With growing pressure to improve performance and become more efficient—and fast—physicians in Northern California’s East Bay medical facilities didn’t want to wait for the training or infrastructure to reach them. Instead, they brought the training and resources to themselves.

Physicians from the Richmond and Oakland medical centers, along with representatives from OPEIU Local 29 and SEIU UHW-West from both medical centers, held an all-day training in the Rapid Improvement Model (RIM) and partnership principles last spring to arm department physician chiefs, managers and shop stewards with the tools to jump on improving performance—together.

The training took hold: In the weeks and months since, several departments have undertaken successful RIM projects. Oakland Radiology, for example, has dramatically cut patient wait times. Doctors were full of praise for the training in a post-meeting survey.

“We had been meeting as a leadership team, talking about performance improvement and efficiency and how we could bring managers, chiefs and stewards together to look at efficient ways of improving performance,” said Shirley Steinback, the East Bay medical group administrator.

Physicians in the mix

While many stewards and managers had previously attended RIM training, this was the first time stewards, managers and physicians were brought together to undergo the training in the context of partnering.

“I think they really saw the partnership,” said Richmond operator Lashrea Alexander, an OPEIU local 29 steward. “They got a clear picture of how we work within the partnership, and how it looks from the outside. They saw and heard different testimony of how we work together and how we’re trying to pull the docs in.”

The training was organized with the aim of creating a team-based culture of performance improvement at the two medical centers, said Lysha Albright, PhD, the director of leader and strategy development for the medical group in the East Bay.

‘Toyota of health care’

“We didn’t want it to be just a flavor of the month. It isn’t just a one-day training,” Albright said.

Referring to the carmaker’s reputation for continuous improvement, she continued, “We want to be the Toyota of health care, so people are constantly thinking about what we can do to make things better for patients.”

Key to the day’s success, many said, were the accounts given by Santa Rosa Medical Center frontline staff, who shared their journey of working in partnership on performance improvement—their stumbling blocks and successes.

“I think people got inspired because they saw themselves,” Albright said. “They could relate to it. We had all of our leaders sitting together, so it was very clear that this was a joint effort.”

Michael Haiman, MD, the assistant physician in chief for performance improvement at
Santa Rosa, gave the physician perspective of organizing and pushing out performance improvement throughout the facility. Family Medicine medical assistant Meggan Williams, a member of SEIU UHW-West, and others shared the labor point of view of trying and tweaking small tests of change in partnership.

Spreading best practices

Williams’ work on reducing unnecessary post-emergency and hospitalization follow-up appointments is a best practice that has since been adopted by the other primary departments at Santa Rosa, including OB/GYN and pediatrics.

Dr. Haiman acknowledged that the process wasn’t always smooth—but emphasized that the payoff was worth working through the rough patches.

“Somebody at the meeting asked, 'How did it go with labor in the beginning?'” Dr. Haiman said. “I said, 'Oh, it went terribly.’ Labor became so frustrated with management that they walked away and didn’t participate in the (performance improvement) committee for three months. But we kept trying and they kept trying until we reached compromise and understanding."

Dr. Haiman continued: "We absolutely didn’t know each other’s perspective, but for the sake of the organization and the patient, we really had to sit down and figure out how to understand each other’s point of view."

Changing beliefs

Chiefs, managers and stewards alike could relate to Santa Rosa’s struggles and successes as they partnered on performance improvement efforts. The training was less about gaining the RIM tools, and more about using those tools in true partnership.

“When you’re talking about performance improvement, it’s about culture,” Dr. Haiman said. “It’s really about beliefs and values, and changing those. Everyone has to believe that improving our performance is the right thing to do and that it is his or her responsibility to be part of the improvement process. You have to have everyone on board with the changes. It was one of the hard lessons we learned."

Local 29 Oakland and Alameda labor liaison Esmerelda Gomez, who helped organize the RIM training, was impressed with Santa Rosa. Their first-hand accounts, she believes, went far in impressing the fundamentals partnership on everyone in the group—the proof being the many successful projects that have since been jumpstarted at Oakland and Richmond.

“Until recently the physicians haven’t really known what their piece of the puzzle is and how they fit into in the partnership,” Gomez said. “The RIM training helped put that puzzle together and showed them that they’re a key component in that puzzle and we need their help…They are that missing part of the puzzle and when they come into the room, that completes the puzzle.”