- Reviewing upcoming ultrasound appointments to schedule reminder calls
- Dividing call duties among different assigned staffers to ensure privacy
- Calling a day in advance of appointments to discuss patient instructions
- Educating about the proper use of VTE orders for post-operative patients
- Coordinating with pharmacists and other teams to ensure orders are followed
- Outlining how the Joint Commission's SCIP guidelines can help improve compliance
- Identifying the number of patients off telemetry monitoring for longer than three minutes and why
- Huddling to discuss the severity and consequences of the problem
- Creating reminders to check monitors, and make it part of the routine
- Identifying which tests oncology patients actually need
- Creating and issuing a "golden ticket" to get patients to the front of the line
- Fast tracking the processing of labs before seeing the doctor
- Identifying eligible members for colorectal screening
- Developing a personalized story for each patient to make it relevant
- Creating a follow-up process to ensure patients are following through with the test
- Reaching out to patients
- Emphasizing the value of taking the colorectal screening test
- Identifying at-risk patients whenever they come into the office
Around the Regions (Fall 2012)
Deck: In support of sponsors
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.
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.
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.
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.
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.
“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.”
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.
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.
Around the Regions (Spring 2014)
The new Lone Tree Specialty Care Medical Office, a 25-acre campus, boasts outdoor patios, picturesque mountain views and a walkway around the perimeter of the building. The facility, which opened in December 2013, was awarded a LEED (Leadership in Energy and Environmental Design) Silver certification by the United States Green Building Council. Lone Tree, which is near a light rail line, used recycled materials, water-wise fixtures and shading devices for balancing solar heat to win the LEED designation. The facility has nearly 350 employees and 45 physicians to take care of the 3,000 ambulatory surgeries and 3,000 minor procedures expected per year.
What happens when two nurses from two different high-performing UBTs transfer to the same brand-new Level 1 team? That team zooms to a Level 4 in only 10 months. Jane Baxter and Ingrid Baillie, both RNs, had been UBT co-leads at the Crescent and Cumberland medical centers, respectively, and then joined the Ob/Gyn staff at Alpharetta. Drawing on their experience—at different times, they each have been UFCW Local 1996 members and members of management—they helped their new UBT move up through the Path to Performance. “We knew the steps in the process and what to expect,” says Baxter. Their advice to fledging teams: Start with small performance improvement projects in areas that clearly are Kaiser Permanente priorities and that already have lots of data collected.
Nurses on the 1-West Medical-Surgical unit-based team at Moanalua Medical Center vastly improved how well they educate patients about medications, moving from about 40 percent of surveyed patients saying they understood side effects and other aspects of their prescriptions to 96 percent reporting this awareness. Between April and December 2013, the RNs, who are members of the Hawaii Nurses’ Association (HNA), made notations on patient room whiteboards, rounded hourly and did daily teach-backs on every shift. The team members designed a three-day survey for a sampling of patients to report what they understood about side effects of their medicine. The survey provided speedier feedback than waiting more than three months for HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores.
A Nephrology team at Tysons Corner Medical Center in Virginia helped patients prevent or manage chronic kidney disease by getting them into the classroom. Just 70 percent of the unit’s patients at risk of renal failure were enrolling in KP disease management classes in February 2013. But several successful tests of change boosted at-risk patient enrollment in March to 100 percent, where it has remained since. The team noted on individual patient charts if the member suffered chronic kidney disease, developed scripting for in-person coaching, mailed class invitations to patients’ homes and handed out class agendas with after-visit summaries.
The Modesto Pediatrics UBT improved wait times for immunizations—and not only increased service scores but also reduced overtime costs, an example of how a change can affect an entire system. The team reduced patient waits for immunizations from 45 minutes to 15 minutes between June and August 2013 and maintained the improvement through the rest of the year. A workflow change was key to the dramatic reduction. When a patient is ready for an injection, physicians now copy the orders to a nursing in-box instead of searching for a licensed vocational nurse to give the shot. The half-hour reduction in wait times—which is credited with improving service scores from 86 percent to 95 percent—also reduced the need for LVN overtime by an hour a day, resulting in savings of more than $16,600 over six months.
The regional Employee Health and Safety department won KP’s “Engaging the Frontline” National Workplace Safety Award. Through the Northwest’s Safety Committee Challenge, facilities had to complete a rigorous set of tasks, including regularly scheduled safety meetings, joint planning with NW Permanente and Permanente Dental Associates, safety conversation training, awareness plans and a safety promotion event during the year. Of the 16 facilities that rose to the challenge, nine met all of the qualifications. The region ended the year with a 4 percent reduction in accepted claims compared with 2013. Leonard Hayes, regional EVS manager, won the individual award for his work, which contributed to the East service area’s EVS team going injury-free for the last four years.
The regional LMP council has set a 2014 Performance Sharing Program (PSP) goal to power up unit-based teams’ achievements on improving affordability. When at least 50 percent of a medical center’s UBTs complete a project that saves money or improves revenue capture—and if the region meets its financial goals—eligible employees and managers there will get a boost in their bonus. “Imagine how powerful it will be to have a majority of unit-based teams achieving measurable cost-savings and revenue-capture improvements,” says Josh Rutkoff, a national coordinator for the Coalition of Kaiser Permanente Unions. “The idea is to take all the strong work on affordability at the front line to a whole new level.”
- 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
- Starting with a truly small test of change: one shift on one day
- Creating a flow sheet to see how long it took for doctors’ orders on walking with patients to be met
- Standardizing a mobility protocol for all patients