Who knew bubble wrap envelopes could help patients sleep better at night?

That’s what the Sleep Medicine team in Falls Church, Virginia, discovered when it purchased padded envelopes and a postage machine and launched a service that allows patients to receive — and return — sleep therapy supplies by mail. Thanks to the team’s new approach, patient complaints about supplies dropped from multiple times a week to zero in 3 months between February and May 2019.

“Our patient satisfaction has really gone up. No complaints,” says Danielle Long, sleep apnea coordinator and the team’s labor co-lead who is an OPEIU Local 2 member.

This effort to fix a broken process is a powerful example of how management and labor can work together to improve service, access and affordability.

“Every single one of us contributed to making the workflow easier,” says Alireza Mallah, sleep apnea coordinator and a member of OPEIU Local 2.

Not ‘user-friendly’

Most patients seen by the team suffer from sleep apnea, a condition in which breathing is often blocked or partly blocked during sleep. To detect sleep apnea, patients wear a portable monitoring device. Treatment involves using a machine that delivers air pressure through a mask while sleeping.

As a service to patients, clinic staff arranged for members to pick up the sleep study devices and respiratory supplies at one of 10 medical office buildings in the area.

But patients sometimes were slow to retrieve the equipment and supplies, which caused storage problems. At other times, supplies were incorrect, late, or missing — frustrating patients and staff. And because the team relied on in-house couriers to make the deliveries, there was no way to track items, causing waste.

“It wasn’t a user-friendly process,” explains George Sweat, the team’s management co-lead and director of Medical Specialities. “There was no reliable system for supplies to get from point A to point B, and some members would get duplicate supplies because we had no way of tracking them.”

The breakthrough

“Why don’t we mail these supplies?” team members wondered aloud. But without guidance or goals, the talk remained just that: talk. Solutions seemed like a “myth to everybody,” Mallah recalls.

Then Sweat arrived in March 2018 with a fresh perspective and a zeal for data.

“The breakthrough was looking at the numbers,” says Sweat, who discovered that 25 sleep study devices were lost in 2018, totaling $120,000 — money the team could have saved or spent elsewhere.

He shared his findings with the team and helped set goals to mail all supplies by June 2019 and reduce the annual cost of respiratory supplies by 20 percent. Along the way, they would survey patients to see if their efforts improved member satisfaction.

Continuous improvement

Using the Plan-Do-Study-Act model, the team started out with small tests of change. Team members bought a postage machine that enables them to track shipments and experimented with different envelopes.

“For the first week or two, it was a little rocky,” explains Long. “We started out slowly.”

Now the team mails most supplies to patients, who have the option of picking up and dropping off equipment at the Falls Church location. The team also streamlined the inventory of respiratory supplies, eliminated the use of couriers, centralized distribution of equipment, and introduced paperless billing.

“We’re capturing 100 percent of the revenue,” says Sweat, who estimates the department has saved more than $111,000 in the first four months of 2019, putting it on track to meet its financial goal.  

Best place to work and receive care

The team’s process improvements also benefit patients by increasing access and member satisfaction.

Because patients can return the sleep study devices by mail quickly, staff can put the equipment back into circulation faster, enabling providers to diagnose patients within days instead of weeks.

Patients are happier, too. As of August 2019, 96 percent of patients surveyed said they prefer receiving their supplies by mail rather than traveling to pick them up.

What’s more, team members say performance improvement has made their work lives easier. “I don’t have to work as hard to satisfy my patients,” says Mallah.

Alaine Lounsbury, RN, is proud of her nursing team at Downey Medical Center in Southern California. 4 West team members have worked together for decades, forming bonds that have led to high patient satisfaction rates and region-wide recognition.

Lounsbury, nursing assistant clinical director, attributes the team's success to rounding — the practice of engaging frontline workers in face-to-face conversations on the floor and listening to their concerns. Managers who round say it helps build a culture of engagement and dialogue, a key goal of the Labor Management Partnership between Kaiser Permanente and the Partnership unions. 

“It’s about making a connection,” explains Lounsbury, who rounds quarterly on 90-plus staff members using Kaiser Permanente’s Rounding Plus online tool [KP Intranet]. “You want to hear the good with the bad.”

Removing roadblocks

With the tool, managers can use their mobile device to identify, track and escalate issues surfaced during rounding conversations. Program-wide, nearly 10,000 leaders and managers use the program.

At Downey, nurses used rounding conversations to speak up about a workflow issue. Because 4 West is the only unit with nurses qualified to give chemotherapy to adults, it meant staff members sometimes had to leave their department to administer drugs to patients. Their frequent absences meant more work for others.

“I heard them in rounding say, ‘You need to figure this out,’” recalls Lounsbury. She and her team developed new protocols to enable others outside the unit to give the medication. “That was a big satisfier.”

Getting visual

To help her systematically follow up and act on her team’s questions and concerns, Lounsbury uses a colorful poster, called the Stoplight Report, that assigns green, yellow and red colors to track the status of issues.

The poster was conceived by Downey Quality Coordinator Suxian Hu, RN, based on the color-coded reports managers receive through the Rounding Plus program. Last year, all of Downey’s inpatient nursing units began using it.

In 4 West, the poster hangs prominently in the conference room, where everyone can see it.

“Staff members know something is being done,” says Donielle Tresvant, RN, a staff nurse and member of UNAC/UHCP, one of the unions in the Alliance of Health Care Unions. “They know they’re being heard.”

Nurses say the information shared on the poster also fosters team communication and collaboration. “It keeps us updated about things at work and it helps us improve our care by being focused,” says Brianna Schneider, RN, a member of UNAC/UHCP. “It makes for a cohesive atmosphere.”

Do you or your teammates want to shrink wait times? Save money on supplies? Reduce time wasters or roadblocks? Once you’ve identified a problem to solve, you may wonder where to start. No need to invent an improvement project from scratch. Visit the Team-Tested Practices section and see what’s worked for others. We’ve got short summaries of successes from every region and every type of work environment to give your team a kickstart.

1. What’s here? 

When you visit LMPartnership.org/team-tested-practices, you’ll find the first several “tiles” of the dozens you can choose from as you scroll through this section. Each tile will have a photo and short preview about a specific, measurable improvement a team has made.

2. Sharpen your search 

Want to narrow down what you see? Use the filters on the left side of the page. There are several to try, including:

• Topic. Choices include affordability, patient safety, service and more.
• Department. See what departments like yours have done.
• Region. Check out the projects done in your region.

Selecting more than one filter at a time works, too. And remember that you can get great ideas from departments very different from yours and regions other than your own. You’ll notice these filters throughout the website to help you focus your searches. 

3. Intrigued? 

See something your team might want to try? Click on the tile to get a more complete description of the challenge the team was facing — and the main tests of change that helped the team achieve its goal. And the measurable result: “Saved $40,000,” “decreased wait times by 11 minutes,” “69 percent drop in costs.”

4. No dead ends! 

So, maybe the practice you clicked on isn’t right for your team. Before you move on, check out the related tools and stories in the colorful columns farther down this page. Throughout the site, the color orange means, “Here are tools to get your team started on work like this.” Blue is, “Get inspired by stories and videos about teams working on similar efforts!” And, “Just for fun” — green will take you to puzzles, games and other light-hearted resources to kick off your improvement campaign on an upbeat note.

What’s your favorite thing to do online? Watch cat videos? Scroll through Facebook? Maybe some occasional retail therapy?

Going online can also help make your work life better and save you time. It can help your unit-based team solve problems so you can deliver the best care and service to our members and make Kaiser Permanente a great place to work. All that, after all, is what the Labor Management Partnership is all about.

This issue of Hank magazine is a whirlwind tour of the Labor Management Partnership website, a one-stop shop for everything you need to turbocharge your team’s performance. Tip sheets, videos and inspiration are always just a few clicks away. If you can’t find what you want easily, just use our vastly improved search function. As one of our biggest fans put it, “Boom — there it is!”

On LMPartnership.org, you will:

• learn from other teams — what worked, what didn’t, what sorts of roadblocks to expect and how to overcome them
• download icebreakers to build trust and help quieter team members gain the confidence to speak up
• meet the Humans of Partnership, a gallery of short, personal profiles that will make you proud to #BeKP

If you don’t sit at a computer as part of your day-to-day work, it’s easy to access LMPartnership.org on the go. Follow these instructions so we’re always at your fingertips on your smartphone. You’ll find yourself in a UBT meeting and calling up just the tool you need to help a team through a sticky situation.

You can even share resources from your phone with others who may not be as smartphone savvy. Pretty much every page has buttons that make it easy to email it to a colleague or share it on Facebook or Twitter.

Here’s another handy tip: even if you don’t visit LMPartnership.org (though I hope you do), reading this issue of Hank will help you learn how and why we do the vital work we do. So read on, log on and enjoy.