August 2, 2015

One Team’s Journey

I recently had the opportunity to hear a presentation from one of the high-performing unit-based teams that are transforming workplace culture across Kaiser Permanente, and I was inspired by their story. The Nutritional Services UBT at the San Jose Medical Center is one of more than 1,500 UBTs–close to half of all UBTs – that are now rated high performing on the Path to Performance. Our teams are responsible for improvements in quality, patient experience, affordability and making KP the best place to work. They represent the commitment we have all made to achieving whole systems transformation and whole systems improvement.

In San Jose I listened to five team members–two dieticians and three nutrition partners–describe their development and achievements. It was remarkable to see and hear and feel the depth of understanding in the use of measurements, run charts and return on investment. Even more, it was emotionally powerful to see our union members and managers speak with such clarity and passion about their mission, their strategy for achieving it, the effective work practices and tools they used together, their fantastic outcomes and their advice for other teams.

Their story provides a roadmap for other teams working to transform health care at KP and the United States.

The mission

A mission statement focuses teams on what they are trying to accomplish. The San Jose Nutritional Services Department agreed on a mission that explicitly puts patients first (“they are the reason we are here”) and commits the team to deliver great, culturally competent service.

The engagement strategy

The team knew that the kind of frontline engagement necessary to launch and sustain workplace change does not happen by itself. The team’s engagement strategy includes:

  • An education campaign on UBTs--how they work and what they can accomplish
  • Ongoing, two-way communications including a team newsletter, regular updates at staff meetings and huddles, and a structured way for UBT representatives to ensure that every member of the 27-member team is part of the team’s improvement work
  • Brainstorming, surveying and feedback methods to allow every team member to participate in tests of change

SMART goals

The team develops SMART goals for all its tests of change -- goals that are specific, measurable, attainable, realistic/relevant and time-bound. For example, to help improve patients’ health and recovery time, one of the team’s goal was to increase by at least 5 percent the percentage of patients getting additional nutrition support (and to aim for 10 percent as a target and 15 percent as a stretch goal) in the 12 months ending December 2012.

The goal was important because patients take less time to recover, and are less expensive to treat, when they are well nourished.

A second goal committed the team to improve its patient service scores by three points in the same twelve months.

Best practices and tools

Here’s what the team had to say about three work practices that enabled success:

  • Communication: Listen to and use feedback from frontline staff; they have the best ideas
  • Data collection: Keep it simple! Get frontline staff involved in the process of collecting data
  • Consistency: Meet regularly, complete action items, engage with sponsors and make time for each other

Advice to other teams

The team concluded with five suggestions for other UBTs on the journey to achieve high performance:

  • Respect each other
  • Invest time in team building
  • Develop common interests to help focus on patient-centered results
  • Ensure transparency
  • Have fun!


The team hits its stretch goal. As a result, 176 patients got better sooner, and underlying health conditions were often identified--which was good for patients and resulted in net savings of more than $1.14 million for Kaiser Permanente in 2012.

The team also achieved improved service scores, attendance, workplace safety and workplace satisfaction.

When I am asked what we are trying to achieve with the development of unit-based teams, the example of the San Jose team answers the question: We are empowering the inherent genius in work, in experience, in the creativity and depth in the life of workers.

I know of no other health system that has achieved this level of team capability on such a massive scale--through the work of some 3,500 unit-based teams across KP. We have accomplished this against all odds, through the determination of union leaders, management leaders and physician leaders, with the help of dozens of skilled, home-grown facilitators at the front line.

But more than anything, we must take the time to listen to the pride, sense of accomplishment and level of caring of the team members themselves who can teach all of us the struggle for collaboration that is the essential dynamic for innovation.

I never forget the many experiences I have of feeling the strength of the empowered worker. Therein lies the power to transform health care, and frankly to think in new ways about our collective future.


See this team's storytelling skills

  •  John eloquently described the impact of this team's story. We are proud to say they used our Inspire Change online storytelling tool. Thank you San Jose Nutrition Services UBT!
  • See SJO Nutrition Services Our Path to a Level 5 UBT,12/13/2012

John August insights strike at the heart yet again!!

And I quote:

"We have accomplished this against all odds, through the determination of union leaders, management leaders and physician leaders, with the help of dozens of skilled, home-grown facilitators at the front line..."


The grass roots or home-grown approach is vital.   You might ask why?  Its because as co-workers learn to lead one another credibility increases exponentially.  Primarily because of trust between co-works and indirectly because of these human connections an overall greater trust in the organization.


I love UBTs and LMP.  KP is the place to see the future of healthcare in action right now!!!

Executive director, Coalition of Kaiser Permanente Unions

To say that John is passionate about social justice is an understatement.