Quality

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How to Find UBT Basics on the LMP Website

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Small Changes, Healthy Babies—A Quicker Path to Vaccinations

  • Giving injections in the exam room, rather than the injection clinic
  • Limiting the choice for physicians to two versions of the same vaccine to choose from—instead of several
  • Huddling among medical assistants and physicians once or twice a day to determine which of their incoming patients need vaccines. Medical assistants then have the shots ready for those patients
What can your team do to use small tests of change in tackling large problems?

Keeping Quality High, With More Patients

  • Providing loaner blood pressure kits to hypertensive patients who had trouble traveling to the clinic.
  • Mobilizing patients to phone their providers every day with their blood pressure readings, furnishing the information needed in just a couple of minutes, without filling up an entire appointment slot.
  • Increasing the number of free appointments available for blood pressure checks.

Women’s Clinic Reduces Lab Errors

  • Standardizing the workflow for collecting specimens and ordering lab tests
  • Educating physicians about the medical assistants’ workflow and the couriers’ pick-up schedules
  • Treating errors as an opportunity for coaching rather than discipline

What can your team do to collect and analyze data to make workflow improvements? What else could your team do to encourage everyone to speak up and share concerns, ideas and suggestions?

Videos

Why Speaking Up Matters

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"Me Tarzan, you Jane," as the model for doctor-nurse relationships? No thanks! This award-winning intensive care unit has built a #FreeToSpeak culture with interdisciplinary rounds on patients. As a result, the team has high morale, low turnover—and its patients suffer fewer hospital-acquired infections. 
 
 
Produced by Kellie Applen.

Videos

Making Early Detection Easy

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By working in partnership and leveraging the power of Kaiser Permanente's electronic health records, this eye care team at Redwood City Medical Center helps patients get the cancer screenings they need.

Videos

When the Game Changes, Change Your Game

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This short video shows how a unit-based team at Kaiser Permanente's Capitol Hill Medical Center in Washington, D.C. is adjusting to a big jump in membership—and improving patient care at the same time.

 

A Matter-of-Fact Approach to Gender Issues

Deck: 
Toward better care for teens

Story body part 1: 

When teen members first visit the Burke Behavioral Health Center in Virginia, they are all asked the same intake questions, ranging from “What do you do for recreation?” to “Does your family have a history of violence?” Their answers help determine the best course of care.

Now, because of a unit-based team project to standardize care for transgender and gender-questioning members, teens ages 14 and older also are asked where they fall on the gender spectrum.

“We included this in the standard behavioral health assessment to normalize it instead of pathologize it,” says Sulaiha Mastan, Ph.D., a licensed clinical psychologist and UFCW Local 400 member. Mastan, who works exclusively with children and adolescents and has about 20 transgender teens in her care, says the information is important for treatment purposes.

For instance, a parent may say a child is depressed and is refusing to go to school. If that child is gender-questioning, gender-nonconforming or transgender, the underlying reason may have to do with changing clothes in the locker room or using the school restroom.

“If I have a teen who says, ‘I have a female body, but I am a male,’ then I am aware,” Mastan says.

High suicide rate

The stakes are high: A 2011 study found that 41 percent of transgender or gender-nonconforming people have attempted suicide sometime in their lives, nearly nine times the national average.

In another change, the unit’s front desk employees now check the electronic medical record to learn each member’s preferred name and pronoun, respecting that a member may, for example, appear male but identify as female.

“At the front desk, we are the first impression,” says Anthony Frizzell, a mental health assistant and member of OPEIU Local 2. “It is imperative that we relate to the patient in the way the patient wishes.”

The UBT also standardized the steps it takes when members are interested in hormone treatments; started a support group on transgender issues for parents; and is developing a brochure that will guide transgender adolescents through receiving care at Kaiser Permanente.

The policies it created follow national and KP guidelines, says Sand Chang, Ph.D., a psychologist and gender specialist in the Multi-Specialty Transitions department in Oakland.

“Although it is not routinely done, this is really falling in line with best practice—to give young people an option,” Chang says.

The project earned the team the R.J. Erickson Diversity and Inclusion Achievement Award at Kaiser Permanente’s 38th National Diversity and Inclusion Conference in October.

The team’s initiatives send the message that wherever a person is on the gender spectrum, it is part of being human, says Ted Eytan, MD, medical director of KP’s Center for Total Health in Washington, D.C.

“What the team is doing is making it very normal,” Dr. Eytan says. “It is something about you that we need to know, rather than something that needs to be extinguished.”

A Mirror for Members

Deck: 
Using the power of language and culture

Story body part 1: 

Early in her nursing career, Yvonne Roddy-Sturm, now the chief nursing executive at Ontario Medical Center in Southern California, saw that caregiver diversity—or lack of it—matters.

“I saw differences in how some providers cared for people,” she says. “It wasn’t just based on race—economic status, language, lots of things came into play. We all make assumptions about others.”

The consequences of such assumptions are serious, impacting the quality of care a patient receives and leading to a wide range of health disparities.

In the 30 years Roddy-Sturm has been with Kaiser Permanente, our member and patient population has become more diverse—as has our workforce. And that’s helped KP deliver high-quality, patient-centered care.

“Patients who can relate to their caregiver are more likely to follow their treatment regimen,” says Roddy-Sturm. “They’re more likely to ask questions of people who are more like them.”

The Labor Management Partnership plays a significant role in building the skills, cultural competence and work environment needed to serve KP’s diverse patient population.

For example:

  • Unit-based teams provide a more inclusive workplace and give staff members a safe place to speak up.
  • Two LMP-sponsored educational trusts provide tuition assistance, paid time off and career counseling to help employees move up the career ladder.

And there’s more. Many departments, including Ontario’s nursing department, make their diverse teams part of the hiring process.

“We always start with the skills required to do the job,” says Roddy-Sturm. “Then our panel members bring their own insights and diversity to the discussion. They look for fit, flexibility, compassion and empathy, as well as skill. We try to live our values.”

The power of language and culture

Research shows that patients fare better when they receive care in their preferred language and providers demonstrate sensitivity and respect for their cultural beliefs and values.

Frontline teams across Kaiser Permanente are doing just that, and nowhere is this more apparent than in California, where 85 percent of KP’s Latino members live. The Northern and Southern California regions have developed language assistance programs that help eliminate health disparities and personalize the care experience for patients, including:

  • Organizing frontline interpreters. The Qualified Bilingual Staff program, developed by National Diversity and Inclusion and pioneered by the Labor Management Partnership, enables eligible employees to serve as interpreters—often earning extra pay—in addition to their regular job duties. To qualify, employees must pass an assessment and complete required orientation. In Southern California alone, the program currently involves 8,000 interpreters who speak 10 languages.
  • Seamless care in Spanish. The San Francisco Medical Center established KP’s first Spanish Bilingual Internal Medicine Module in 1997, composed entirely of bilingual and bicultural staff and providers. Unit-based teams have helped replicate the module region-wide, improving diabetes care and colorectal cancer screening rates for Latino patients.
  • “Breast is best.” Studies show that breastfeeding benefits both mother and baby. But many Vietnamese and Latina members believe formula has more nutritional value. Staff members at the San Jose Medical Center decided to offer health education classes in Vietnamese and Spanish, get learning materials translated, and learn more about the cultural perspectives so they could address patients’ concerns. As a result, exclusive breastfeeding rates jumped by 15 percent for Vietnamese mothers and 6.5 percent for Latina mothers.

“When we show respect for our patients’ cultures and values, we are more likely to provide better care, because they trust us and are more likely to follow through on the instructions we give them,” says Andrea Rudominer, MD, senior physician for Pediatrics and chief of diversity for the San Jose Medical Center. “Culturally competent care leads to better health outcomes for all of our patients.”

Creating a Safety Net for Sickle Cell Patients

Deck: 
Team approach helps members live full lives

Story body part 1: 

Brandon Johnson was close to giving up on his dream of becoming an X-ray technician.

Born with sickle cell disease, a genetic blood disorder that primarily affects African-Americans, the 35-year-old Southern California man was forced to drop out of school for semesters at a time.

But thanks to the sickle cell care team at the Inglewood Medical Offices, Johnson is now on medication that reduces complications. Last fall, he was able to complete his studies, and he has started looking for a radiology job.

“They got me on a plan to keep me out of the hospital,” says Johnson, who drives 60 miles one way from his Riverside home to see his doctor in Inglewood, even though other providers are closer. “If I didn’t have my health, I wouldn’t be where I am today.”

Johnson’s success is not uncommon for the Level 5 unit-based team, a group of physicians, managers and employees that provides personalized care for nearly 500 sickle cell patients in Southern California. About 300 of the region’s adult patients are treated directly by the team. Its approach is working—only five of the 300 needed frequent hospitalization and emergency care in the past year.

“Our goal is to keep sickle cell patients out of the hospital by giving them the care they need,” says Pippa Stewart, Inglewood’s department administrator.

Stigmatized as drug addicts

Nationwide, about 70,000 people have sickle cell disease, which can cause chronic anemia, acute pain, infections and stroke. Although most are African-American, the disease also affects people of Indian, Middle Eastern, Hispanic and Mediterranean heritage. Patients often get stigmatized as drug addicts when they ask for narcotics to deal with their pain.

The current UBT grew out of a team that was established in 1999; before that, there was no comprehensive treatment program for KP’s sickle cell patients.

“Ninety percent of patients were getting their primary care in the emergency room,” says Shirley Brown, RN, a UNAC/UHCP member and the team’s care manager. Patients saw as many as 17 doctors as they went from appointment to appointment.

Now, the 12-member UBT—which includes four physicians, two registered nurses, a physician assistant, a pharmacist and a social worker—helps patients control symptoms by offering pain management care, providing resources such as a case manager, and urging them to keep appointments, which help minimize visits to the emergency room and hospital.

Team members coordinate with and help train the KP providers who care for the region’s remaining 200 patients. Last fall, Brown helped lead a session for 70 registered nurses from around the region. Osbourne Blake, MD, an internist and the team’s lead physician, provides regular updates to fellow physicians. “We’re trying to get everyone on the same page,” says Dr. Blake. A recent test of change focused on reducing the number of patients who miss appointments. For three months, Brown and a co-worker called patients every day to remind them about upcoming visits. The calls helped. The team’s “no-show appointment” rate dropped from 20 percent in May 2015 to 14 percent in August 2015.

Dramatic improvement

“They all know you personally,” says Ryan Hull, a 27-year-old TV production assistant and film student. A few short years ago, he suffered frequent crises that required immediate medical attention. After he and his physician co-created a pain management program, his health improved dramatically.

“They did everything they could to find out what regimen works for me,” Hull says of staff members, who greet him by first name and offer walk-in appointments to accommodate his sometimes unpredictable schedule. “They figured out the perfect way to treat me.”

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