October 26, 2016


Bustling Pediatrics Unit Improves With Better Communication

Team members Heather Williams, co-lead Lily Cuevas, Anika Chavez and former management co-lead Janice Gines

With 80 employees serving almost 100,000 patients a year, the San Jose Medical Center’s Pediatric department is big and bustling. Its member satisfaction scores are rising, and employee attendance is improving. Morale is on the upswing, with staff members enjoying their jobs and one another.

So what does the department credit for all this good news? They credit each other—all 80.

Currently ranked at Level 4 on the Path to Performance, the department’s unit-based team is a showcase for what’s meant by “having the engagement of team members,” one of the hallmarks of high-performing teams. Employees say the UBT has triggered a snowball effect of positive change.

“The UBT engages all players taking care of patients, including PSRs, MAs, LVNs and MDs,” says Berry Armstrong, MD, a pediatrician who has been active in the team since it was launched about five years ago. “We each bring unique perspectives to the table, but have the shared goal of making life better for our patients and for each other. Giving all of us a voice means we all feel a stake in our work and our outcomes.”

Who’s on the team?

The definition of a unit-based team says UBTs include “all the participants in a natural work unit or department.” In practice, however, smaller departments typically have had an easier time getting full participation of all staff members.

Lilia Cuevas, a medical assistant in the Pediatrics department, the UBT’s labor co-lead and a member of SEIU UHW, says maintaining direction and focus is challenging with a large UBT.

In large departments, which often rely on a “representative” model, there’s frequently been confusion about who’s on the team—with those who aren’t part of the smaller group of representatives leading the work thinking they’re not actual UBT members. Even when everyone understands they’re part of the team, as is the case with San Jose Pediatrics, the larger size doesn’t automatically translate to meaningful collaboration.

A few years ago, San Jose Pediatrics was struggling to meet performance goals and the department was weighted down by sagging morale. “Everyone was doing their own thing,” Cuevas says. “Organization wasn’t centralized. It was difficult to keep up on what was going on.”

Member Patient Satisfaction (MPS), for example, was 77.3 percent in 2010.

Attendance was at 7.1 annual sick days per FTE (full-time equivalent) in 2011.

By 2012, however, MPS scores had risen 10 points to 87.3 percent. Sick time usage had dropped to 6.9 days per FTE, an inching improvement toward the goal of 6.5 days.

Improved communication spurs change

The turnaround started when the UBT members asked themselves what wasn’t working and why, Cuevas says. A departmental survey showed poor communication was a top concern.

Next came a survey asking employees how they wanted to communicate. Many ideas were tossed about, from emails to newsletters. But huddling emerged as the clear winner, and ever since, the informal, short meetings are called whenever one is needed by whomever needs it.

They don’t replace more formal, twice monthly UBT meetings but are used for conveying daily departmental information from shift changes due to vacations or sickness to staff birthdays and updates on UBT projects.

“It’s going very well. That’s how we communicate the majority of our things,” Cuevas says.

The UBT instigated a number of other successful tests of change, including:

  • Bear Bucks: Gift certificates for Kaiser Permanente brand items, earned by employees for good attendance.
  • “Simply the Best”: Employees who have made a special or unique contribution, small or large, are singled out for recognition on a departmental bulletin board.
  • UBT subgroups: These focus on Kaiser’s Six Pillars of Work (people, access, quality, inpatient service, technology/efficiency, service), with volunteer subgroup leaders reporting back to the full unit-based team.

The subgroup effort started by asking employees what they’d like to see in the perfect pediatric department. The answers were customized for San Jose, and specific projects proposed under each pillar.

“We asked how can we ‘wow’ our members and each other,” Cuevas says. “We got great feedback.”

“We’re headed in the right direction. There’s always room for growth,” says Maria Errico, the administrative services supervisor of the department and the UBT’s management co-lead. “The UBT is very important. It’s an important way to communicate.”

‘Mastering meetings’ helps engage employees

Janice Bautista Gines, the department’s former manager and UBT co-lead who is now the assistant manager of Adult and Family Medicine at the medical center, credits a “mastering meetings” training by UBT members with having major positive impact. The tips for holding effective meetings were applied to all gatherings, from major UBT meetings to hallway huddles and subgroup get-togethers, she says.

“We learned to get people’s attention by having everyone take notes on the large poster boards. We’d rotate who was taking notes, and we’d all be involved in the agenda review,” Gines says. “At the end of every meeting, we’d literally do a review of what worked and what could be improved—our wrap-up.”

This consistent value placed on employee input is creating a workplace culture primed for positive change, employees say.

“Everybody is welcome to throw in an idea. No idea is dumb. We’ll discuss it, we’ll see if we can test it. Most people like to learn new things and improve,” Cuevas says.

“We all voice our opinions, we all work together. We’re not at each other’s throats. We try to come up with solutions—we work it out. We don’t work against one another,” says Niomi Mendoza, a medical assistant and SEIU UHW member.

The future of health care delivery

Dr. Armstrong takes it a step further.

“I believe it’s the model of the future of medicine, not just in pediatrics, but all departments,” he says. “Bringing people together across the board, rather than keeping them in isolated silos, leads to a higher level of engagement and problem solving. This dynamism creates a strong and more flexible foundation for a department.”