Unit-based teams are on their way to becoming a fact of life at facilities throughout Northern California. More than 100 targeted UBTs are slated to launch by July 20, and some 400 frontline workers and managers recently attended a kickoff training session in Oakland.

Their task is daunting: to organize unit-based teams that will measurably improve performance to make KP a leader in health care and a model for health reform. The targeted teams will focus on five key areas:

• Attendance
• Overtime
• Missed meals and breaks
• Inpatient service
• Outpatient service

In addition, they will choose one or two issues that will improve their work environment.

Leaders on the same page

At the June 15 kickoff, union and KP leaders emphasized the big picture—working together to ensure Kaiser Permanente's position as a leader in health care.

Mary Ann Thode, president of the Northern California Region, laid out the reasons for adopting UBTs as a platform for driving better service and care. She said that keeping KP affordable is critical to staying afloat in an increasingly cutthroat industry where companies are trying to edge out their competitors.

"If we are to stay successful," Thode said, "we must be more efficient and provide better service and quality...It is our moral obligation. Health care is our mission."

Union leaders agree that unit-based teams will make Partnership tangible at the frontlines and help make KP a high performance organization. They stopped short, however of declaring UBTs a panacea for all that ails the health care system.

"Will unit-based teams fix the health care crisis?" asked Sal Rosselli, President of SEIU UHW-West, in a videotaped speech. "No. But they can help keep Kaiser Permanente and our unions strong and take Partnership to the next level."

Dr. Judy Lively, Physician in Chief of the Diablo service area, noted that frontline workers frequently question the reticence of many physicians regarding Partnership. She said that UBTs provide an opportunity for MDs to work with high-performing teams. Lively added that physicians are trained to look for hard evidence of success and they will be convinced as the data comes in.

"UBTs give us a way to systematize our experience and track our progress," she explained.

Nuts and bolts

Fifteen percent of the region's departments are slated to become unit-based teams by the end of the year, as called for by the 2005 National Agreement. By 2010, all departments program-wide are set to make the transition to UBTs. For this first round of UBTs, selected medical centers will each have five teams—one focusing on each of the targeted areas—and regional service facilities, like the Livermore distribution center, will have two. The teams will collect data to track their progress.

The UBT emphasis is on results. Participants in the kickoff received training on how to make and evaluate change quickly and not get bogged down in process. They were introduced to the "Rapid Improvement Model" based on "plan, do, study, act" techniques. The idea is to try out small changes and evaluate their effectiveness quickly before deciding whether to adopt them on a larger scale. Rather than invest lots of time and effort in planning and evaluating, UBTs are asked to learn by doing.

Many participants found these new methods useful. Starlene Holguin, a program assistant in the family medicine department at the Santa Rosa Medical Center, said she would bring the new approach back to her team.

"It's a good way to start the conversation," said Holguin, whose department is focusing on improving attendance.

Cynthia Escoto, an ophthalmology technician at the Redwood City Medical Center, thinks the trial-and-error approach will work.

"We are all doing this together," she said. "None of us are novices. There is a wealth of information."

In fact, the teams will get more training in their facilities and support from an on-site Implementation Resource Team. Escoto will be on tap as a facilitator as part of the Redwood City resource team.

UBT co-leads understand that transforming how KP operates will come in small increments throughout the program that when taken together amount to big changes. Administrative Service Supervisor for the Richmond Medical Center Pediatrics Clinic, Cynthia Ramirez, has gained a deeper appreciation for the need for her department to work together as a team to get results.

Her department has been able to reduce last-minute Friday sick calls by instituting small morale boosters. By putting in place fun, team-building activities on Fridays, they have cut sick calls down to just one in the last two months.

"It's incredible how small a thing this is and how incredible the impact is," Ramirez said.

Local kickoffs will be held at facilities throughout Northern California in the coming weeks.