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Changing Times, Changing Care

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Without well-child visits, many young patients are not receiving recommended immunizations for preventable diseases, including measles and whooping cough. The Fontana Pediatrics team brainstormed and developed a drive-up vaccine clinic.

 

TOOLS

Coalition PSP Fact Sheet

Format:
PDF 

Size:
8.5"x11" (2 pages) 

Intended audience:
Frontline union members, managers, and leaders involved in the Coalition Performance Sharing Program 

Best used: Understand the goals, metrics, and eligibility for bonuses under the Coalition Performance Sharing Program for plan years 2024 to 2027.

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Optical Team Solves Swirling Mystery

Deck: 
Techs overcome problem damaging new eyeglass lenses

Story body part 1: 

If one word inspires dread in the Optical Lab Surface department, it is “swirl.”

The Northwest team helps make eyeglasses for Kaiser Permanente members. Their work is sometimes complicated by swirls – circular scratches on the lenses that can occur during the production process.

In 2022, the team - based at Kaiser Permanente Sunnyside Medical Center outside Portland - grappled with a mysterious increase of swirls.

“Normally, we will get about one swirl per day that we can’t polish out,” says Rodney Edwards, department supervisor and the team’s management co-lead. “But suddenly we were seeing 12 or 13 per day. We knew we were dealing with something very strange.”

When extra polishing can't remove a swirl, the team must fashion a new set of lenses. This raises costs and slows production, delaying delivery of eyeglasses to KP members.

By conducting a painstaking review of its processes, the team uncovered the cause of the swirl surge and improved care and service.  

When everyone participates in performance improvement, the better the results and the stronger the work environment. Collaborating on performance improvement also advances a culture at KP in which continuous learning and improvement come naturally.

From technicians to sleuths

Finding the source of the swirls was not easy. The Level 4 team prepares about 700 eyeglass lenses each day.

“It’s tough for us to troubleshoot these things," says Dustin Rushing, an optical lab technician and OFNHP Local 5017 member, who is the team's labor co-lead. "We’re operating at such a high volume we can’t really stop the presses."

To identify the problem, the team performed multiple tests of change.

Team members analyzed vats of liquid lens polish. They improvised new polish filtration devices. They scrutinized surfacing procedures and the calibrations of each piece of machinery. The tests and tweaks occurred while the team tried to keep up with high demand for eyeglasses.

Weeks of testing uncovered the problem: wear and tear on machinery was leaving metal shavings in liquid used to polish new lenses. The solution? Modifying worker procedures and intensifying maintenance and replacement of machine parts.

As a result, the team saw a 94% reduction in swirls during the first 4 months of 2023. That success continues. The team reduced monthly costs to replace damaged lenses, from $525 to $31, for a projected annual savings of $6,000.

While the cost savings may seem small, it illustrates the impact of unit-based teams. Enterprisewide, more than 3,600 teams contribute to KP’s national leadership in measures of affordability, quality, service, and care.

The project earned the optical lab team a UBT Excellence Award from regional leaders.

“The biggest reason for this project’s success was the openness and communication between us all,” Edwards says. “That really opened up some doors for us as a team.”

Getting Personal to Improve Patient Care

Deck: 
Teams collect patient demographic information

Story body part 1: 

Jenna Li and Autum Tomlin serve in different specialties at opposite ends of the country. Yet each plays a central part in efforts to harness patient data to improve care and eliminate health disparities at Kaiser Permanente.

Li is a chemical dependency counselor with the Mid-Valley Addiction Medicine team in Salem, Oregon. Members of her unit-based team, represented by Alliance-affiliated unions, make standard practice of asking patients about their sexual orientation, gender identity and preferred pronouns.

Tomlin is an urgent care technician at Reston Medical Center in Virginia. She and her team – represented by Alliance- and Coalition-affiliated unions – collect information about patients’ race, ethnicity, and preferred language. She has seen, first-hand, the power of speaking to patients in words they can understand.

“Usually, you can see the patient is at ease and feels a sense of relief that they are able to communicate in their preferred language,” says Tomlin, the team’s labor co-lead and a member of OPEIU Local 2, part of the Coalition of Kaiser Permanente Unions.

Like others across the organization, the Level 5 unit-based teams are seeking to address disparities in health and access to quality care that persist across a range of dimensions – including race, language, gender, and sexual orientation. By asking patients about their backgrounds in a safe, respectful, and compassionate way, the teams are changing how they deliver care and service to members – and relate to one another.

“The effort is minimal, and the effectiveness can be really high when we help a patient feel seen and understood,” says Li, labor co-lead for the Mid-Valley team and a member of OFNHP Local 5017, part of the Alliance of Health Care Unions.

Making members feel welcome

To better understand patients’ health risks and needs, the Mid-Valley team began asking members about their sexual orientation and gender information. They asked the questions during the intake assessment and entered patients’ responses into their electronic health records, making important background information available to all KP providers.

The practice is already changing how the Northwest team delivers care to LGBTQ+ patients.

For instance, Mid-Valley is referring more members to a weekly group therapy session for LGBTQ+ patients to discuss their unique challenges. Misunderstandings about sexual orientation or gender identity are among the obstacles such patients face in accessing effective care. They also are at elevated risk from health threats including alcohol and substance abuse.

Recently, the team hustled to track down a teen-ager in crisis who had fled their clinic’s waiting room. Knowing the teen identified as nonbinary, staff members convinced them to return after expressing sensitivity to their fears and addressing them with their preferred pronouns.

Gestures to support these patients are especially important because they come to treatment reeling from the “double whammy” of stigmatization for their addiction struggles and LGTBQ+ identity.

“We can do a lot to make a member feel welcome by using language they are open to hearing,” says Carri McCrary, Mid-Valley clinical services manager and the team’s management co-lead.

Breaking the Sick-Time Cycle

Deck: 
Avoid burnout: plan time off, use sick days for illness

Story body part 1: 

It was a vicious cycle: As last-minute sick calls surged, so did overtime costs and burnout among staff working extra shifts in Urgent Care at Panorama City Medical Center in Southern California.

The sick calls “impacted our entire team on multiple fronts,” said Fisayo Bhebe, department manager.

So UBT members came up with a plan. They realized that people were more likely to call in sick when work was stressful. So they urged employees to schedule time off in advance and save their sick days for illness. 

Department leaders were then able to plan and maximize staffing resources – reducing stress and burnout for workers. They also rewarded those with outstanding attendance.

And, after realizing patient volumes were rising, they reviewed the budget and hired more staff. Over 10 months, last-minute sick calls dropped 40%, from an annual average of 4 days to 2.5 days per full time employee.

“Every member of the team contributed to the success of this project,” said Rosimar Carpenter, an LVN and Coalition union partnership representative. “You can definitely see how proud they are.”

A two-pronged approach

The Level 3 team includes employees represented by the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions. They staff Urgent Care, a fast-paced department that can receive as many as 300 patients a day, 7 days a week.

Sick calls mean paying overtime to employees available to fill staffing gaps and take on extra shifts. When replacements can’t be found, staff members work short-handed as patients keep coming.

“It can be a continuous loop,” said Javier Barrios, RN, a member of UNAC/UHCP. “When people are out you carry a heavier load and it makes the day feel a lot longer.”

In 2022, challenged by last-minute sick calls, members of the unit-based team began exploring ways to reduce such calls and ensure staff members got time off. They took a two-pronged approach: partnering with leadership to bring in per-diem workers to plug staffing gaps and focusing on last-minute sick calls during UBT meetings.

Team co-leads ─ Jeanelle Concepcion, RN Supervisor, and Teresita “Tita” Obusan, an LVN and SEIU-UHW member ─ were sympathetic to the team’s struggles. They encouraged team members to plan time off in advance to avoid last-minute staffing scrambles. They also recognized workers for outstanding attendance.

Excited to work

The strategy worked. The team met its 6-month target to reduce last-minute sick calls from an annual average of 4 days to 3 days per full time employee.

What’s more, success came despite surging service demands. Member visits to the department increased by 20% in 2022 over the previous year. After reviewing the budget, the department received authorization to hire 3 new part-time licensed vocational nurses to handle the increased patient volume.

Last-minute sick calls continue to drop. In November 2022, the team recorded an annual average of 2.5 days per full time employee – a 40% reduction over 10 months.

Even better, the sense of burnout has waned. Said Obusan, “We feel less burdened and are excited again to come to work.” 

 

     

    Teamwork Tames Back and Neck Pain

    Story body part 1: 

    At the Spine Center of Excellence in the Northwest market, team members strive to connect patients to treatment as quickly as possible.

    But the Level 5 team struggled when it came to providing timely access to care for Medicaid members.

    Before receiving treatment, Medicaid members must undergo a state-mandated pain evaluation administered by the team’s registered nurses. The nurses’ workload, however, meant patients sometimes waited as long as 37 days to be evaluated.

    To improve access to care, everyone on the team began screening Medicaid members. In 4 months, they reduced wait times from referral to consultation by 35%.

    “When you’re dealing with acute or chronic pain, quicker access to treatment means happier patients,” says Kali Dailey, RN, an OFNHP Local 5017 member and the team’s labor co-lead.

    Coordinating spine care

    The Spine Center, based at the Sunnybrook Medical Office in Clackamas, Oregon, is part of Kaiser Permanente’s coordinated approach to spine care. Across markets, spine centers help members with neck and back pain find the right treatment programs or surgeries in an expedited way.

    In the Northwest, Spine Center staff are represented by the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions. They gather information through questionnaire calls and follow an evidence-based treatment plan for members based on their responses.

    Previously, only registered nurses were responsible for completing the questionnaires. They did so during the intake call they conduct with all members to consider which treatments – including injections and surgery – are appropriate.

    But the nurses’ workload meant there was a lag time between referral and intake call. Before the team overhauled its evaluation procedures, the wait time averaged more than 37 days.

    For members experiencing acute or chronic pain, that’s a long time to wait for a first intervention.

    “Some of these patients were feeling like they had been forgotten,” says Jodi Lippmann, the team’s licensed practical nurse and a member of SEIU Local 49.

    Fast tracking patients

    To connect Medicaid members to care faster, the team obtained permission from Northwest practice leaders to allow its licensed practical nurse and medical assistant to complete the questionnaires.

    The team’s new “fast track” system for Medicaid members meant wait times decreased by 35% -- from 37 days to 24 days – from March through June 2021.  This far exceeded the team’s original goal to reduce the wait time to 32 days.

    The revamped approach continues to pay dividends – with wait times for all Spine Center referrals continuing to drop. Market leaders have taken notice, too. They recognized the team for improving service access, holding it up as a model for others to follow.  

    “Everyone on our team came together on this project,” says Sophia Le, the team’s management co-lead. “The result is better service to our patients.”

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