When her employees got honest and told her she was being too bossy, Christine White turned to the people who knew her best: her husband and an older sister. Yup, they said "you're like that at home, too." White listened. She changed her ways.

She made a deliberate effort to back off and give her employees more freedom. Making all the decisions "was my style - now it's making collaborative decisions."

The outcome for Kaiser Permanente? The Affiliated Health Care Operations (Claims) department, which White manages and which was selected to form one of the Georgia region's first unit-based teams, recovered more than $4.8 million in overpaid claims in 2007. That's a cool $1.8 million more than the usual total. The team has identified an additional $900,000 that they're working on recovering.

How did that happen? With some discomfort, initially.

"I always wanted to be the boss because everybody always told me what to do, growing up," said White, who was the youngest of 12 children. "That was always my excuse....But people came to me and were very honest and candid so I thought, 'You better get your act together.'"

Not all the UBTs launched in 2007 had a clear-cut monetary goal - and not all the teams with successes were formal UBTs. Some teams used longstanding partnership tools to improve. Others jumped in with the new "plan, do, study, act" steps of the rapid improvement model.

Vallejo call center UBT members (left to right) Denise Barker, Linda Harder, Melinda Aasen, Connie Hill and Maureen Prasad, all represented by UHW-West.

What they all have in common is a focus on working together to do the job better, today, tomorrow and all the days after that, building on each improvement, one small change at a time.

As with White's team, that often means discarding how things had been done before. For the Labor Management Partnership at large, there's been a new emphasis on aligning the teams' work with regional business priorities. Strategies are evolving so that workers get just the training they need, when they need it, "no more, no less," said Mike Hurley, the Union Coalition director of training.

"Continuous improvement will be the way we do our jobs," he continued. Looking for ways to do the job better "is not another job on top of what we're doing, it's the way we look at our job in the first place."

The shifts leave some people unsettled, though, and there are hurdles yet to clear. Some managers still give lip service to partnership, while some union employees still want to clock in, do the minimum required and collect their pay. The focus on performance improvement leaves some employees wondering, "What's in it for us?"

To Juli Jacobson, a Colorado staff clinical pharmacist and Local 7 shop steward, the answer is easy. "When you get your work flow down so there's less waste, you're less frazzled and you're not doing double work," said Jacobson, who has been part of a regional UBT that developed ways to reduce the number of prescriptions that had to be returned to stock.

To Yvonne Henry, White's labor co-lead in Georgia, there's a tradeoff in committing to making partnership and UBTs work. Henry, a claims auditor and Local 19 member, said employees have to give their all during the workday, "instead of playing around and only doing six hours or five hours" worth of work. But in return, the UBTs "let our voices be heard." It wasn't just White who needed to change her style, Henry said. When the team was deciding how to organize the claims recovery work, she realized it wasn't just about what she wanted and thought best. "I thought I could make decisions on my own, but it's not just what I can do as an individual," Henry said. "What I have learned over the last 19 years I have to share with my team."

Take this job and turn it around

Call centers are notorious for burning through sick days - but this UBT in Vallejo has done an about-face "Oh, no!" was the first thought that entered Ailene Richards' mind when her team of service representatives was selected as the first unit-based team at the Vallejo Appointment and Advice Call Center. In nearly 20 years at Kaiser Permanente, Richards had seen plenty of good ideas fizzle, and she was afraid this might be another.

But when she found out the team's assignment was to continue the work they began at the end of 2006 on reducing last-minute sick calls, she agreed to give it a go.

"I knew it would be a learning experience for me," Richards said, "and it has been." Certainly it was an issue that needed attention. In January 2007, the UBT had the fourth-highest number of absences of the center's 25 teams, with a rate of 35.28 sick days per year per productive FTE (a calculation that looks at the time an employee is actually at work). No one anticipated how quickly the team of 22 teleservice representatives (TSRs), working with Richards and former UBT co-lead Rhonda Gore, would turn that around.

The service reps have tough jobs. A TSR follows the same scripts, day in and day out, and takes scores of calls back to back. Members are sometimes frustrated and cranky when they cannot get an appointment or get through to their provider—and a TSR hears all about it. They are trained to express empathy and defuse tension but don't always get recognized for the important role they play in patient care and service.

Yet in just six months, the UBT had leapfrogged up to ninth place at the call center. And that trend held steady through the year.

Their secret? Teamwork and keeping careful track of their results. "Every time we meet, it comes together," Richards said. "Listening to what employees want does a lot for my team's morale."

When you get your work flow down so there's less waste, you're less frazzled and you're not doing double work."

Juli Jacobson, staff clinical pharmacist, Local 7 shop steward

The team has lots of institutional support. The call center's attendance co-leads, Angela Smith and Candice Bell, have worked closely with the group to create a commitment to member service and to the team - which requires using sick days judiciously, not taking them as extra vacation or personal days.

The relationships that the UBT has built, as well as its commitment to serving members, is making the difference between a monotonous, burnout job and an engaging one.

"If we are not here, we are not helping people get what they want from Kaiser," said current UBT co-lead Candace Alberts.

Knowing they are being scrutinized has UBT members striving for perfect attendance, not wanting to let their colleagues down when monthly statistics are posted.

"Feeling the sense of connection and seeing attitudes change taught me that working together can make a difference," agreed Gore, a shop steward with SEIU UHW-West.