Although they are the newest members of the partnership, Hawaii’s UBTs have made some dazzling progress over the last year. Some of the teams have won a prestigious award, while others are making strides in patient care, safety and reducing waste.

Helping patients heal by reducing pain

The pain management teams at the Moanalua Medical Center in Honolulu have contributed to a terrific accomplishment: They made the greatest progress in pain management by any unit in all of Kaiser Permanente, and for that, they won the Kaiser Permanente President’s Award. Patient scores of pain management soared from 66 percent effective to over 95 percent effective.

If post-surgical patients’ pain is not controlled, healing and recovery are slower and riskier and patient satisfaction goes down.

Nurses belonging to Hawaii Nurses Association/OPEIU Local 50 teamed up with their managers to develop a comprehensive project to improve pain management. It was the first improvement project for some of the newly formed unit-based teams in Hawaii. They used the Rapid Improvement Model, and small tests of change led to big results:

• Pre-Admission staff educated patients about pain expectation before surgery.
• The Post-Anesthesia Care Units and the receiving units improved their communication about patient pain levels.  
• Team members charted every patient’s pain levels and took vital signs every15 minutes
• The teams developed a visual tool that lets patients easily communicate their pain level.

This was a huge accomplishment, especially since the Hawaii nurses joined the union coalition and the LMP in 2009 and launched their first unit-based teams in 2010. Their work has accelerated in 2011, and they expect to have launched 100 percent of the medical center’s UBTs by the end of the year.

Labor and Delivery helps newborns and moms bond

In the Labor and Delivery department, staff members decided to look at their performance on “skin-to-skin” measure. Moanalua is one of only a few U.S. hospitals designated as “baby friendly” by the World Health Organization. One of the requirements for maintaining this designation is that the facility must show that newborn babies are allowed at least 60 minutes of skin-to-skin contact with the mother immediately after birth. Research shows that babies do better when this happens.

The Labor and Delivery team measured whether or not the department was maintaining this threshold, and they determined they needed to improve. They realized the skin-to-skin contact times recorded in KP HealthConnect didn’t reflect actual minutes but blocks of time (for instance, less than 30 minutes, 31-59 minutes or more than 60 minutes).

They established a communication tree across shifts and quickly got everyone recording actual minutes, to be sure the threshold was being met. Just a few months after starting their first Plan, Do, Study, Act cycle, they are on track.

This effort is an amazing example about how KP HealthConnect can be optimized through unit-based team improvement efforts.

Many more rock stars

In two days, I visited 11 teams. Here are a few more examples from this inspiring experience:

• The Oncology unit had a history of high injury rates. When I visited, the unit had gone for more than a year without a single injury.. The RNs worked together to always use a “slider” for transferring patients from bed to gurney, along with other safe lifting techniques. This practice has spread to many other units, who have also achieved zero injuries for more than a year as well (Department 2 East, for example).
• Several units worked hard on reducing waste. They developed systems to eliminate hoarding and to prevent supply shortages. They paid close attention to expiration dates on supplies to avoid waste. These efforts saved the Ambulatory Surgery Recovery (ASR) unit $10,000 a month and provided better service to patients, as supplies were always on hand.  
• The ASR unit is ready to become a self-directed team. They started a recycling project that has expanded throughout the hospital. The team was not a tight unit when they started. The co-leads convened daily huddles for 21 days in a row and now there is improved communication and organization. The manager said she felt empowered because she no longer has to worry about the team’s performance.

Staff members also worked on patient medication education to improve HCAHPS scores; they improved their workflows; People Pulse scores went from an average in one department from 17 percent to an average of 90 percent! Every team I visited had a true sense of empowerment as their UBTs coalesced. Staff members expressed a renewed commitment to nursing.

I made a point of asking managers what the experience of the unit-based team was like for them. All answered that they felt more empowered as the staff took on more and more responsibility.

This, in turn, empowers staff. As a 30-year staff nurse put it, “Since we started our unit-based team, I feel validated, and as a result I feel like a real nurse now.”