How UBTs Help Doctors Improve the Care They Give
Show its value by taking the mystery out of the UBT
David Jones, MD, works in the Georgia region with the Southeast Permanente Medical Group. He has been with the medical group for more than 11 years, and currently works in the Panola Medical Office. He spoke with LMP senior communications consultant Julie Light.
Q. What is your partnership role?
A. My role with the Labor Management Partnership in Georgia is assistant to the medical director for unit-based teams. I serve as the physician regional co-lead for all the UBTs for the region. I’m excited about this role and how it can help engage our physicians.In this role, I work closely with all of the teams, with a particular focus around supporting the physicians and helping them understand the value of UBTs and how UBTs really can improve what we do day to day in the offices and how they can improve the care for patients. It also means removing any potential barriers that the physicians may face, or anticipate, to allow them to be more engaged with the UBT process. Another part of my role is working with our unit-based team’s resource team. In that capacity, I bring more of a clinical perspective to UBTs.
Q. How do teams improve care?
A. A project I had personal involvement with was the pediatric team at our Panola office, which addressed ADHD (Attention Deficit Hyperactivity Disorder) medication management. Before our UBT project, we were meeting the goal of having a follow-up visit within 30 days approximately 25 percent of the time. Through our UBT work, we increased those results to reaching and sustaining a rate above 90 percent after three months.
Q. Why haven’t more physicians embraced partnership?
A. The first thing I tell physicians about the UBTs is that it is about improving the work that we’re already doing. It’s not about adding more work, it’s about looking at the work that you're doing and figuring out how to do it better.
I think one of the barriers physicians face has been just lack of understanding. It wasn’t clear to physicians the value that UBTs can bring to the team. So it’s taking the UBT process and putting that into terms that are meaningful to physicians. Time is always a barrier for most people, and particularly for physicians. That’s why it’s important to have them understand that it’s not about doing more or working harder, it’s about working better. This is a very new way of thinking about teamwork. It’s about the physician being engaged and involved and still having a leadership role, but also embracing the value and the input, perspectives, talents and skills of the whole team, and understanding how everybody can share the same goal and work together and improve the accountability across the board.
What it really takes is physicians and teams going through the process. I can talk with them all I want, and tell them how it is in theory, but once they start to go through the process and see the results, and see how morale and efficiency improves—that’s when they become believers.
The first thing I tell physicians about the UBTs is that it is about improving the work that we’re already doing. It’s not about adding more work, it’s about looking at the work that you're doing and figuring out how to do it better.
Q. Have UBTs changed how you work?
A. My experience with UBTs has changed the way I deliver care. I practice differently in the sense of how I communicate with my patients, and how I think about the information they give me. It’s not only about asking the questions about the symptoms and the length of the illness. I've started to think about [things like], What made this parent go through these steps? What was their motivation, or what was the reason behind their decision?
So I started thinking about not only the “how” but the “why.” And that helps me understand how to communicate back to them.
Q. What’s the relationship between UBTs and performance improvement?
A. UBTs are about performance improvement (PI) on a small scale, doing small tests of change for that group of people. But the principles—using the PDSA cycles and measuring your work and understanding your processes—is similar to a lot of other PI tools and methodologies that can be used on a broader scale. UBTs help teams understand and use those concepts daily. UBTs really help teams develop the capacity to understand and utilize PI methodologies.
I think UBTs really help us leverage the power of team-based care and the power of true partnership. At Kaiser Permanente, we have shared goals and more accountability at a team level, for both physicians and non-physicians. I think that really is a competitive advantage that we are starting to increasingly leverage as we move forward.
I’m excited about more and more physician involvement with UBTs….I think it’s clear that performance improvement and true team-based care is really the wave of the future. We’re setting ourselves up to have a bright future.