A unit-based team includes all managers, physicians, dentists and partnership union members in the work unit. All employees in the unit participate and support the team in meeting its goals and objectives.

UBT members

For the team to move up and become high performing, its important for all team members  to:

• complete UBT training
• attend and participate in meetings
• represent the interests and perspectives of others — not just their own
• use UBT processes collaboratively and with an open mind toward mutually acceptable results
• maintain open, direct, and respectful communication
• support partnership principles
• communicate regularly with staff in the department
• honor confidentiality agreements
• actively support all team decisions

Visit the Team Member Engagement toolkit to learn more. 

UBT co-leads

Each UBT has a management and labor co-lead. In departments with physicians, it’s ideal to have a physician co-lead as well. Co-leads organize the team’s meetings and huddles and make sure the team’s performance improvement work stays on track.

The role of UBT co-leads is to:

• advocate for partnership success
• prepare for meetings and huddles
• use appropriate meeting management tools
• communicate early and often
• troubleshoot where appropriate
• act as point person for information
• keep team records
• ensure team is following charter and charter is relevant
• communicate with others (including sponsors and stakeholders)
• make off-line decisions when needed
• build relationships and share expectations with co-lead partner(s)

Visit the Leadership toolkit to learn more. 

UBT sponsors

Sponsors are the go-to people for UBT co-leads, providing resources, guidance and oversight for teams.

The role of UBT sponsors is to:

• review the team’s progress on department’s UBT goals
• promote the use of the Rapid Improvement Model (RIM+) to improve department performance
• support full team engagement
• remove barriers and assist, as needed, with attaining data for team’s performance improvement projects
• recognize the team’s accomplishments
• spread successful practices

Visit the Sponsorship toolkit to learn more. 

Colorado

The Regional Imaging teams in Colorado are lucky to have two effective sponsors: Joseph Gonzales, clinical operations for Regional Imaging, and Rebecca “Becky” Torres, a pharmacy technician and SEIU Local 105 member. Part of their success, the pair says, is the emphasis they have placed on sharing information—with each other and with their teams. The pair also figured out a way to spread effective practices. Using a PowerPoint template, the sponsors asked co-leads to explain what they’re working on, how it supports regional goals, whether it worked and the outcome. Then, the teams came together for a UBT Fair and shared their PowerPoints.

Georgia 

David Jones, MD, has a title unique at Kaiser Permanente: assistant to the medical director for unit-based teams. He mobilizes his fellow physicians in the Georgia region to get involved with UBTs and unleash the power of partnership to improve performance and grow membership. “The first thing I tell physicians about the UBTs is that it is about improving the work that we’re already doing,” he says. “It’s not about adding more work, it’s about looking at the work you're doing and figuring out how to do it better.” Read more from Jones—including how his experience with UBTs has transformed the way he delivers care to his patients.

Hawaii

A small region, Hawaii needed a novel approach to sponsorship: Branch out rather than always branch up. Initially, a five-member unit-based team committee tried to troubleshoot issues for the region’s fledgling teams. Often, those committee members, who also had roles as team co-leads or contract specialists, were trying to wear too many hats and got jammed. So the region, which now has more than 40 teams, has tapped 19 people to receive sponsorship training. The group includes middle managers, directors and other executives, frontline nurses who serve on the Kaiser Permanente board of the Hawaii Nurses Association, OPEIU Local 50, and former labor team members and co-leads.

Mid-Atlantic States

While the Mid-Atlantic States region’s clinical unit-based teams have management and labor co-sponsors, large teams such as lab and radiology are sponsored in a different way: A UBT leadership group made up of labor and management from these area performs sponsorship functions as a united body. “We generated a vision of our UBT sponsorship. We got very specific on how we would work together,” says Jane Lewis, executive director of health plan regional services and a member of the group that sponsors eight pharmacy UBTs. The UBTs report their projects and team dynamics at monthly meetings. The leadership group reviews People Pulse, service scores, quality results and other metrics, identifies struggling teams, and recognizes teams that excel.

Northern California

The region has been on a roll with its “A Leader’s Role as UBT Sponsor” training. Launched in the spring, the tutorial gives management and labor leaders an easy-to-understand yet in-depth look at providing effective support to unit-based teams and their performance improvement work. The short, online training covers everything from outlining a sponsor’s role and how a sponsor can model partnership to tips on developing strong UBT co-leads and high-performing teams. Several facilities have combined the training with in-person, interactive exercises, and early feedback suggests the blended approach is striking a chord with sponsors. The online training can be found at KP Learn.

Northwest

“My role as a senior sponsor is to bring the message of UBTs to physician leadership,” says Rasjad Lints, MD, the region’s executive sponsor of UBTs. Lints is especially interested in helping teams focus on outcome metrics—a measure of the final result of something, such as how many patients with hypertension have their blood pressure under control—and to help everyone on the team understand that improving on process metrics often drives improvement on outcomes. It can be difficult to see the value in participating in process metrics if team members don’t see how it relates to the outcome measures. “At the end of the day, physicians have to drive the care,” Lints says. While working in UBTs presents physicians with some unique challenges, he believes that “if the physicians aren’t engaged, it’s a lost opportunity.”

Ohio

In an effort to improve the quality of team project information in UBT Tracker, the regional LMP support team solicited the help of the people who support the work of teams—sponsors. In June, an improvement adviser met with Ohio’s 20-plus sponsors and asked them to work with their teams to boost the input of that data. To illustrate the value and role of quality data in UBT Tracker, they used the data in Tracker to brief the sponsors on their UBTs’ projects and status. Their approach made an impact: The region has reported an increase in sponsor engagement, and several teams have reported performance and relationship improvements. 

Southern California

The regional Labor Management Partnership department is launching a new sponsor training curriculum that covers the nuts and bolts of what sponsors do and how they do it. Topics include: the responsibilities of sponsoring bodies (such as helping define how the teams should be structured and guiding selection of co-leads); coaching skills to help develop UBT leaders; the similarities and differences between labor and management sponsorship; how managing in partnership differs from traditional management; and how the sponsor role differs from that of facilitators, project managers, trainers and consultants. Also included in the course are basics of the Labor Management Partnership and unit-based teams, such as the key elements for UBT success, the roles and responsibilities of UBT co-leads and members, and consensus decision making.

Health care costs too much. The cost of care threatens Kaiser Permanente’s social mission to provide affordable, quality health care to all.

There are no simple solutions, but KP has many advantages that others do not—including our integrated model of care that can better manage and prevent illness; a prepaid, nonprofit structure that keeps revenue in the system to better serve members and patients; and unit-based teams. As they create the best place to work, UBTs are continuously improving quality, service and affordability at the front lines of care.

This report highlights many ways that unit-based teams are getting results that matter to members and patients. Affordability of care, one of the issues that matters most to members, was the fastest-growing focus area for UBTs in 2012 (see Figure 1).

Teams launched nearly 1,400 efficiency and cost-reduction projects last year, more than doubling the number of such projects undertaken in 2011.

That bodes well for the future, because the number and effectiveness of UBTs’ performance improvement projects increase as teams develop. For instance, UBTs that are rated high performing—defined as reaching Level 4 or 5 on the UBT Path to Performance—are three times more likely than Level 1 teams to take on cost-reduction projects, using proven tools such as process mapping, the “6S” performance improvement tool, and spaghetti diagrams (see Figure 2).

And these teams are getting results. Waste- and cost-reduction projects can yield immediate savings of $20,000 to $50,000. Spread across the organizations, these efforts could save more than $100 milliion a year. Some examples of the work being done:

• At the Baldwin Park Medical Center Laboratory in Southern California, phlebotomists worked to reduce the use of more expensive butterfly needles, substituting standard needles when they will work—saving more than $45,000 in 2012. Other labs are also doing this; potential savings if implemented program-wide: $2 million.
• The Fremont Medical Center Operating Room team in Northern California, after taking business literacy training and looking at their own costs and budget, identified wasteful practices in the use of ready-made surgical supply packs, saving about $34,000 a year. Potential savings if implemented program-wide: $750,000.
• The Point Loma Primary Care team at the San Diego Medical Center in Southern California applied 6S to organize supplies and standardize ordering, saving more than $20,000 in 2012. Potential savings if implemented program-wide: $4.2 million.

As these examples show, individual teams can implement improvements that can save a significant amount of money in their own corner of the system. As practices spread among the 3,500 unit-based teams now working across Kaiser Permanente, the savings can add up quickly.

Achieving the full cost-saving potential of UBTs will not be automatic. More teams need to take on cost and waste issues. Even with the jump last year, only one-fifth of UBTs undertook such projects. Successful practices must be spread more systematically across departments, facilities and regions. And more teams need the kind of business training that led the Fremont OR team to act.

But those changes are coming. “The growing number of cost saving and efficiency projects are helping build a culture of savings and waste reduction among high-performing teams across KP,” says Peter Nixon, director of metrics and analytics, Office of Labor Management Partnership.

High-performing UBTs outscored others on two questions in the 2012 People Pulse survey regarding employee views of their department’s efficiency. (see Figure 3). Members of high-performing teams are more likely to say their departments have efficient work procedures and seek improvements to reduce costs.

“These findings suggest that members of high-performing teams see waste reduction and efficient work processes as part of their job,” Nixon says. “That is good news, because it’s the discretionary effort, commitment and intelligence of frontline teams that gets results.”

For the past few years, unit-based teams have been driving a powerful transformation. It’s helping to control chronic diseases; assisting in the early detection of cancer; providing familiarity with a patient’s community; and enabling frontline employees to speak a patient’s language. It creates customized care for each of Kaiser Permanente’s more than 10 million members.

It isn’t a cool new gadget or something out of a sci-fi flick creating the change, but rather a modern care approach that takes into account the infinite number of ways KP members are unique—that emphasizes diversity and inclusion.

“All of us as individuals have all these different multicultural identities, and so do our patients,” says Ron Copeland, MD, senior vice president of National Diversity and Inclusion Strategy and Policy and chief diversity and inclusion officer. “We have to create high-performing teams that work together to deliver culturally responsive care that addresses those differences.”

Increasingly, the workers, managers and physicians working together in UBTs are considering the many facets of individual patients as they transform—in small and large ways—how they care for and serve those patients, using their knowledge and empathy to rethink how we deliver care.

As the stories in this issue of Hank illustrate, some of those changes are aimed at eliminating race- and gender-based health disparities. Other changes are taking place outside our medical facilities—working with school-age children, for example, to give them better food choices and teach them healthy habits that can last a lifetime. 

By doing this, UBT members are ensuring that Kaiser Permanente members are the healthiest they can be no matter their background or beliefs, language or gender, disability or economic status, whether they live in a big city or on a farm.

“UBTs have always led on innovating care by putting patients at the center, listening to them and customizing care for them,” says Hal Ruddick, executive director of the Coalition of Kaiser Permanente Unions. “This work strengthens and deepens that high-quality care.”  KP’s workforce is full of diversity, and UBTs are designed to draw on all employees’ perspectives in deciding how best to do the unit’s work. It’s a natural step to include our members’ and patients’ viewpoints as well. Understanding and considering the complexity of the patients and communities we serve directly affects quality of care and health outcomes.

“It’s about using our knowledge of differences as an advantage to better understand the patients we care for,” says Dr. Copeland. “Our goal is health care equity—so that all our patients achieve optimal health. For that to happen, it’s essential that we have approaches that account for our patients’ unique needs, preferences and living conditions.”