We can’t change whole systems without changing the hearts and minds of individuals.

And what would be the point of systemic change if it did not come from the hearts and minds of individuals who contribute to and benefit from that system? This is the fundamental question not just for improving systems in health care delivery, but for how a democratic society is supposed to work.

So, how did frontline health care workers in Anaheim, California, and Jonkoping, Sweden, end up creating exactly the same expression of their sense of empowerment without ever having met or even knowing of one another’s existence?

It occurred because in Anaheim and in Jonkoping, the unions and management have agreed to create an adult learning environment in the workplace. Such an environment creates the freedom within people to bring out the deep-seated knowledge that exists within each of them. Empowering workers to unleash their knowledge becomes a joyful leap forward in human development, creating improvement for the social good—in this case, for the patient.

Anaheim’s lab team

I recently had the privilege of spending the day at a unit-based team fair at the Anaheim Medical Center. Two dozen teams put their work on display as examples of the whole system change that is taking place at the medical center and throughout Kaiser Permanente. These are examples of what’s being done by the more than 94,000 frontline union members who are now part of UBTs!

When I stopped to listen to the presentation of the Laboratory team members—who later won first prize at the fair for their story and presentation—I learned of their journey to reach their goal. In just six months, team members achieved 90% on-time delivery of lab reports, up from a 20% rate when they began.

When the members of the lab team asked themselves what was needed to achieve their goal, they agreed that they needed to become a team. They realized that just calling themselves a “team” did not mean that they possessed the attributes of a team. How would they discover what a team really was? They asked themselves, “What am I a part of?”

They spent weeks asking staff for their definition of a team. They asked what would be needed to transform the environment. They asked what was in the way. The UBT leaders listened.

When they finished their inquiry, they had answered the question. The lab team created a graphic and put it on a plastic card that all lab employees wear along with their ID card.

The graphic is a puzzle. In this case, four differently colored figures, each with their own discoveries represented by a puzzle piece. The four figures are sliding their pieces together to make a whole team.

Swedish health care workers come to the same conclusion

In 2007, I had one of the many great privileges I’ve enjoyed since I have been in my position: I led a group of six frontline Kaiser Permanente employees on a weeklong journey to learn from our friends in Jonkoping, Sweden. Jonkoping County is an integrated health system much like Kaiser Permanente, and the two organizations collaborate through our strong work with the Institute for Health Care Improvement (IHI), founded by Donald Berwick, MD, the director of the Centers for Medicare and Medicaid Services. Dr. Berwick teaches us that in order to succeed at improvement work, we must have the courage to ask ourselves, “What am I a part of?”

In the Jonkoping hospital, we noticed employees wearing T-shirts displaying a piece of a puzzle, as well as posters and stationery and other representations of the same piece of a puzzle. The employees explained that everyone brings their own learning to make a whole and each person’s learning is represented by a puzzle piece.

See where this is going?

People go to work every day with all the answers. Sometimes, they know that they have them, but mostly they are just frustrated that their knowledge is not put to better use. Our society as a whole works the same way. Common sense would never create the kind of chaos we live in. And if people’s common sense were put to use, our society would find the resources and the will to improve.

Think of the joy that would be possible if only people’s knowledge was put to use for the common good.

Tears of joy

When the lab team at Anaheim described their journey of creating a team, the tears flowed, tears of joy. As senior staff member explained as she welled up, “I have waited all my life to have our ideas and our knowledge make positive change for everyone. I never thought it would happen, but it has.”

Our journey in our Partnership is to empower knowledge that already exists. When we do, we change everything. But it all begins with the individual. Our Partnership must focus its attention there if we are to truly succeed.