Summer interns often are put to work fetching coffee or making copies. But last year, UBT consultant Geoffrey Gamble wanted to create a more valuable experience for the teens of KP’s Summer Youth Employment Program at the Modesto Medical Center. So he trained a small army of performance improvement consultants to help support unit-based teams.

Despite initial skepticism from some team members and managers, the results were stunning. By the end of the summer, 12 of the 13 teams supported by the interns advanced at least one level on the Path to Performance. What’s more, four of the 19 projects carried out by the UBTs yielded savings or cost avoidance totaling $400,000. The program was such a success, it has returned to Modesto this summer and has spread to the Sacramento and San Jose medical centers. And in the process, the interns are gaining on-the-job training that translates to their studies and to the work world.

“I went in thinking we were going to do grunt work, but in reality it was like, ‘Wow, I’m actually doing something I can apply,’” says Nate Aguirre, who interned in Modesto’s Emergency Department last year. “It was a life-changing experience.”

The Community Benefit program has offered training and work experience to teenagers in underserved communities since 1968. In the past, that experience included clerical work or coaching on speaking in front of a large group. When Modesto’s internship coordinator retired in 2013, Gamble agreed to oversee the program as long as it supported his work developing UBTs.

Overcoming doubt with results

“When I first proposed the idea, directors were very skeptical,” Gamble recalls. “People would say, We’re struggling to do this with professionals—how do you expect to get momentum from a 16-year-old?’”

But Gamble saw the opportunity to offer teams a fresh perspective and the daily support many need to get started. He also wanted to show team members that performance improvement didn’t have to be complicated and could be incorporated in their daily work.

“I told managers that I was going to treat (interns) like adults and give them the skills I would give employees,” Gamble says. “If you hold them to that expectation, they will rise to the occasion.”

In the first few days of the eight-week program, Gamble trained the 16-year-old interns in basic performance improvement tools, including the Rapid Improvement Model, process mapping and Labor Management Partnership basics. By the second week, the youth were assigned to Level 1, 2 and 3 unit-based teams and started helping the teams launch projects and enter data into UBT Tracker.  

Rosemary Sanchez, Modesto’s Emergency Department supervisor, was one of the loudest doubters.

“At first I was like, ‘Ugh, one more thing to do.’ But then I thought, ‘OK, this could work and help us accomplish our goals and share our knowledge.’” 

Intern Nate Aguirre was crucial in helping the team on its project to streamline and standardize supplies in the treatment rooms.

“Nate was awesome,” Sanchez says. “He was so enthusiastic collecting data.”  

Getting the ball rolling

Aguirre also spent time talking to employees in the department to learn about their jobs and the challenges they face in their work.

Meghan Baker, an Emergency Department clerk and union co-lead for the UBT, says that sparked interest and support from UBT members—a shift from before, when they had struggled to get employees involved.

“People were into having their voice heard by someone,” says Baker, who's a member of SEIU-UHW. “Now people are talking and getting the ball rolling on things. And we’re making it known that people are being heard.”

At the start of the program, the Emergency Department UBT was ranked at Level 3. The team advanced to Level 4 after completing the work.

Michelle Smith, manager of Specialty Surgery Reception, appreciated the new perspective and support her team received from its intern for its project to reduce surgery no-shows and last-minute cancellations.

“It was nice to have someone get our project going,” she says, “because we were at a standstill.”

The team’s intern walked the UBT members through mapping out their process. New workflows emerged that included calling patients ahead of scheduled surgeries, which reduced no-shows and increased service scores.

When the teams were asked what they thought helped them advance, many said it was because of the interns coming to the departments every day to help push and support the work. 

“We would have eventually worked on the project, but having her come in and start us off in a positive way was great,” Smith says. “She taught us how to be a team, because we realized we all had to be part of the work.”

Want a safer workplace served up on a silver platter?

Then stop by the operating room at Kaiser Permanente’s West Los Angeles Medical Center in Southern California. Surgeons and the other health care workers there pass sharp instruments to one another on silver trays—rather than passing them hand to hand—which reduced injuries related to handling sharp instruments during procedures by 34 percent between September 2013 and May 2014.

“We can see the results,” says Lisa Duff, a surgical tech and workplace safety champion at the facility. This success is part of a new emphasis at the facility on task standardization—analyzing each step of an activity, identifying the potentially hazardous steps, coming up with a safer way of doing things and then ensuring everyone follows the new process the same way, every time.

How to reduce risk

“Injuries occur when there is not consistency,” says Tracy Fietz, chief administrative officer for Southern California Permanente Medical Group at West L.A.  “If you break [a task] apart on a fishbone diagram, you can identify where the risks are. It is about removing variation.”  

Standardizing practices also has helped several departments reduce—and in some cases eliminate—sharps-related injuries for up to 17 consecutive months. It’s also helped reduce injuries to EVS workers by 75 percent when they clean floors.

Another practice that is improving safety at West L.A. Medical Center is regular monthly meetings between senior leaders,  including Fietz, and the labor and management safety leaders of targeted departments. Departments that have special line-of-sight safety goals (see below) in the region’s Performance Sharing Program get special attention. The gatherings are a space to analyze processes, see what’s working—and what isn’t—and collect information to share with others.

How partnership helps

“I work with managers and the workplace safety champions, because it’s a partnership,” says Nor Jemjemian, the chief administrative officer for Kaiser Permanente Hospital/Health Plan at West L.A., who also leads those meetings. “I want the employees doing the tasks to be part of the solutions.”

Union-represented employees, for their part, appreciate the crystal-clear message top leadership is sending.

“You need management to back you up when you speak up,” says Duff, a member of SEIU-UHW. “Employees know that our managers will back them up 200 percent.”

Open communication, trust and partnership processes are the foundation of a safer workplace, says Jemjemian.

“When I was an employee, there were [hazardous] tasks I did that my manager didn’t know about,” he says. Today, in contrast, “UBTs create a venue and a forum to discuss the everyday work.”  

The Transportation department in the Northwest is coming out of a tumultuous time. A lack of trust between managers and employees created a barrier that affected morale—and made it difficult to focus on improving routes and processes.

The department uses a robust but complex process for optimizing its routes. For maximum efficiency, it has to integrate a variety of work streams and figure out where there are redundancies that can be eliminated. Because of the complexity of the process, however, it had been more than 15 years since the criteria and requirements for the transportation system from the customer’s point of view had been reviewed.

Eventually, the UBT worked out a thorough route-modernization plan based on data-driven service requirements and metrics that established parameters on how to revise and design its routes.

But before it got there, it had to fix its communication, which broke down so badly the team entered into an issue resolution. In the Northwest, the LMP Education and Training department is responsible for facilitating issue resolutions.

Blame-free solutions

“There was a lot of tension in the department, and people were nervous about losing their jobs as a result of our work around revamping routes. Poor communication was a problem,” says Greg Hardy, sponsor and manager of the department.

The issue resolution process uses interest-based problem solving, and that helped the team focus on a common goal: Serving its customers was the top priority and improving communication was a necessity. From there, other agreements came more easily, and the department was able to maintain staffing levels and improve processes as a result of its efforts.

Improved communication improves service

As a result of the improved communication, the team was able to improve service levels and achieve the efficiency and cost savings it had strived for.

“We have a group of dedicated workers who want things done the right way,” says logistics supervisor Chris Dirksen, the team’s management co-lead.

When it came to improving communication, the team members’ first step was to get a baseline measurement of what they were trying to improve. They created a survey that would measure not only communication but also morale and UBT effectiveness. Once they had that information, they created a SMART goal: to improve employee perception of communication, morale and UBT effectiveness by 15 percent within three months, raising the overall survey score from 2.55 to 2.93 by February 2014.

As the team began to investigate the issues, it discovered email was not a good form of communication. Fewer than 20 percent of the team members knew how to log on and use Lotus Notes. The team brainstormed ways get employees to use Lotus Notes email and frontline staffers began to instruct and coach one another.

Three months later, the team sent the survey out again and found it had met its goal. Perception of communication improved 48 percent, morale improved by 56 percent and UBT effectiveness improved by 21 percent. The team scored 3.4 on its survey, exceeding its stretch goal of 2.93, and anecdotal reports are that the communication success is continuing now that the team has successfully completely the issue resolution.

New ways to communicate

Team members use several means now for communicating with one another, including email. A communication board has been set up in the department’s headquarters, near dispatch, that includes information about the projects the team is working on, notes from UBT meetings and a copy of the department’s weekly e-newsletter, “Heads Up.”

In addition, the team has gone from a representative UBT to a general membership UBT and now has regularly scheduled meetings throughout the region, so that all employees are able to participate. “This has been our biggest success to share information,” says UBT union co-lead Nickolas Platt, a courier driver and member of SEIU Local 49.

“It’s cool to watch from meeting to meeting how more people show up each time,” Hardy says. “The engagement of the team has increased as we began to see improvement, and people could see change.”

Hundreds of Kaiser Permanente health plan members live in the rural communities of Kern County. Faced with driving yawning distances through winding, sometimes snow-covered mountain passes, many find it daunting to come to clinics for medical care. So in March 2012, KP leaders in the service area started to bring care to these members via a mobile health vehicle.

Great idea, right? But first, they had to figure out the details. How many providers and staff members could fit in the van? Who was going to do which tasks? Could medical office assistants collect co-payments and schedule appointments? Or would they be too tied up giving shots, checking HealthConnect for care gaps and performing other duties? And what would the van drivers do when they weren’t driving?

Rewriting the playbook

The old-fashioned playbook would call for the union to insist that KP hire a receptionist for the van and for the employer to exercise its prerogative to do whatever it wanted. But the Labor Management Partnership is strong in Kern County, so union and KP leaders worked out a solution that transforms care delivery and provides a model for how jobs of the future can be flexible, innovative and satisfying. On Kern’s two mobile health vans, the drivers take on reception tasks, such as collecting co-payments and booking appointments.

“I love member service,” says driver Alfredo Alvarez, a UFCW Local 770 member. “We are in contact with doctors, nurses and members.” He and fellow driver Javier Gonzalez spent several weeks receiving additional training in clinics and a call center. “I am getting paid, so why not stay busy and learn new things?” says Alvarez. Today, the clinic on wheels provides more than 500 doctor and nurse visits a month.

Keeping up with change

Holly Davenport, a UFCW Local 770 union representative who helped negotiate the innovative work agreement, says she sometimes hears resistance from union activists who wonder if this type of arrangement will lead to job losses. “We have to keep up with the way health care is changing,” says Davenport. “We did this in partnership. I heard what management had to say, they heard what I had to say, and we worked it out.” 

Davenport gives credit for the successful solution to her strong, trust-based relationship with Candace Kielty, an assistant medical group administrator in Kern. Says Kielty: “My role as a manager is to paint the big picture. We want to serve an underserved population, and we want to meet people where they are.”

However, Kielty says creative problem solving cannot rely solely on individual relationships, but must be built into the structure and culture of Kaiser Permanente through the Labor Management Partnership.  

“When I hire department administrators, in the orientation and mentoring, I talk about developing trust,” says Kielty. “It's an expectation.”

Want to supercharge efforts to improve performance and help reach Kaiser Permanente’s strategic goals? Then bring unit-based team leaders together for a summit.

UBT consultants at several facilities in Southern California have organized summits that focused on Performance Sharing Program (PSP) goals, performance improvement strategies and affordability projects. All say they are seeing results in the forms of more robust UBT projects, clearer SMART goals, and stronger alignment between top medical center leadership and the work of UBTs.

After seeing teams improve service scores, reduce workplace injuries and save more than $160,000 in just four months in the San Diego service area, Sue Smith, a senior UBT consultant, concludes, “The overall experience was wonderful. Many teams had an exciting opportunity to network with other teams and learn new skills in a fun way.”

This spring, San Diego Medical Center hosted a UBT affordability summit, which brought together co-leads for a half-day to build the skills to tackle a new PSP goal for 2014 in the region: to increase the percentage of UBTs that successfully complete a project with hard dollar savings or improved revenue capture. (The projects are reviewed by finance departments to ensure they could lead to cost savings.)

Seated around large tables, UBT co-leads played a spirited game of “KP-opoly,” which offered a crash course in the organization’s finances. They heard from a UBT whose work resulted in cost savings. And they had time to work on driver diagrams and process maps for their own team’s affordability projects.

Co-leads gain PI skills

The year before, San Diego leaders—inspired by an event at the Riverside Medical Center—had held a more general, daylong UBT summit. That event brought UBT co-leads together for intensive training on performance improvement tools and created a space for them to refine their existing projects. Deadlines were set for finalizing driver diagrams and process maps, beginning tests of change and formulating sustainability plans.

The effort culminated in a UBT fair that showcased the projects that had begun as mere inklings at the summit: The ultrasound UBT demonstrated how it had gone injury-free for six months (it had been having at least one injury per month); the diagnostic imaging department boosted patient satisfaction scores from 87 percent in May 2013 to 93 percent in December.  

Leaders at the Woodland Hills Medical Center followed the same playbook, hosting an LMP summit in April that launched an array of of affordability projects to be showcased at a UBT fair scheduled for mid-July.

Mobilizing on PSP

At Fontana and Ontario medical centers, UBT staff used the summit model to mobilize the workforce around all of the region’s PSP goals. Top leaders from both management and the unions kicked off the day, then gave subject matter experts each 10 minutes to discuss the goal (whether it be service, workplace safety, attendance, etc.) and challenge co-leads to take on a performance improvement project to tackle it. A highlight was an impassioned and dramatic account from Roy Wiles, president of Steelworkers Local 7600, about a union member who did such a good job of saving up unused sick time that he recently retired with a five-figure nest egg in his Health Reimbursement Account.

The key to attracting co-leads to the summits, the consultants say, is to plan well in advance and to enlist top leadership to encourage participation. That lets managers and employees make plans for attending while ensuring their departments’ operational needs are met.

“This is part of their work,” says Priscilla Kania, senior UBT consultant at Ontario. “Your leaders are inviting you. People are excited to be in the room with top leaders.”

As more and more unit-based teams answer the call to improve affordability for health plan members, they are finding new tools that can help manage their cost-improvement projects.

One such tool, a handy spreadsheet, can help teams track and report their cost savings.

Teams track own savings

Developed by UBT consultants and financial analysts in Colorado and later adopted by UBTs in the Northwest, the tool can help teams determine the economic benefits of a performance improvement project with little or no assistance from a consultant or sponsor.

“It’s a great add-on to teams’ reporting in UBT Tracker,” says Luanne Petricich, chief pharmacist, Pharmacy Professional Affairs, in Colorado and a sponsor of 12 UBTs in the region. “It can be a very impactful way for co-leads to show their teams and others what their savings were and how they achieved them.”

In addition, teams can now record their financial results directly into UBT Tracker thanks to a new data field, Annual ROI, that allows teams to share how much money a project saved or generated. The field can be found under the Project Details tab (see graphic below).

Click to enlarge.

Tool use spreads

Petricich sends the spreadsheet to any of her teams working on a cost-reduction or efficiency project to help them document their results.

One team that used the tool was the pharmacy UBT at Baseline Medical Offices in Boulder. The team had completed an inventory-reduction project that far surpassed its goal—which was to reduce its drug inventory by 10 percent, or $50,000, in three months. By adjusting order quantities to better match usage and returning overstocked medication to the mail order pharmacy for use before the expiration date, the team saved $143,000—nearly three times its original goal.

“It’s important to track your results, and this tool can help teams do that in a simple way,” says Don Larson, Baseline’s pharmacy supervisor. “It’s something we would use the next time we do a similar project.”

It’s one thing to identify effective practices in an issue as important as workplace safety. It’s another to educate and engage teams in adopting a consistent set of practices across a region.

The Northwest’s Employee Health and Safety Department has done just that—and earned program-wide recognition for its approach.

In November 2012, the department’s Labor Management Partnership Workplace Safety team issued a challenge to the region’s 16 facility safety committees. The committees, established to help identify and resolve safety issues at the facility level, often differed in their approach and results. The safety challenge provided a fun way for the local committees to get to know more employees in their facilities, follow a consistent protocol and improve safety.

Challenging teams to step up

“The Safety Awareness Challenge provides safety committees an opportunity to work together with their labor, management and Permanente partners to effect real change around workplace safety,” says Chris Mozingo, RN, workplace safety labor consultant for the NW Region.

The yearlong campaign challenged each facility to:

• submit monthly or quarterly safety meeting minutes, to help keep their work on track
• have physicians and dentists attend at least 80 percent of their facility’s safety meetings, to ensure widespread participation and leadership (nonclinical departments were asked to send representatives to each meeting)
• promote safety conversations (a blame-free approach for observing work practices) and ensure at least 25 percent of employees are trained to lead such conversations
• adopt and promote safety awareness plans to help teams identify and correct at least three different workplace hazards (for instance, trips and falls or sprains and strains)
• host a safety fair, safety barbeque or other facility event within the year

“The Safety Committee Challenge goes beyond recognizing achievement. It fosters and reinforces the relations between Regional Safety, management and frontline staff,” says Employee Health and Services Safety Specialist II Brian Cekoric.

Getting results, recognition

Nine facilities completed the safety challenge by meeting each of the five established criteria. These efforts helped the Northwest region—already a leader in some key measures of workplace safety—record a 4 percent decrease in injury rates compared with the previous year. Teams that met the challenge will receive additional funding to support safety awareness promotions in their facilities.

For its part, the Northwest Employee Health and Safety team won the 2013 National Workplace Safety Award for its work in engaging frontline teams.

“The simple focus on injury prevention and raising awareness goes a long way to changing the culture of safety,” says Rob Weiking, Employee Heath and Services program manager.