Imagine this:

A flowing line leading to a heart; underneath the image the words: “PICC Team Going Great Lengths to Care for You”

These words can be found on the lab coats, scrubs and other clothing of each member of the Infusion team at Woodland Hills Medical Center in Southern California.

The team members designed the emblem as a reassuring message to the patients they serve. It sums up their story.

A critical job

Members of the Infusion Center spend their days inserting and monitoring PICC lines, or peripherally inserted central catheters.

The lines are usually inserted through the arm and wind their way to areas near the heart to carry life-saving medications. PICC lines are very invasive, and insertion and monitoring are critical procedures. They can be a source of hospital-acquired infections and other complications. Practitioners must be absolutely sure where the line is in the patient’s body to ensure that it is both safe and effective.

The Infusion Center’s unit-based team (“department-based team” in Woodland Hills’ vernacular) is made up of RNs who are members of UNAC/UHCP, medical assistants and receptionists with SEIU UHW, and managers.

Neneki Lee, the Union Coalition’s national coordinator in Southern California, Ursula Doidic, Woodland Hills’ assistant medical group administrator, and I recently spent time with the unit. We were given a detailed explanation of its improvement work by Beth Kouba, RN, a UNAC/UHCP member and the team’s union co-lead. Among the team’s accomplishments:

• The team reduced PICC line infections to zero. The unit has gone a year without a single infection.
• The team is spreading the success to other units in the region, and team members told their story at the recent National Quality Conference.
• It has reduced turnaround time and accuracy for the PICC Tip Verification, an important ultrasound procedure that ensures proper placement of the PICC line in the patient’s body. This work has received national recognition in the industry.
• Based on a collaborative study of its budget and staffing, the team decided to add a full-time medical assistant to the team.
• The team is “self-directed” and does its own staffing and scheduling.
• The team is working on the new products council, workplace safety, service quality improvement and also develops rewards and recognition for team members.
• The UBT meets twice a month and huddles often.
• Team members interview all new employees.
• Morale had been low, but today, through their fine-tuned collaboration, they are high-performing  team with high morale.

Co-lead Beth Kouba told us that the LMP must be “authentic and genuine.” By this she meant that the team must have the opportunity to work together on clear improvement for patients, focusing on strategy that is in everyone’s interest.

Urgent Care

After our inspiring visit at the Infusion Unit, we spent time listening in on the Adult Urgent Care Center’s department-/unit-based team meeting.

The team included the department administrator and physician leader as well as a good cross-section of employees, including RNs, LVNs, MAs and receptionists who are members of UNAC or SEIU UHW.

The meeting, lead by a union member, covered a range of topics, including a complex discussion about approaches for wound healing.

In this last matter, the team came up with a small test of change involving placement of supplies, staffing and detailed notes by staff.

The team is transitioning from a representative model to a more all-inclusive team in order to enhance communication and overall performance.

It was wonderful to see the team so well organized, prepared and using data on every subject for problem solving. It was also great to see principles of LMP behavior at work: facilitation, interest-based problem solving, with all of the work focused on patient-centered outcomes.

Let’s take stock of the great work being done by thousands of teams throughout Kaiser Permanente. Unit-based team collaboration is a growing success. Indeed, it is the path to high engagement and performance for all employees and for the best outcomes for the members of Kaiser Permanente.

It was exciting to see that the work of these teams appeared intuitive. This underscores how far union, manager and physician roles have evolved from traditional relationships to relationships based on  a learning environment in the workplace.