Unit-based team concepts

Every quarter, Colorado leadership recognizes a unit-based team that excels at putting our members first while building camaraderie.

The Autism and Development Pediatrics UBT, which started in April 2015, is a classic example of how collaboration can make the care experience even better. Members of this cross-functional team tackled the dreaded ‘no-show’ rate for their area of focus. They zeroed in on making process improvements to significantly lower the rate while also increasing access and member satisfaction.

To see this team in action, watch the video on Inside KP at http://www.insidekpco.net/value-compass-award-improving-access-lowering-no-show-rate. Please note, this link works on KP computers only.

Fairy Mills, a pharmacy technician and member of UFCW Local 555, has worked for Kaiser Permanente for 29 years. Not long ago, however, there were days she left the Mt. Scott Pharmacy ready to cry, exhausted. Wait times were up and service scores had plummeted. She thought about retiring but decided to tough it out—and was voted in as the union co-lead for the department’s unit-based team.

About the same time, Linh Chau arrived as the new supervisor. He wasn’t sure what he’d stepped into. “It was the perfect storm,” he says. “The team was stressed out, members were unhappy, membership was up, and in the midst of it all, we were implementing a new software system.”

Pharmacies in the Northwest region were in a tough spot a year or so ago—and that was especially true for the Mt. Scott Pharmacy. Part of the Sunnyside campus, it’s the second busiest pharmacy in the region, seeing an average of 500 patients a day and filling nearly 1,000 prescriptions.

Although other regions had already made the transition to ePIMS, a software system that syncs up with KP HealthConnect®, the migration process hadn’t been easy.

“We had to reenergize the team,” Chau says.

Chau and Mills’ first strategy was to give staff members confidence that things would improve. The two co-leads began rounding, checking in with UBT members regularly and making sure everyone had a chance to offer suggestions for improvement— giving them the power to shape how things are done, one of the key elements for beating back burnout.

Katie Richardson, MD, is a master juggler: She’s a pediatrician at Highlands Ranch Medical Office in Colorado two days a week and the director of Physician Experience for the Colorado Permanente Group (CPMG) the rest of the week; she’s a sponsor of the CPMG Physician Wellness Committee; and at home, she’s the mom of an 11-year-old daughter. Dr. Richardson recently talked about the pressures of practicing medicine and what the Colorado region is doing to help its doctors sidestep stress and burnout.

Q: Why do so many doctors suffer from stress and burnout?

A: As physicians, in general we are not as good at taking care of ourselves as we are at taking care of others. We don’t tend to ask for help—and we need to change that culture. There are a lot of clinicians out there who are suffering and they don’t recognize the signs of burnout or know what to do.

Q: What happens when physicians are burned out?  

A: We are the leaders of the health care team. We’re trained to solve diagnostic dilemmas and do what is best for our patients. If we’re burned out, we may not think through our decisions as well. Healthy, happy physicians take better care of their patients. We want to make sure that we take care of our physicians.

Q: How do you help doctors deal with stress?

A: We know this is a high-pressure environment and look for resiliency in our physician hiring process, which helps us identify candidates who have experience managing stress. In addition, our yearly physician survey includes questions around burnout and resilience. We use that information to identify strategies to improve the physician experience.

We are trying to foster conversations around stress and burnout. We’re encouraging physician chiefs to meet with their physicians regularly and ask, “How are you doing?” Educating providers to look for signs that they might be experiencing stress, as well as providing education about available resources, will help. The first step is letting people know we are aware there is an issue.

The new goal was dramatic: Reduce hospital stays to 23 hours for total joint patients.

Renee Portillo, RN, was worried.

“It was a shocker. Our staff was used to patients going home in two to three days,” says Portillo, former assistant clinical director and management co-lead of the 7 South medical-surgical team at Fontana Medical Center in Southern California.

The accelerated time frame meant that the unit’s nurses, who care for total joint patients following surgery, would have less time to prepare them for discharge. They’d also need to help choreograph care across multiple departments—Orthopedics, the operating room, Physical Therapy, Home Health—from pre-admission to discharge.

Who best to help the team through this change? The team itself.  

“We used our UBT to help change the culture,” Portillo says.

Wave of the future

“We helped our nurses be successful by having them anticipate patients’ needs and prepare them for discharge,” says Enrique Rivero, RN, a surgical nurse and UNAC/UHCP member who is the team’s union co-lead.  

Fontana is among a growing number of hospitals across the United States to offer a combination of shorter hospital stays and more outpatient care for hip and knee replacement patients. The trend is driven by less-invasive surgical techniques, improved pain management and rehabilitation practices, and patients’ desire to return home as soon as possible.

“There were a lot of challenges. A lot of it had to do with bringing people together,” says Mary Hurley, MD, chief of Orthopedics, who championed the new approach. “They all had to buy in and be willing to support this in order to have a successful program.”   

The new approach, which Fontana introduced in January 2014 after months of researching best practices, gets patients walking within hours of surgery and enables them to recover within the comfort of their own homes. The initiative takes advantage of Kaiser Permanente’s integrated model of care and is designed to improve clinical outcomes and reduce costly hospital stays.