in Southern California, it’s an occupational hazard that she looks forward to—again and again. Like coaches everywhere, she enjoys seeing her teams take what they’ve learned and make it their own.

“I do a lot of mentoring,” says Lewis, who acts as coach, counselor and head cheerleader for her facility’s 68 unit-based teams, nudging them past milestones on the Path to Performance, the five-stage “growth chart” UBTs use to measure success. “I’m teaching teams how to function without me.”

For example, she recently helped a team of critical care nurses advance from Level 1 to Level 4 by using an array of strategies from team-building activities to involving union representatives. Another team advanced to Level 4 in part because she coached the management co-lead, who was new to Kaiser Permanente, in how to manage effectively in a partnership culture.

A team to help teams

Lewis doesn’t work alone. She’s part of Baldwin Park’s UBT Strategy Group, a SWAT team of union members and managers who target at-risk teams. That team’s goal is to help UBTs excel so they can drive performance to provide the best service, quality, affordability and job satisfaction. Low-performing teams, says Lewis, tend to suffer from poor communication, paltry trust and a lack of transparency.

“It’s hard to get past that stuff,” she says. “They flounder there. They don’t trust each other and it’s hard to be a team.”

Part of Lewis’s talent in helping turn teams around is her skill in assessing stumbling blocks and getting teams engaged with the right resources. She draws on her experience as an LMP coordinator, trainer and improvement advisor to nuture her teams.

“I don’t like to stare at that elephant in the room,” says Lewis. “If it’s a contract issue, then we need a contract specialist. If it’s an HR issue, let’s make sure that HR is involved. I like to address the problem and get the team’s leaders involved, from both labor and management.”

Tops in Southern California

Her approach speaks for itself. Baldwin Park has the highest percentage of high-performing teams in Southern California: Of 68 teams at Baldwin Park, 88 percent are at Levels 4 and 5 on the Path to Performance.

Her passion, integrity and ability to help others overcome their differences and work together to improve member and patient care has earned her praise from LMP leaders throughout Southern California—but Lewis, in turn, credits her success to the many people who support her efforts.

“I have the support of the regional LMP office, and I have a strong support system at the medical center,” she says. “It makes my job easier.”

For years, success eluded the Baldwin Park Critical Care team. Mired in distrust, staff members didn’t participate in unit-based team meetings. As recently as 2011, few in the 49-member department knew the team existed.

“I didn’t even know what UBT stood for,” says Sheryl Magpali, RN, a member of UNAC/UHCP and now the team’s union co-lead. “No one claimed to be part of it. It was pretty much nonexistent until 2013.”

With a new manager on board, interest in the UBT grew. Staff members from the Critical Care Unit and its sister department, the Step-Down Unit, elected 12 representatives, who in turn chose Magpali as the labor co-lead. Celso Silla, RN, the new department administrator, became the management co-lead.

Old issues die hard

It was rough going at first.

Attendance was spotty. When the team did meet, members focused on long-simmering grievances about labor and personnel issues. The team reached out to Charisse Lewis, Baldwin Park’s UBT consultant. While consultants often focus on helping teams with using the Rapid Improvement Model and designing tests of change, they also help teams learn to work as teams—clearing up issues that are distracting them from the work at hand.

Lewis’s first steps were to encourage the team’s union members to meet separately with a labor representative.

“That helped relieve the stressors of the union issues,” Magpali says.  Now, she says, “team meetings focus on changes that affect the unit, rather than things we have no control over.”

The department—nearly all nurses, but also including ward clerks, who are SEIU-UHW members and one of whom is a team representative—began building trust in other ways, too. At Lewis’s suggestion, staff members organized a bowling night and had dinner together. This summer, they held a backpack drive.

Moving the team forward

“Charisse has been good at guiding us—attending our meetings, observing and listening and seeing how we can do better,” says Silla.

Lewis didn’t stop with team-building activities. She coached Magpali, a soft-spoken nurse, to speak up during meetings and make her voice heard, and she helped Silla overcome his reluctance to leave his union co-lead in charge of meetings.

Once trust was established, the team could turn its attention to improving patient care, with remarkable results. UBT members have reduced central line-associated bloodstream infections from five in 2014 to none as of August of this year. Buoyed by that success, they are working to reduce catheter-associated infections.

Silla attributes the improvements to the culture of partnership and putting frontline employees in charge of decisions that affect their work.

“We would have been in limbo” without Lewis’s guidance, Silla says. “Now we’re on the same page. We can be a Level 5 in the future.”

Some departments glide effortlessly into becoming high-performing teams. Not so for the San Rafael Health Information Management team.

Now at a Level 5 on the Path to Performance, the team had to overcome numerous hurdles to get to where it is today.

“They went through a lot of hell to get there,” says Richard Orlanes, a regional LMP consultant who worked with the team during some of its darkest days. “To see the transformation they made in about a year—it was almost like they fired the old people in the department and brought new people in.”

As recently as 2011, the team members, whose work is to maintain KP’s medical records, were negative and distrustful, their morale was low, and they didn’t participate during UBT meetings.

“You could hear a pin drop at the meetings—nobody said anything,” says Richard Incaviglia, an outpatient ambulatory coder, SEIU UHW member and the team’s labor co-lead. “At one time people even said they wanted to dissolve the UBT.”

Sponsor involvement is key

But instead, the co-leads—with assistance from Joan Mah, the local UBT consultant—reached out to the LMP regional office for help. They brought in Orlanes to observe the department and lead a series of interest-based problem-solving exercises. He also suggested including sponsors in the exercises; when the management sponsor accepted and also brought her boss to the meetings, it sent a message to the team that leadership really wanted to turn things around. To provide a sponsor perspective on the union side, the co-leads involved Kisha Fant, a union partnership representative, and Zachary Adams, a contract specialist.

“Bringing in the sponsor means everything. Her being there told us that this was a serious effort,” Incavigilia says.

The management sponsor, Freida Smith, the Marin/Sonoma HIM director, is now the team’s management co-lead. As she remembers it, she wasn’t so much invited to participate in the problem-solving sessions—she invited herself.

“I stuck my nose in,” Smith says. “I had to step in and assume some responsibility because the sponsor needs to be involved and is ultimately responsible.”

Discussing positions and interests

Smith believes that the turning point for the team came when they discussed their positions and interests with Orlanes as the facilitator.

“We had to decide as a team that there was nothing we could do about what happened in the past,” Smith says, “but we could step out on faith and move forward.”

After working with the LMP regional consultant for several months, the team members were finally ready to start working together on their common interests. They prioritized the issues of communication, trust and honesty, and transparency, and worked to transform the negativity in the department. One of their early tests of change was to introduce a daily 8 a.m. huddle. The team huddles over the phone because half the team members work remotely. After the huddle, Smith sends an email to the whole department summarizing what was discussed.

“Once we started communicating and voicing opinions, and we realized we didn’t need to worry about retaliation, everybody started participating,” Incaviglia says.

On to high performance

Now the team has a long list of successful performance improvement projects under its belt, including a project to reduce the number of medical records that have missing documentation and another to make sure charts are coded within four days or less.

Smith believes that being transparent was the key to success.

“No matter how small or large the issue, be transparent,” she says. “I share every single thing that impacts the team’s day-to-day existence, including the budget.”

These days Smith is not only the management co-lead of the San Rafael HIM team but also the sponsor of a team in Santa Rosa. Her advice for other sponsors of dysfunctional teams? “I think the key is to communicate with the UBT co-leads first and then, if things don’t improve, take it to the whole team.”