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What can your team do to work with other teams to improve outcomes for patients?
What can your team do to make the best use of your "down time"?
What can your team do motivate peers to hold each other accountable?
What can your team do to allocate staff time and attention effectively and strategically?
Creating a better workplace turns cynics into champions of unit-based teams. UBTs give workers represented by a union in the Coalition of Kaiser Permanente Unions a way to lead change. They help workers, managers and physicians better serve Kaiser Permanente members and patients. Yet too many people don’t know they are part of a UBT. Truth is, everyone in the unit is a UBT member. And, as you’ll see in this issue, engaging with your team can change lives—including your own. Read on and see how.
Kimberly Carolina, clinical assistant, OPEIU Local 2, Neurology (South Baltimore Medical Center, Mid-Atlantic States)
"When we first learned about working in partnership, I thought it would be difficult. I was a little skeptical and reluctant. It was hard to work with management because they’re actually your boss. I was part of a hiring team and felt uncomfortable speaking up to say why I thought certain candidates wouldn’t work.
Working as a team was very new to everyone. I wondered if there would be backlash or repercussions. Some employees didn’t feel secure about their jobs and didn’t feel like they even had a voice. One day, I realized they were the same as I was. I had a fear of speaking up and so did the managers. After I realized that, we were able to move forward. Employees, providers and everyone needed to have a voice. We needed to not only talk, but to make things happen. It’s been a lot of learning, a lot of great experience and growth.
When I first started out I didn’t see how you needed each person and each piece to make the company grow. The puzzle came together for me.
Now the communications piece is there. We work to be effective, efficient and see the broad picture. It’s amazing to see everyone come together with one common goal to fix things, such as patient wait times.
I enjoy it better now. I’m learning more. I like the results I have seen. Partnership is like you had a child two decades ago and they’ve grown up to be a successful person."
The Labor Management Partnership operates in eight states and the District of Columbia, where Kaiser Permanente has a presence. These markets serve the needs of their respective KP members and patients, guided by a common set of partnership principles and practices. Learn more about each.
Serves nearly 506,000 members in 32 medical offices. Of its 264 unit-based teams, 184 (70 percent) were rated high performing as of December 2024.
Serves more than 327,000 members in 27 medical offices. Of its 100 unit-based teams, 79 (79 percent) were rated high performing as of December 2024.
Serves over 785,000 members in Maryland, Virginia and the District of Columbia in 42 medical offices. Of its 252 unit-based teams, 179 (71 percent) were rated high performing as of December 2024.
Serves 4.6 million members in 206 medical offices and 21 hospitals. Of its 1,359 unit-based teams, 542 (40 percent) were rated high performing as of December 2024.
Serves over 612,000 members in Oregon and Southwest Washington, in 50 medical and dental offices and 2 hospitals. Of its 373 unit-based teams, 261 (70 percent) were rated high performing as of December 2024.
Southern California serves 4.8 million members in 198 medical offices and 16 hospitals. Hawaii serves nearly 266,000 members throughout the islands, in 23 medical offices and 1 hospital. Of 1,276 unit-based teams, 979 (77 percent) were rated high performing as of December 2024.
Serves nearly 587,000 members in the Puget Sound area and east to Spokane with 36 medical facilities. The Washington region became part of Kaiser Permanente in 2017. It has 83 unit-based teams as of December 2024.
These departments (Finance, Health Plan Administration and IT) serve KP members, patients and staff across the program. Of 80 unit-based teams, 49 (61 percent) were rated high performing as of December 2024.
Most people think about advancing their careers as a personal goal—if and when they get the time and support to map out a plan. But Panorama City’s Emergency Department unit-based team saw that boosting the team’s skills also matters to KP members, patients and the department. It used collaboration—and LMP trust funds—to improve the workflow and put several staff members on a solid career path.
“It’s not just about making more money. It’s also about being able to provide the best care possible,” says Richard Rowland, one of two emergency room assistants finishing courses needed to earn promotions to emergency service technician positions.
Early last year, the unit-based team started a “door-to-doc” project aimed at moving patients more efficiently through the ER. Results soon stalled because many staff members lacked the training or official certifications to help nurses with such triage duties as drawing blood and organizing labs. About that time, Sylvana Hrovatic arrived as assistant department administrator and management co-lead. She was focused on improving patient service and care, and says it was her labor partners who steered the conversation to career development.
With the help of ward clerk transcriber Becky Linares, labor co-lead and an SEIU UHW steward, the UBT reached out to the SEIU UHW-West & Joint Employer Education Fund to create a plan for employee career advancement in the department.
What can your team do to support each other's concerns? What else could your team do to follow up on issues?
Receptionist Sam Eckstein encourages his co-workers at the Woodland Hills Medical Center lab not only to meet—but to exceed—patient expectations of excellent service. To back up his coaching, he’s using the knowledge he gained in a new LMP course on business and economic literacy.
During the course, Eckstein and about a dozen other workers and managers learned about the rising cost of health insurance in the United States and the trend toward businesses’ shifting more health care costs to employees.
Because patients are paying more, “Their expectations are higher,” says Eckstein, a member of SEIU UHW. “When patients come in without an order [for a lab procedure], we can’t just send them home,” and inconvenience them by making them come back another day, he says. “We have to help meet their needs.”
Eckstein took part in a pilot project to test the Labor Management Partnership’s new approach using popular education techniques to ensure frontline employees and managers have the context and know-how they need to continue improving team performance and keep Kaiser Permanente affordable.
Popular education turns the old-fashioned schoolroom model of teaching and learning on its head. It is ideally suited to the Labor Management Partnership, which is built on the belief that all employees, managers and physicians bring their expertise and experience to bear on improving service and care at KP. No longer is the teacher or trainer the sole expert in the classroom, there to fill students’ minds with information they passively receive, memorize and repeat.
Instead, popular education taps into participants’ experiences in their communities and workplaces and uses them to generate dialogue. It explores the social and economic context of students’ lives and asks probing questions: What are people happy about? Worried about? Fearful about? Hopeful about? Students are encouraged to analyze that information—and to take action.
Quan Nguyen, DO, learned in seventh grade how devastating a workplace injury can be. His father, a carpenter, severed part of his thumb when he lost control of the power saw he was using. The accident put him out of work for a time and forced the family to stretch its skintight budget even further.
Years later, the memory inspired him to join Orange County’s Workplace Safety Steering Committee, says Dr. Nguyen.
“I’ve witnessed, firsthand, how things at work can lead to pain and suffering for the person and his family,” says Dr. Nguyen, a physical medicine and rehabilitation physician at the Chapman Medical Offices in Orange, California. “We’re like a big family at work and I don’t want to see people hurt.”
As the sole physician on the 12-member committee, Dr. Nguyen uses his singular perspective to engage physicians and others to build a culture of workplace health and safety.
“He’s very unique,” says Jim Ovieda, assistant medical group administrator and the committee’s management tri-chair. “He brings another voice of authority to the conversation.”
Four years ago, Dr. Nguyen helped form the Tiger Team, a task force of union members and managers who visit units with high injury rates and offer expert advice on how to reduce risks. They developed a simple process to identify and address workplace hazards at the local level (see “Five Tips for Workplace Safety Site Visits”).
“It’s not a punishment. We’re there to help departments succeed and to help our staff and physicians to be safe,” says Dr. Nguyen, who named the Tiger Team in honor of “Tigger,” the fictional tiger character who bounces around and helps others.
Collaborating with frontline union members is vital to keeping everyone safe, says Dr. Nguyen.
“There seems to be two cultures inside the hospital – the physician and non-physician. We’re trying to bridge those two cultures by bringing together a diversity of voices to improve the culture of health and safety for everyone,” says Dr. Nguyen.
Host teams say the visits and ensuing discussions help create an environment where everyone feels comfortable speaking up—essential to building safety into daily work.
The team aims for six site visits a year and had conducted 31 visits as of November 2015. Most of those departments reported significantly fewer injuries in the months after the visit; many reduced injuries by 50 percent or more. The approach has gained attention region-wide and other medical centers in Southern California are adopting the practice. The team also presented its partnership approach at the 2016 National Workplace Safety Summit.
“It’s a way of taking the pulse of the department,” Ronald Jackson, a medical assistant, SEIU-UHW member and the steering committee’s labor tri-chair, says of the team's site visits.
“We bring a fresh set of eyes to the department,” says Albert Alota, workplace safety coordinator for Orange County.
Recently, the committee’s labor and management members sat side by side reviewing workplace safety records for the Irvine Medical Center’s recovery room. The department had accrued nine injuries in as many months, three of them involving employees and gurneys. The team identified several hazards related to work space and storage and recommended ways to fix them. For example:
Employees appreciate the attention. “It’s good to have the team come in,” says Sol Estrella, RN, a staff nurse and UNAC/UHCP member. “It shows that management and higher-ups are responding to our staff needs.”
