The Arapahoe Medical Offices' After-Hours clinic makes change look easy.

In just two years, its unit-based team overhauled the way the department was run—by becoming self-directed—and made improvements in two key areas: service and attendance.

“After becoming self-directed, we really became a team like never before,” said RN Becky Sassaman, a member of UFCW Local 7. “It gave us the opportunity to do what’s important to us….People get really engaged when they have the opportunity to make an impact.”

With an engaged team, the UBT found that improving service and attendance were quite simple. Seemingly small changes shifted the culture, improving patient satisfaction and staff morale. In 2009, one year after the team became self-directed, it launched three initiatives and surpassed their stretch goals on all.

Successful practices easy to copy

"People often think if they don’t do something big, it doesn’t matter. But these little changes have big effects,” Sassaman said.

Some of their key small changes were these: 

• Attendance. The unit-based team reduced last-minute sick calls by 30% simply by announcing at each team meeting how many staff members from SEIU Local 105 and UFCW Local 7 were absent that month. 
• Patient satisfaction. All department staff members now greet and introduce themselves to patients and ask, at the end of every appointment, whether all their needs were met. A department survey conducted in September showed that more than 90% of 200 members questioned responded that their needs were met and they were properly greeted.  
• Appointment bookings. The team also decided to train all staff to make follow-up appointments for those patients who need them, rather than asking members to make them from home. A survey showed that after their first training effort, about half of the staff members were booking appointments. The team held a second training and surpassed its stretch goal of 90%.

 “Booking appointments had not been something our staff had been trained to do,” Sassaman said.  “We decided to take on this challenge, knowing it was a cultural change to book into other departments’ schedules and knowing there was some fear and concerns around this.”

‘This is the best our team has ever been.’

The After-Hours Clinic serves members who need to be seen during non-business hours but not so urgently as to require an emergency room visit. Department managers rarely stayed in the position long due to the off hours. The UBT’s decision to become self-managed (a term that is used interchangeably with self-directed) came in 2008 after the department grew tired of the turnover.

“Every time we got a new manager they wanted to change everything,” Sassaman said.

The unit-based team did not make the decision lightly. With Cindy Brooks, who was then the manager of the Family Medicine department, taking on the role of management co-lead, the team’s co-leads met with every union member in the department and asked how they felt about the prospect of self-management. The team would come under the wing of the Family Medicine department manager, who would take care of those tasks that could not be done by the frontline workers—things like reviews, corrective action and discipline. But frontline workers would make the decisions about how to improve patient care and do the scheduling, meeting and in-service planning, supply management and more.

At first, there was a lot of skepticism, but the co-leads kept discussing the possibility, and finally the group agreed it was worth a shot.

Their decision changed the department culture. There’s more accountability, interaction and engagement—and it continues to save KP $90,000 annually, the salary of having a manager just for the After-Hours department.

Brooks, who left her position as the Family Medicine department manager in the fall of 2009, said the biggest surprise in all of this was how much better the team functions self-directed.

“They set the goals and do the work required,” she said. “The team is so fulfilled.”

And they get along better than ever.

“We have gained so much congeniality,” Sassaman said. “I’ve worked here five years, and this is the best our team has ever been.”