Transforming from the frontline up

"Case for Change” provides call to action in Colorado, with unit-based teams leading the way

By Kellie Applen August 12, 2008

A unit-based team in Colorado recently came up with new procedures that, within a few weeks, wiped out most specimen tracking errors, which had long plagued the department and slowed down patient lab results.

Another UBT in the region set up a hypertension clinic and within eight months, about 150 hypertensive patients at Skyline Medical Offices had gotten their blood pressure under control.

This sort of work, being done in unit-based teams throughout Kaiser Permanente, is the answer to the problems articulated in the Case for Change, a film that details the economic challenges and competitive pressures the company faces. A July 31 leadership forum, attended by managers, union stewards and physician leaders, marked the beginning of a formal rollout of the film in the Colorado region.

Frontline involvement

Many of region's frontline workers will watch the film during unit-based team training, said Dan Ryan, a national coordinator for the Coalition of Kaiser Permanente Unions.

The film makes the case that each individual who works at KP has a role to play in transforming it so that it can grow, remain affordable and be the model for the future of US health care. The work will be guided by the Value Compass, a tool for group decision making that keeps the focus on the patient and member while emphasizing key priorities: providing the best service and best quality of care at the most affordable price, while being the best place to work.

That transformation also depends on the teamwork and frontline involvement fostered in UBTs.

A sense of urgency

"The Case for Change right now is so relevant to KP Colorado's future success," said Ginny Mclain, vice president of operations Denver/Boulder. "Every single employee has a role in that success...and we have to work with a sense of urgency."

The region is challenged with improving affordability and customer service scores, Colorado leaders said. That has to change for Kaiser to grow. Out-pricing and "out-nicing" the competition give Kaiser Permanente the best chance at luring potential members away from the competition, who have larger provider networks and more insurance flexibility.

"We have a challenge because we are not a state-wide plan," said Donna Lynne, Colorado regional president. She noted, "Our health plan competitors typically have 10 times the number of physicians and hospitals in their networks than we do."

Bottom-line difference

Even though Kaiser Permanente has a price advantage over the competition, it's not enough of a differential, said Bill Wright, MD, executive medical director of the Colorado Permanente Medical Group. Even though Kaiser Permanente coordinates care better than any other organization, Wright said, employers—who are the primary purchasers of health care—are interested in the impact of health care costs on the bottom line.

"For us to grow, we are going to have to convince people to switch to Kaiser," Wright said. "That means we are going to have to convince employers that it's worth a line of people forming outside the CEO's office, who will be asking, 'Why are you making me switch docs?' For it to be worth the headache, we are going to have to be double our price advantage."

KP Leaders in Colorado are asking employees to come up with ideas for transforming the organization. The Case for Change, Wright hopes, will "tee-up conversation."

"We need to be engaging the staff who know their world," he said.

"The only way change will occur is if each of us takes it personally," said Tony Caliendo, a physician's assistant at Westminster Medical Offices and UFCW Local 7 shop steward. "We all have to own the success or failure of this company."