Performance Improvement

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.

Colorado

Thanks to a diligent chart review process, the Medicare Risk Business Services unit captured an additional $10.3 million last year in Medicare reimbursements unclaimed in 2010. The hospitals Kaiser Permanente contracts with in the region were submitting documentation with incomplete physician signatures, which prevented KP from submitting the bills for reimbursement. The technical error causing the problem was corrected, but the team had to review 26,000 hospital inpatient notes for 2010. The total collected is more than three times what the team predicted when it began correcting the error.

Georgia

When staffers at the Cumberland Medical Office Building pharmacy in Atlanta open bottles of pills to dispense prescriptions, the bottle is supposed to be marked with a big X, a flag for reordering. But often, a pharmacist or pharmacy tech would find only a few pills left in unmarked, open bottles, not enough to fill a patient’s prescription. So the team brainstormed ways to ensure the bottles are properly marked, including posted reminders and giving everyone his or her own marker. The number of unmarked bottles fell from 30 to zero the first week; went back up the next week; then dropped back down and stayed down—lowering costs and improving service.

Hawaii

When the Honolulu clinic’s Obstetrics and Gynecology team members realized patients were waiting six minutes or more for routine injections, they decided to designate one nurse each week as the “shot nurse,” whose priority duty is giving shots, and one as a “floor nurse,” who helps direct patients to the shot nurse and pitches in when it’s busy. Whiteboards let staff know who is filling the roles. The team has dropped member wait times to an average of 3.2 minutes.

 Mid-Atlantic States

Unit-based team storyboards, a homemade “test of change” video shot by the Radiology UBT on its efforts to boost co-pay collections, and a roomful of enthusiasm and healthy snacks marked the inaugural UBT Expo in the Mid-Atlantic States region. A dozen teams at Largo Medical Center in Maryland—from Adult Medicine to Vision Essentials—exhibited projects on service, quality, best workplace and affordability. When attendees weren’t networking at the exhibits, they heard formal presentations from teams, who were introduced by their sponsors.

Northern California

The Redwood City Medical Center inpatient pharmacy is celebrating success after sustaining, for more than six months, a dramatic reduction in the rate of medications administered late (a half-hour past their scheduled time) in the medical-surgical wards. Previously, 26 percent were late; now, the range is 12 percent to 15 percent. Working with the med-surg nurse manager, the team began using color-coded bins to distinguish new medications from discontinued ones and delivering medications 15 minutes before the hour in which they are scheduled to be administered. These and other changes have improved communication and give nurses more information about where to retrieve the medications.

Northwest

By focusing on hospital quiet and Nurse Knowledge Exchange, the Women and Newborn Care arena at Sunnyside Medical Center has earned recognition as one of the best of its kind the throughout Kaiser Permanente, improving its HCAHPS Overall Hospital rating by 17.5 in 2011. The report rooms—where staff members congregate and talk—have doors that close automatically, and nurses try to respond to all call lights within three dings. “A patient does not belong to one nurse, but the whole department,” says Dory Schutte, RN, a member of OFNHP and one of the UBT’s co-leads. In addition, Nurse Knowledge Exchange at shift changes and having nurses join physicians and midwives on rounds has improved communication and patient satisfaction.

Ohio

Giving post-procedure snacks to patients is standard, but Ohio’s Gastroenterology department realized it was averaging $750 to $800 a month on snacks, well over budget. After Carol Zimmerman became manager, the UBT implemented small but key changes: Eliminating rarely eaten snacks, replacing more expensive items (Oreos) with less expensive choices (graham crackers), and removing temptation by keeping supplies locked out of sight. Zimmerman also began to regularly share the department’s budget and costs with staff. The team noticed an impact within two months, with hundreds of dollars saved in short order. Reviewing the budget is now a standing part of team meetings.

Southern California

Faced with the teams using linens inappropriately, Panorama City Medical Center’s Materials Management unit-based team set out to educate other hospital staff about the costs involved—reminding them not to use linens to mop up spills or as makeshift tablecloths and to refrain from overstocking linen in patient rooms. Managers and union leaders worked together to develop a storyboard and presentations and reviewed linen usage and stocking levels with individual departments. The result? The overall costs of linen for Maternal Child Health, one of the first departments targeted, were reduced by 6.8 percent, more than three times the original goal.

You get to a certain age, and it’s time for a makeover. Surely you understand.

We heard you whispering. In fact, it inspired us to conduct a statistically valid survey to make sure what we’d overheard was a true reflection of what you thought. Some of it was a pleasant surprise—such praise! But you were blunt, too: Awkward size. Overly long articles. Not enough variety. And so on. 

So, here’s our equivalent of slimming down and building some muscle. (Amazing what walking a half-hour a day will do!) With our new ’do, you’ll find:

• shorter articles and more of them
• more tips and tools, information you and your unit-based team can put to immediate use
• more coverage from all the regions
• and some fun

While we’re on the subject of our virtues: Our paper is certified by the Forest Stewardship Council, ensuring the use of responsible forest management methods that address social, economic and environmental issues.

Why does that matter? Well—working in partnership addresses profound social and economic issues, too. We hope you like our makeover because we want to serve you—the frontline workers, managers and physicians of Kaiser Permanente—well. Because what was achieved this spring in National Bargaining, the subject of this issue’s cover story, makes it clear what an extraordinary journey we are on together.