The Hawaii region is an island no more, at least when it comes to the quality, service and affordability work of Kaiser Permanente’s Labor Management Partnership unit-based teams.

The newest partnership region joined the seven other regions in getting unit-based teams (UBTs) under way with three jam-packed days of information sessions and training.

Training included a dive into the Rapid Improvement Model, and the co-leads and their team members—about 14 frontline employees and managers—gained a better understanding of how to use RIM’s plan, do, study, act (PDSA) cycle for rapid performance improvement.

“This has been presented in a very optimistic way,” said Gregory Gibbons, an RN in the Post Anesthesia Care Unit (PACU), who’s on the unit’s team. “It gives people the mindset from the beginning that working in partnership does not mean compromising any values.”

Aligning with strategy and goals

After viewing videos on other teams in other regions and going through problem-solving exercises, the teams gained more insight into what projects they could work on to align the region’s business strategy and performance goals.

The Hawaii Nurses Association (HNA) joined the Union Coalition more than a year ago, and earlier this year, it reached an agreement with the Kaiser Permanente Hawaii region on its first contract. The decision to become part of the Labor Management Partnership under the terms of the 2005 National Agreement covers nearly 800 members of HNA.

We are becoming part of a productive history. You can’t just go out and do the work without understanding the purpose behind it

Marina Robinson, RN and Union Partnership Representative  

“Creating unit-based teams is one of the best outcomes of our new partnership,” said Janet Liang, the region’s Kaiser Foundation Hospitals/ Health Plan president. “Our nurses have always been strong patient advocates so it makes perfect sense that UBTs would be a natural next step in our work together to achieve our region's goals for service, quality and affordability.”

Collaboration experiences

Nurses in Hawaii, however, are no strangers to collaboration with colleagues. The MedRite program, which minimizes interruptions for nurses dispensing medications, was launched in inpatient departments throughout Northern California, the Northwest and Hawaii.

Other leaders in the Hawaii region praised this inherent sense of collaboration and encouraged the teams to new heights.

Patt A. Gibbs, HNA executive director, called the partnership a positive step for nurses and an opportunity to become more involved in the service and care they provide at Kaiser Permanente.

“Because our professional RNs are the backbone of Kaiser, I believe that the LMP partnership lays an important foundation for a successful future for the HNA RNs,” Gibbs said. “They utilize their skill set to improve patient care and safety while applying their knowledge and expertise to improve relations within each unit in the workplace.
This results in better working conditions for everyone.”

The teams were launched at the Moanalua Medical Center in the PACU, the Ambulatory Surgery Recovery unit, and the oncology inpatient clinic.

The region, with 4,400 employees and more than 400 doctors, has provided care and health coverage for 50 years to the people of Hawaii, including members on the islands of Oahu, Maui, Hawaii and Kauai.

Understanding of purpose

Marina Robinson, an RN and the region’s Union Partnership Representative, said the background and history of the partnership are important for all frontline employees to learn.

“We are becoming part of a productive history,” Robinson said. “You can’t just go out and do the work without understanding the purpose behind it.”

Robinson plans to take more information and training about partnership and UBTs to Hawaii’s other islands: “There is an excitement out there about it. We have to get the information out to the rest of the people.”

Jim Griffith, MD, a pediatric pulmonologist and chief of the hospital medical staff at Moanalua, who represented the Hawaii Permanente Medical Group at the kick-off, said the key to success is to start small, in targeted areas with energetic groups who have already been working well together.

“Am I excited?” he asked. “Yes. Do I think great things will come from it? Yes.”

Ravada Benjamin, an RN who is labor co-lead of the recovery team and an HNA member, made a connection between what she does every day and the region’s success: “You learn that if you don’t do the things to help KP survive, you aren’t going to survive either.”

Training days

Dozens of providers and employees at the center attended one-hour information sessions hosted by representatives from Kaiser Permanente Hawaii, the Hawaii Nurses Association, and the national Office of Labor Management Partnership and the Coalition of Kaiser Permanente Unions to outline the rollout and training of the new teams.

Dan Ryan, Union Coalition field director, and Paul F. Staley, vice president of Operational Initiatives and Performance Improvement in the national Labor Management Partnership office, described how other UBTs have been working in collaborative groups, and how to varying degrees, the teams have been using interest-based problem solving and consensus-building techniques to improve a host of important measures.

At Moanalua, Murray, Suzann Filleul, regional nurse executive, and Jeff McDonald, the Union Coalition’s national coordinator in Hawaii, discussed how the new teams will expand on Hawaii’s current cooperative spirit by involving more frontline employees in designing solutions as well as in targeting tangible and measurable goals. McDonald and his management partner, Albert Mossman, the region’s director of Employee and Labor Relations, will serve as the regional partnership co-leads, guiding further training and support of the teams.

Challenges remain

Hawaii, like other regions, faces outside issues that include the changing health care environment and the challenge of gaining and retaining members affected by unemployment or other consequences of the flagging economy.

Gary Kienbaum, management co-lead of the recovery team, said the special nature and complexity of the region presents different challenges. Many members from neighboring islands must board planes even for routine outpatient appointments and procedures, and fly back home the same evening.

“Nurses often have to deal with the patient’s stress,” he said.

The center’s Ambulatory Surgery Room is a catchall that serves members who are coming in for local anesthesia, recovery from GI or diagnostic imaging. The team plans to work with the center’s PACU to improve patient flow to and from the surgery center.

Kienbaum welcomes the opportunity to work more closely with his staff on key issues.
“I expect them to be part of the problem solving. As a manager I need them to be active partners.”