Change might be necessary, inevitable or even the only constant.

In driving performance improvement, unit-based teams are in the business of change. But when, instead of being the agents of change, change is happening to them—when co-leads leave a team, or shifts are being revamped or an entire facility is closed and a new one opened—even the most stalwart of teams can come apart at the seams.

That sort of change, says Ian E. King, a performance improvement adviser for UBTs in the Georgia region, “tends to redirect a team’s focus” away from performance.

Sometimes, King says, teams need outside help staying pointed in the right direction. But individuals on teams and teams themselves also are coming up with ways to stay on track.

The Outpatient Pharmacy in South San Francisco, which went through months of changes and turnover on the management side, is one of them.

Despite the lack of continuity during that period, the team changed its reputation for having some of the lowest member-satisfaction rates around: From March 2010 to December 2010, the team reduced complaints by 45 percent. In order to serve members better, the unit—which once had almost 200 complaints in a single year—tackled wait times, patient instructions and other measures of the unit’s efficiency.

Led by management co-lead Kumar Atmuri and labor co-leads David Hong and Philip K. Lieu, both of SEIU UHW, the team kept tracking and reviewing quarterly complaint data and creating tests of change to deal with the subject of each complaint as it came in.

The team’s secret to staying on track:

Educating new staff members and temporary transfers keeps everyone focused on efforts to reduce member complaints.

Niambi Lincoln, a senior consultant for UBTs, says the team’s focus was a money-saver. Each complaint costs about $300 to address and resolve—not to mention the potentially significant cost to KP’s reputation for each complaint.

“It’s a real testament to this team that it showed sustainability in the midst of many lead role changes,” Lincoln says.

Lincoln cites another reason why the team is so strong and was stable through the changes in management:

Everyone in the department takes a turn serving on the team’s representative body, with new representatives rotating in every three months.

It takes time for new representatives to get up to speed, but Atmuri says the time spent is worthwhile. Rotation allows team members to participate directly instead of always providing ideas through someone else.

“The staff gets an opportunity to…become a part of the decision making,” Atmuri says.

The strategies that help teams can help an individual, too.

Avis Yasumura, RN, stepped into the role of labor co-lead of the Ambulatory Surgery Recovery team at Moanalua Medical Center in Hawaii before she had even completed LMP training. It was a taxing situation. Her team was a latecomer to the region’s roll-out party, replacing another team that went through a major staff reorganization. It was having to get up to speed fast. And although she’d been a KP nurse for 17 years, she was new to the unit.

How did she manage? Yasumura, a member of Hawaii Nurses Association, OPEIU Local 50, gives credit to the assistance provided to her and her management co-lead, Janet Lundberg.

Just-in-time training helps develop better communication and coaching skills.

That training, she says, also helped the pair, who were working closely together for the first time, understand each other’s working styles.

“Trust, communication and a good work environment,” Yasumura says, “makes it easier for us to achieve our goals.”

The team got past the early hiccups at launch to become the Hawaii region’s high-performance poster child. It chronicles a myriad of successes in its quarterly, widely read newsletter: The team saved about $10,000 a month over three months in a project to streamline supply orders, has helped improve patient flow in the operating room, and increased staff satisfaction with huddles that pass on information and recognize individual employee achievements.

“Our traditional ways of decision making have changed. (With) a new generation of nurses, the likelihood of success in decision making, problem resolution or issue resolution on any level involves more of a collaborative approach,” management co-lead Lundberg says.

In addition to the work co-leads must do to address change, a team’s consultants, facilitators and advisers have a key role to play in coaching UBTs through transition, says King, the UBT adviser in Georgia, where departments have weathered mergers and unit restructurings.

King coaches several teams and their co-leads, including one pair that is working with a team with just two original members left after a staff reorganization.

He recommends a three-step process for navigating these waters:

1. Recognize that change can be frustrating or scary.
2. Allow team members to openly discuss changes and the impact on their department.
3. Keep the focus on the work at hand.

“The more the team (members) can put their feelings or reactions on the table, the easier it is to see how we can harness any negativity and turn that into positive energy for the work,” King says.

In a recent meeting with the facility operations team at the newly retooled Town Park medical offices, he marveled as the co-leads decided this was a great chance to rebuild the team and promote performance improvement.

“They came up with a ‘divide and conquer’ plan to reach out to facility staff and encourage their participation,” King says. “Even in the aftermath of a major organizational restructure, this team was able to focus on what needed to be done to move improvement work forward.”