Unit-based team concepts

The dread is familiar: You have a question or a problem, and you need to call a service center to get the matter cleared up. Will the issue be fixed quickly? Or will the call be transferred from one person to the next—to the next—to the next?

As the second open enrollment period under the Affordable Care Act approached, Kaiser Permanente’s Customer & Member Services team knew that it didn’t want the thousands of new members joining KP to have that sort of frustrating experience. Just the year before, C&MS’ Member Service Contact Centers (MSCC) had been swamped by three times as many calls as expected. That had led to many handoffs to Membership Administration, which works with the MSCC customer service representatives to get questions answered. 

And so the first-ever “super unit-based team” sprang into action in September 2014. Its mission: To combat long wait times and better handle the anticipated surge in calls that would come with open enrollment.

What made it “super” was that it transcended locations and time zones, bringing together on a single team representatives from across the country—from the MSCCs in Denver, Colorado; Fulton, Maryland; and Corona, California, and from Membership Administration in Denver and San Diego. In the past, an individual UBT at one of the centers might develop a good practice, but it was left largely to chance that other centers would learn of it and follow suit. But under the umbrella of the Open Enrollment 2015 Readiness Initiative, 29 frontline and managers, supported by regional and national leaders, took a fresh approach to testing initiatives and spreading best practices.

Unifying approach

The combined team helps everyone operate as one team instead of separate entities, says Deashimikia Williams, a customer service representative at MSCC-Fulton and an OPEIU Local 2 member.

The collaborative effort was important because members don’t distinguish between different centers or different divisions. “They see us as One KP,” says Marie Monrad, vice president of strategy and operations for the Office of Labor Management Partnership, “and with this, we are doing performance improvement as One KP.”

The Super UBT’s biggest success so far is known as “one and done”—meaning that the member’s question is taken care of by the representative who picks up the phone. Before, a member’s request to stop an online payment, for example, might have taken up to a half-dozen calls. But with the introduction of the one and done process, the MSCCs were able to reduce the number of handoffs by 60 percent from January 2014 to January 2015.

The secret to success was looking to the customer service representatives for answers, says Jerry Coy, senior vice president of Customer & Member Services. “We asked the people who actually take the calls, ‘What questions are members asking?’ and ‘What would make your job easier?’” he says. “We are the front door to KP. We welcome the members and want them to be a member for life.”

“All of this work is in line with the Labor Management Partnership’s commitment to grow and maintain membership for KP,” notes Janelle Williams, consultant specialist for frontline engagement and growth. 

Answering calls from all over

The call centers that participate in the Super UBT answer the majority of KP member calls from the entire organization, fielding questions on a range of topics from billing to details of the health plan to helping members who haven’t received their membership cards.

Super UBT members received additional education and created a rapid resolution team within Membership Administration. While the representative stays on the phone with the member, he or she can consult with specialists via Lotus Notes SameTime chats or by opening another line. From mid-January through early March, the MSCCS handled nearly 5,400 calls—and more than 5,000 of them were successful rapid resolution calls, with the members helped in a single interaction. In addition, through staffing changes, operational improvements, and the implementation of the rapid resolution team, Membership Administration has reduced mean processing time for member issues from 26 days in January 2014 to three days in January 2015.

While Kaiser Permanente members benefit from the work, the frontline staff members benefit, too.

“We have a better understanding about the changes in different regions,” says Deashimikia Williams, who is the Fulton UBT’s labor co-lead. “Before the Super UBT, it was hard to get everybody engaged. Being engulfed in this work motivated us.”

LaDondra Hancock, senior account administration representative for Membership Administration in San Diego, also says the initiatives started by the Super UBT have improved the way she and her teammates work. “It has lessened the calls we get in from the different Member Services Contact Centers,” says Hancock, who serves as her local team’s labor co-lead and is a member of OPEIU Local 30.

Model practices

The success of this collective effort provides a model for other teams and departments looking to share and spread best practices, and underscores the importance of reaching out to other teams doing the same or similar work.

“Not only is this work of the Super UBT critically important for improving the member experience,” Monrad says, “but it also shows that it is critically important to test, model and explore new ways to bring improvement through our partnership that cuts across not only multiple regions, but multiple unions and multiple functions.”

Although Rahul Nayak, MD, calls himself “fundamentally lazy,” it might be more accurate to call him lazy like a fox. Instead of starting from scratch to create Georgia’s centralized Outpatient Safety Net Program, his team started with a recipe provided by Southern California.

“Someone has already done something that works. Why not start there?” says Dr. Nayak, who was physician program director of patient safety for Georgia when the program launched.

Dr. Nayak’s outlook serves as the guiding force behind spread—the art of adopting a practice, workflow or project from another team, medical center or even an entire region. The benefits? As the Georgia team learned, new initiatives often get off the ground faster if they’re modeled on an already proven concept. The Southern California safety net system had already won a 2012 David M. Lawrence Patient Safety Award for its work.

“The foundation was laid,” says safety net team member Eula Maddox, LPN, a member of UFCW Local 1996. Maddox makes up to 60 calls a day, phoning members who have had abnormal lab results and scheduling follow-up appointments. “These calls reduce stress for patients and costs for Kaiser Permanente,” she says. But, she notes, the team had to adapt the program for it to work well for Georgia members, including changing the hours that calls were made.

For its work, the team won the 2014 David M. Lawrence Patient Safety Award in the transfer category—an award for a region that successfully implements a project from an earlier award winner. The award recognizes the importance of spreading best practices, which ensures that members receive the same high level of care regardless of which medical center they visit. That’s a primary principle of One KP, which sets the goal of providing every health plan member with “the best experience, everywhere, every time.”

“Our members and customers believe—rightfully so—that we know how to operate as one organization,” says Bernard J. Tyson, KP’s chairman and CEO, “and that whatever we learn about the best ways to care for people in one geographic area…is available to all of our 9.6 million members.”

Best practices occur at all levels and in all departments. In Colorado, for example, the Regional Lab unit-based team tackled the issue of standardizing labels. Even a simple mistake—putting a label on crooked—can adversely affect patient care. The team is creating visual aids and tip sheets that will spread to 28 locations by this fall.

“This is a problem people have had to deal with for years and are passionate about fixing,” says Beth Fisher, a medical technologist, member of UFCW Local 7 and sponsor for the regional lab team.

Spreading practices takes effort from both sides. At Virginia’s Burke Medical Center, a project launched by the Primary Care team four years ago has sustained its success in helping patients with hypertension get their blood pressure under control—and the team has helped other facilities in Northern Virginia adopt the practice.

“If it works for us, it will work for other people,” says the Burke team’s lead nurse, Angela N. Williams-Edwards, RN, a UFCW Local 400 member. “Other teams saw it was easy and ran with it.”

After their letters to members went unanswered, the members of the Burke Primary Care team changed their approach.

Instead, clinical assistants called patients with the message, “Your doctor is concerned that your blood pressure is not being controlled,” says Angela N. Williams-Edwards, RN, a member of UFCW Local 400, the team’s lead nurse and former labor co-lead. “It worked better because it was more personal.”

This was in 2011, when the team had challenged itself to get more patients’ blood pressure under control and reduce their risk of a wide range of diseases. They succeeded—and their success mushroomed, with the other centers in Northern Virginia adopting it. All Primary Care teams share the goal of having more patients with blood pressure in a healthy range, and there was no reason for the other teams to start at square one since Burke had demonstrated its way worked—and worked well.

Four years ago, to entice members to come in more frequently to better manage their hypertension, the Burke team also made changes to make the visits for blood pressure checks as appealing as possible:

• Patients could pop in almost any time for the mini-checks, so they could stop when they were at the medical center for other reasons. There was no copay for the quickie visits.
• The members don’t have to wait long. “If they wait too long,” Williams-Edwards says, “their blood pressure will go up.”
• If a member’s blood pressure reading was too high, the doctor came in during that same visit to discuss options—possibly making medication changes—and to urge the member to return for a follow-up within 10 to 14 days.

All of these factors helped the Burke unit-based team increase the percentage of patients whose blood pressure is under control from 75 percent in January of 2011 to 85 percent by August of 2011. Today, the team has not only maintained that improvement but surpassed it. As of November 2014, the team boasts that 90 percent of its patients with hypertension have their blood pressure under control.

“Burke worked so hard to have the results sustained,” says Eileen Chiama, who has been the team’s management co-lead and clinical operations manager for about three years. “We achieved these gains through the huddling process and by keeping focused on it. It became part of our normal workflow.”

Moreover, Chiama says, “The workflow process was shared with other medical centers. The way you spread is to find a champion—someone on the team who is so passionate about the goal.” She says Edwards-Williams is that champion at Burke. “Never underestimate the power of one to generate enthusiasm in the rest of the team.”

Marianne Henson, RN, who was the team’s manager when the project first started, says she met regularly with the area’s other internal medicine clinical operations managers. “We share best practices that way,” she says. Now, several Northern Virginia teams—including Henson’s current teams at Falls Church and Tysons Corner—have improved their rate of blood pressure control, too.

When Marianne Henson, RN, left her position as clinical operations manager of the Burke Primary Care team in Virginia, she took something with her—a plan.

In 2011, Henson helped launch a project at the Burke Medical Center that boosted the percentage of patients with their blood pressure under control. Instead of creating a brand-new plan to solve the same problem at her new facility in Falls Church, Virginia, she became a copycat.

“Why reinvent the wheel?” Henson says. “We already knew what worked.”

When Henson was in her role at Burke, other clinical operations managers and physicians from the 10 Northern Virginia medical centers held regular area-wide meetings that allowed teams faced with similar issues to learn from one another. As a result, other facilities began adopting Burke’s practice of having clinical assistants call members with hypertension to ask them to come in for more frequent blood pressure checks. Burke had already discovered that members ignored requests sent via mass mail, so the other centers didn’t waste time or money repeating that experiment.

“We have members waiting only five to 10 minutes,” says Andrea Brown, a clinical assistant at Falls Church and member of OPEIU Local 2. “We let them know over the phone that this will be a quick visit and they will be on their way.”

Brown and the other clinical assistants try to call at least five members each day to see if they can pop in for a check while at the pharmacy or when they have an appointment with a specialist. And each day, depending on the weather, between three and five patients take advantage of the mini-blood pressure appointments. “This brief visit is cost effective, saves time and helps us make sure the member is on the right track,” Brown says.

Brown says members have given her positive feedback because of the convenience.

“It made sense because the whole region was expected to bring hypertension control up to better levels,” Henson says. “We standardized what we do.”