When we began moving to unit-based teams in 2007, a lot of us wondered what we were getting into. But today more than two-thirds of our union-represented staff are working in UBTs and are helping us achieve our goals for service, quality, affordability and the work environment. In many cases they’re getting results that managers had struggled for years to accomplish by themselves.

As one of four UBT sponsors for the Pharmacy department, I currently support 17 teams. Many team co-leads who are new to UBTs still have questions about how these teams work. Their concerns fall into three areas, which I try to help them deal with early on.

1. Rocky work relationships

There’s no question that departments with poor work relationships have a hurdle to overcome, and there’s no quick or easy solution. You have to sit down and honestly address your issues, get past them and rebuild trust one day at a time. But UBTs are a chance to take a new approach. Identify a shared interest—say, improving workflows—and jointly develop a solution. Start with small but meaningful goals, apply your rapid improvement training, establish baseline metrics and get tangible results. Doing so builds confidence and capacity for change, and better work relationships will usually follow.

2. Lack of clarity about roles

Partnership does not mean co-management, but rather participation in decision-making forums and processes. Everyone is accountable for results, and for managers that means setting goals, allocating resources, coaching and facilitating performance. But how we engage in our work—with our patients and members at the center—involves everyone. The team co-leads need to set clear expectations and provide business understanding. When an issue is well defined, and it’s clear that change is needed, I’ve seen teams work out tough details of staffing, scheduling and job assignments for themselves.

Some things can’t be mandated—they only happen with the insight and involvement of the whole team.

As a UBT sponsor, I help remove barriers like allocating backfill for UBT work, supporting the team leaders (perhaps taking up an issue with other stakeholders) and ensuring that the team’s projects are aligned with the Value Compass. I might make suggestions or simplify a goal, but getting it done is the team’s responsibility.

3. Confusion about the work of UBTs

UBTs are an instrument for performance improvement at the front line. What sets them apart from past initiatives is that they provide an infrastructure for learning, problem solving and assessing results. In Colorado, they have allowed us to cut wait times at our pharmacies, eliminate unnecessary work in some of our clinical pharmacy services and enhance efficiencies in our Pharmacy Automated Refill Center. Those things can’t be mandated—they only happen with the insight and involvement of the whole team.

UBTs also can give members a greater understanding of how their work affects the larger system. For example, our Clinical Pharmacy Anticoagulation Service UBT looked at their internal processes and found that eliminating one unnecessary step would free up 60 seconds per patient. Over the course of a year, those savings equaled the cost of approximately one full-time employee. That freed up time and resources we now use to better serve our members and patients.