Unit-based team concepts

Alaine Lounsbury, RN, is proud of her nursing team at Downey Medical Center in Southern California. 4 West team members have worked together for decades, forming bonds that have led to high patient satisfaction rates and region-wide recognition.

Lounsbury, nursing assistant clinical director, attributes the team's success to rounding — the practice of engaging frontline workers in face-to-face conversations on the floor and listening to their concerns. Managers who round say it helps build a culture of engagement and dialogue, a key goal of the Labor Management Partnership between Kaiser Permanente and the Partnership unions. 

“It’s about making a connection,” explains Lounsbury, who rounds quarterly on 90-plus staff members using Kaiser Permanente’s Rounding Plus online tool [KP Intranet]. “You want to hear the good with the bad.”

Removing roadblocks

With the tool, managers can use their mobile device to identify, track and escalate issues surfaced during rounding conversations. Program-wide, nearly 10,000 leaders and managers use the program.

At Downey, nurses used rounding conversations to speak up about a workflow issue. Because 4 West is the only unit with nurses qualified to give chemotherapy to adults, it meant staff members sometimes had to leave their department to administer drugs to patients. Their frequent absences meant more work for others.

“I heard them in rounding say, ‘You need to figure this out,’” recalls Lounsbury. She and her team developed new protocols to enable others outside the unit to give the medication. “That was a big satisfier.”

Getting visual

To help her systematically follow up and act on her team’s questions and concerns, Lounsbury uses a colorful poster, called the Stoplight Report, that assigns green, yellow and red colors to track the status of issues.

The poster was conceived by Downey Quality Coordinator Suxian Hu, RN, based on the color-coded reports managers receive through the Rounding Plus program. Last year, all of Downey’s inpatient nursing units began using it.

In 4 West, the poster hangs prominently in the conference room, where everyone can see it.

“Staff members know something is being done,” says Donielle Tresvant, RN, a staff nurse and member of UNAC/UHCP, one of the unions in the Alliance of Health Care Unions. “They know they’re being heard.”

Nurses say the information shared on the poster also fosters team communication and collaboration. “It keeps us updated about things at work and it helps us improve our care by being focused,” says Brianna Schneider, RN, a member of UNAC/UHCP. “It makes for a cohesive atmosphere.”

Do you or your teammates want to shrink wait times? Save money on supplies? Reduce time wasters or roadblocks? Once you’ve identified a problem to solve, you may wonder where to start. No need to invent an improvement project from scratch. Visit the Team-Tested Practices section and see what’s worked for others. We’ve got short summaries of successes from every region and every type of work environment to give your team a kickstart.

1. What’s here? 

When you visit LMPartnership.org/team-tested-practices, you’ll find the first several “tiles” of the dozens you can choose from as you scroll through this section. Each tile will have a photo and short preview about a specific, measurable improvement a team has made.

2. Sharpen your search 

Want to narrow down what you see? Use the filters on the left side of the page. There are several to try, including:

• Topic. Choices include affordability, patient safety, service and more.
• Department. See what departments like yours have done.
• Region. Check out the projects done in your region.

Selecting more than one filter at a time works, too. And remember that you can get great ideas from departments very different from yours and regions other than your own. You’ll notice these filters throughout the website to help you focus your searches. 

3. Intrigued? 

See something your team might want to try? Click on the tile to get a more complete description of the challenge the team was facing — and the main tests of change that helped the team achieve its goal. And the measurable result: “Saved $40,000,” “decreased wait times by 11 minutes,” “69 percent drop in costs.”

4. No dead ends! 

So, maybe the practice you clicked on isn’t right for your team. Before you move on, check out the related tools and stories in the colorful columns farther down this page. Throughout the site, the color orange means, “Here are tools to get your team started on work like this.” Blue is, “Get inspired by stories and videos about teams working on similar efforts!” And, “Just for fun” — green will take you to puzzles, games and other light-hearted resources to kick off your improvement campaign on an upbeat note.

For Jennifer Cuevo, an urgent care nurse in Pasadena, the opportunity was too good to pass up: Earn a Bachelor of Science in Nursing without paying fees.

For Joel Boyd, manager of pulmonary clinical services in South Sacramento, teaming with a trust fund created an opportunity to teach nearly 500 respiratory therapists ways to improve care and lower costs.

From earning degrees to learning best practices, Kaiser Permanente employees are using the 2 Labor Management Partnership-supported education trusts (Ben Hudnall Memorial Trust and SEIU UHW-West & Joint Employer Education Fund) in record numbers. Program enrollments rose 26% in 2018 to 113,494; there were nearly 59,000 enrollments in the first half of 2019, on pace for another record year.

“We can address solutions,” says Rebecca Hanson, SEIU Education Fund executive director. “There’s overwhelming demand among the workforce for training opportunities aligned with patient care delivery needs.” 

Through the trusts, employees can build skills, meet targeted needs in training programs, and work with career counselors to set career goals and create plans to achieve them.

“We’re preparing our workforce for the jobs of tomorrow,” says Jessica Butz, Ben Hudnall trust co-director.

Click to enlarge.

Going for it

Cuevo, a 16-year Kaiser Permanente employee and UNAC/UHCP member, started as a licensed vocational nurse, then became a registered nurse. She always wanted a bachelor’s degree but put her dreams on hold while raising her children — until she talked with a Ben Hudnall career counselor and learned good news.

With a few additional courses, Cuevo could qualify for a bachelor’s program. The trust would pay the fees.

“I’m so thankful,” Cuevo says. “I wouldn’t have done this without the help of the trust and the partnership of Kaiser with the universities.”

Most classes were online, which Cuevo took at home. She did in-person requirements on days off — coordinating with her manager and family — completing her degree in 4 semesters. Her 17-year-old daughter is “really inspired,” Cuevo says. “She wants to go into research or be a doctor.”

Cuevo’s inspired, too. In November, she started a master’s program – paid again by Ben Hudnall. Cuevo, who wants to teach nurses, encourages colleagues to use trust services.

“Go for it,” she says. “It’s so worth it. Get your degree. Move up. You can do it. I did it. I love it.”

Benefits of partnership

When Boyd and pulmonary clinical services colleagues in Northern California reviewed their operations, they saw a need to standardize some patient care practices. Their goal: to decrease the length of stay for patients on mechanical ventilation to reduce the risk of such complications as pneumonia, improve care and lower costs.

They partnered with the SEIU Education Fund to organize 8 group trainings for respiratory therapists at Kaiser Permanente’s Garfield Innovation Center.

Working with the education fund was easy and helped get employee buy-in and participation, Boyd said. The trainings were so effective, more may be offered in Northern California and other regions.

“Nothing at this scale has ever been done for respiratory therapists,” Boyd says. “It was a true example of how we can get positive benefits from the Partnership.”