Unit-based team concepts

Receptionist Sam Eckstein encourages his co-workers at the Woodland Hills Medical Center lab not only to meet—but to exceed—patient expectations of excellent service. To back up his coaching, he’s using the knowledge he gained in a new LMP course on business and economic literacy.

During the course, Eckstein and about a dozen other workers and managers learned about the rising cost of health insurance in the United States and the trend toward businesses’ shifting more health care costs to employees.

Because patients are paying more, “Their expectations are higher,” says Eckstein, a member of SEIU UHW. “When patients come in without an order [for a lab procedure], we can’t just send them home,” and inconvenience them by making them come back another day, he says. “We have to help meet their needs.”

Eckstein took part in a pilot project to test the Labor Management Partnership’s new approach using popular education techniques to ensure frontline employees and managers have the context and know-how they need to continue improving team performance and keep Kaiser Permanente affordable.

What’s different about popular education?

Popular education turns the old-fashioned schoolroom model of teaching and learning on its head. It is ideally suited to the Labor Management Partnership, which is built on the belief that all employees, managers and physicians bring their expertise and experience to bear on improving service and care at KP. No longer is the teacher or trainer the sole expert in the classroom, there to fill students’ minds with information they passively receive, memorize and repeat.

Instead, popular education taps into participants’ experiences in their communities and workplaces and uses them to generate dialogue. It explores the social and economic context of students’ lives and asks probing questions: What are people happy about? Worried about? Fearful about? Hopeful about? Students are encouraged to analyze that information—and to take action.

UBTs use a performance improvement method called the Rapid Improvement Model (RIM+). It’s a quick way of improving work processes that allows teams to make a small change, test and evaluate it, and then adopt it if it works — or reject it if it doesn’t.

Use these three questions to guide your team’s efforts to improve quality, service and affordability, and to make your department a great place to work:

• What are we trying to accomplish? Clarify the improvements your team wants to make and define how you want to change. Be specific.
• How will we know a change is an improvement? Identify what you will measure to make sure you know whether the change you make is truly an improvement.
• What changes will help us improve? What options are most likely to work? What do we think is a good idea? What have other people done? Keep objectives in mind. Use the team’s knowledge and experience as a guide.

Visit the Use of Tools toolkit to learn more.

Small tests of change

The plan, do, study, act (PDSA) cycle is part of the Rapid Improvement Model. It allows teams to rapidly test a change on a small scale. Risk taking is encouraged and failures are okay because the team learns from them.

The steps are:

• Plan: Plan the test or observation, including how you’ll collect data.
• Do: Try out the test on a small scale.
• Study: Set aside time to analyze the data and study the results.
• Act: Refine the change based on what team members learned from the test.  

Then start preparing a plan for the next test!

Other performance improvement tools

In addition to PDSAs, there are a diversity of performance improvement tools — process maps, fishbone diagrams and more — that can help teams understand what’s not working about their team processes and which are the best ideas for improving them. The How-To Guide on performance improvement is a great place to start exploring performance improvement tools that go beyond PDSAs.

Consensus decision making and interest-based problem solving

In the course of doing performance improvement work, team members use specific methods to help them make decisions and understand one another’s point of view.

Teams use consensus decision making to decide things like which project the team is going to tackle and which improvement idea is going to be tested first. Consensus is a form of group decision making that is often used in collaborative work. Because everyone discusses the issues to be decided, the group benefits from the knowledge and experience of all members. Consensus occurs when every member of the group supports the decision.

Interest-based problem solving is a process that addresses individual and group differences. Participants work together to reach agreement by sharing information and remaining creative and flexible, rather than by taking adversarial positions.

The four steps to interest-based problem solving are:

• define the problem
• determine interests
• develop options
• select a solution

Visit the Team Member Engagement toolkit to learn more about consensus decision making and interest-based problem solving.