Right before Thanksgiving, Kaiser Permanente's smallest region joined most of the rest of KP and officially kicked off their clinical unit-based teams.

Who was there: More than 100 doctors, union stewards, managers and others from the greater Cleveland, Ohio, service area.

What they did: They got 43 primary care and specialty medicine UBTs officially launched—and they learned new communication and problem-solving tools to help them become effective collaborators.

What came before: Ohio is following the larger regions in getting UBTs underway, but they are hardly unfamiliar with partnership, says Ohio's National Coordinator, John Kolodny.

For the past five years, Ohio's clinical departments have been working in collaborative groups dubbed "triad teams," each with a physician, a union steward and a manager. To varying degrees, the teams have been using interest-based problem solving and consensus-building techniques to improve patient wait times and work-flow efficiency.

"To those who have fears I always tell them, we're not changing direction from what we've been doing," Kolodny explained. "I bring them back to the value compass," which puts the focus on service, quality, affordability and keeping KP the best place to work—with the patient at the center of it all.

"As we move forward, instead of working harder, we'll be working smarter," Kolodny continued.

Here's how UBTs will expand on Ohio's collaborative environment:

• More involvement from frontline workers
• Greater focus on tangible, measurable changes/goals
• Strong team sponsorship

The UBT launch "is a good time to pull everyone back together and say, 'how are we working together in partnership,'" said organizational development consultant Karen Tingley. "There's been such a focus to get KP HealthConnect running, now is a good time to take a step back."

2007 pilot project

Ohio rolled out a pilot unit-based team in late summer 2007, when it merged its two internal medicine departments at Cleveland Heights Medical Center, the region's largest facility.

Since then, that team has been working to cut patient wait times and increase patient access to doctors through phone calls and emails. While progress has been slow, that team hopes to use the partnering and problem-solving tools taught at the Nov. 15 launch to continue to improve, Tingley said.

Challenges ahead

Some of challenges in Ohio, which has been struggling to gain members, are shared by other regions: There's a shortage of funds to backfill positions, so while the teams are working to gain traction, their members will face difficulties in getting the time to attend monthly meetings.

Ohio teams are being encouraged to make changes by using the simpler Rapid Improvement Model when appropriate and to take advantage of opportunities to learn on the job—both of which can help ease the time crunch.

"I don't think the transition will be that hard," Kolodny said. "But I think in the Ohio region people feel beat up because of the financial situation...There are two different levels we need to think about. One in terms of the Labor Management Partnership, and also in terms of the world we're living in and the state of healthcare."