Problem

Where to begin? For years the Adult Medicine department at Walnut Creek Medical Center in Northern California was plagued by poor attendance, high injury rates, grievances and missed meals and breaks, for which KP was heavily penalized. All of this dysfunction was wrapped in a long history of mistrust and hostility between staff, managers and physicians.

“It was very chaotic,” recalls Marci Hendricsen, the department’s assistant manager. “People treated each other badly and were afraid to speak out.”

Solution

“There was no quick fix,” says Paula Lowery, the department’s manager. “It was a long-term process of building trust and chipping away at an unworkable culture.”

But she took some important first steps. Soon after she arrived, Lowery agreed to grant days off if people requested them in advance rather than calling in sick. She also worked to jointly resolve problems, such as weekend scheduling. To establish credibility, she says, “You have to do what you say you will do. People need to see that things can change.”

The team’s two stewards, Ilda Rodrigues and Emerciana Powell, also stepped up to lead. “It was hard on everyone to work in such an adversarial environment,” says Rodrigues. “I made a promise to myself that whenever a problem came up I would hear both sides before making a decision.”

Our focus is always on the patients. That’s why we’re here.

The department, which sees more than 400 patients a day, 365 days a year, was already working better when unit-based teams were introduced in 2007. The next step was to have physician-medical assistant pairs take the lead for performance improvement at each of the four patient stations. Ideas were then shared and implemented across the department.

Some of the changes were simple. To help room patients on time, the staff suggested starting and ending their lunch hour 10 minutes earlier. The change was piloted at one station at a time, to give others a chance to assess results and buy in.

In addition, medical assistants developed a plan to reconfigure the floor plan, consolidate member check-ins at one station, and provide more flexibility. “It changed our relationship with the physicians for them to see us making changes to help the department run more smoothly,” says Powell.

The team regularly discusses the economy and its impact on KP, its members and employees personally. Such discussions foster a connection among the 38 physicians and 48 staff members, and reinforce their shared goal—to help members see their physicians as quickly and cost-effectively as possible. “Our focus is always on the patients,” says Powell. “That’s why we’re here.”

Results

Annual sick days have fallen from 9.14 days per full-time employee in 2007 to zero as of May 2009. There also have been no workplace injuries and no missed meals or breaks so far this year. Adult Medicine earned the Diablo Service Area’s Four Star Award for its results in budget, patient satisfaction scores, People Pulse scores, and quality measures two years in a row—the only department out of 57 in the service area to win the award. And Hendricsen describes another less measurable, but very real, change: “We always try to believe the best about one another and not assume the worst.”