Unit-based teams

Most people think about advancing their careers as a personal goal—if and when they get the time and support to map out a plan. But Panorama City’s Emergency Department unit-based team saw that boosting the team’s skills also matters to KP members, patients and the department. It used collaboration—and LMP trust funds—to improve the workflow and put several staff members on a solid career path.

“It’s not just about making more money. It’s also about being able to provide the best care possible,” says Richard Rowland, one of two emergency room assistants finishing courses needed to earn promotions to emergency service technician positions.

Early last year, the unit-based team started a “door-to-doc” project aimed at moving patients more efficiently through the ER. Results soon stalled because many staff members lacked the training or official certifications to help nurses with such triage duties as drawing blood and organizing labs. About that time, Sylvana Hrovatic arrived as assistant department administrator and management co-lead. She was focused on improving patient service and care, and says it was her labor partners who steered the conversation to career development.

With the help of ward clerk transcriber Becky Linares, labor co-lead and an SEIU UHW steward, the UBT reached out to the SEIU UHW-West & Joint Employer Education Fund to create a plan for employee career advancement in the department.

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.

For nearly a year now, the Neonatal Intensive Care unit at the Fontana Medical Center has welcomed parents 24 hours a day, thanks to a unit-based team that put the patients’ needs first.

Since April 5, 2011, parents have been able to stay on the unit with the newest member of the family regardless of the hour and even during shift changes and rounding.

“The belief in family-centered care is put into action here,” says management co-lead Annette Adams, RN. “Nothing should come between parents and babies.”

Team members put themselves in the shoes of the parents whose children are treated on the unit: The distress of having a newborn baby staying anywhere other than right by your side, of having to leave your baby in the hands of strangers, and being told when you could come and see your own child.

Making it better for parents

Keeping the service point on the Value Compass in mind, the team looked inward to tackle the problem of concerned parents lacking 24-hour access to the unit.

The UBT began by researching what it takes to have successful open visitation in the NICU and what the benefits are for members and patients. The team found that many NICUs were not truly open to parents 24 hours a day, as parents were asked to leave during change-of-shift reports and physician rounds.

The UBT concentrated on how to make sure parents could remain, despite the concerns.

Shift reports are done at the bedside. But the NICU is one big room where anyone can hear anything. Team members researched how to solve this problem by asking how other Los Angeles-area NICUs, such as Cedars-Sinai Medical Center, handle shift reports without compromising privacy.

Involved in shift hand-offs

Not only do parents now get to see their babies whenever they desire, they are also asked to participate when the physicians round and during the change of shift hand-off, which gives them the opportunity to meet the nurse assuming care of their baby.

“The belief that family-centered care is an essential part of each family’s experience was the driving philosophy behind the progressive move in visiting policy,” says Sheila Casteel, RN, the NICU team’s labor co-lead and UNAC/UHCP member.  

The representative team members enlisted help from the rest of the unit by introducing the concept through the monthly staff newsletter and giving presentations at staff meetings.

Unit staff members were asked for their ideas about how to overcome barriers—real and perceived. Some of the practices adopted included:

• moving the staff hand-off huddle outside the unit to the conference room
• making the relief and admitting nurse available to answer parent questions during hand-offs