As a union partnership representative (UPR) from UFCW Local 770, Annamarie Marin helps support 72 unit-based teams at the West Los Angeles Medical Center. Last year, she helped the Oncology team overcome low morale to move from Level 2 to Level 4—and it’s now on the cusp of achieving Level 5. Marin recently was interviewed about her role as a UPR by LMP Communications Manager Sherry Crosby.

Q. What experiences helped prepare you for your position?

A. I have been part of UBTs since 2005. I started as a co-lead and then became an executive sponsor. This experience helped me tremendously, because I can relate to the teams on a personal level. I have been in the exact same place, dealing with similar challenges.

Q. What is your approach to working with teams?

A. Some teams need team-building exercises, while others need to learn to trust one another and share information on projects. Starter teams don’t know how to create agendas or structure meetings, so I help facilitate their meetings. The most important thing is making sure I’m available and that teams have what they need to succeed.

Q. What early challenges did the Oncology team face?

A. They were struggling with membership involvement and morale was low. Nobody wanted to participate in meetings.

Q. How did you help the team succeed?

A. I helped staff members understand that the UBT is not there to add work to their plate. Eventually, we got a group to participate in team meetings.

We went through different trainings and started on small projects. First, they focused on staff morale. Staff members practiced expressing appreciation for each other until it became part of the team's culture. Then they moved to an affordability project. That was a pivotal point in that team’s development, because the idea came from a labor partner.

It shows team members are involved in decision making and contributing to the department’s success.

Q. What was key to the team’s success?

A. I helped the team members understand their work through a different lens—what the function of a UBT is, and their role in it. They realized they have a great department and an engaged manager. It was really about helping them understand their value to each other.

The Family Practice unit-based team at the Sunset Medical Office in the Northwest was thrilled that its work to get members to sign up on kp.org was a success. But team members quickly grew dismayed when the onslaught of new signups had an adverse effect on patients’ experience.

The challenge began in 2014, when the team launched several projects to increase the number of Kaiser Permanente members signed up on kp.org, knowing that people who use kp.org usually give KP higher satisfaction scores. The office is located in Hillsboro, Oregon, near one of Intel’s campuses. Intel offers Kaiser Permanente as a health plan option, so the effort to get more people online made perfect sense.

But, on the flip side, the increased number of messages coming in through kp.org wound up increasing turnaround times for return emails and phone calls.

More than two-thirds on kp.org

The department now receives between 450 to 650 email messages per week. Seventy-one percent of its patients—29,000 members—are signed up on kp.org. The team sought to improve its turnaround time on messages by reducing the number of times staff members and physicians touched each message. Instead of multiple people working a message, each one is now triaged one time by either an LPN or RN. At the same time, the team decreased its time spent on messages per week from 13.6 hours to 10.9 hours.

Ed Vrooman, an improvement advisor and union partnership representative, coached team members on how to test and implement their improvements.

“We learned how to use process mapping, so we could identify where the holes were in how we were approaching the work,” says Eliseo Olvera, the assistant department administrator and the UBT’s management co-lead. “Ed knew where we could get the data we needed and help us understand it, so we could do the work.”

Vrooman also introduced the team to the 6S tool—sort, simplify, set in order, sweep, shine, standardize—to improve its work processes. The team broke into different workgroups and each group identified tests of change. Some of the ideas were abandoned, some were refined and adopted, and some still are being adapted.

Staying on track

“I tended to focus too much on the information and the numbers,” says Rikki Shene, a licensed practical nurse and SEIU Local 49 member who is the team’s union co-lead. “Ed helped keep us organized and simplified the data so that we could keep moving forward and accomplish something in our 45-minute UBT meetings.”

Vrooman’s role in the team has been critical for the team. He attends the co-lead planning sessions and UBT meetings. He stays in the background until needed—and then he speaks up.

“He’s part of our community,” says Olvera. “His expertise with data has been critical. It’s a gift.”

Colorado

Unit-based teams are hitting their stride, with 190 out of 261 teams reaching a Level 4 or 5 on the five-point Path to Performance. Teams are engaged in several types of projects, including those that save the organization money. The region will see a financial savings of $1.85 million this year through the 175 affordability projects of UBTs. The five UBT consultants in the region are coaching teams impacted by regional restructuring and helping those teams rebound quickly. Teams also are focusing on workplace safety, patient safety and HEDIS measures (Healthcare Effectiveness Data and Information Set).

Georgia

Starting in May and running through December 2015, Georgia medical centers are conducting an experiment. This region-wide test involves using greeters to usher in members. During the trial period, 15 greeters will make the member feel welcomed and convey the message they are important to Kaiser Permanente. Greeters also will answer questions, escort members to their appointments, maintain waiting rooms, ensure wheelchairs are available and welcome members with a smile. “They will provide a concierge-type member experience,” says Elizabeth Ramsey, the Georgia region’s senior manager of loyalty and retention.

Hawaii

The Hawaii region recently re-set its 57 unit-based teams’ scores on the Path to Performance to Level 1. Three consultants—two also are registered nurses and one is a project manager—will help teams quickly advance as they meet such core requirements as sponsor training. The region is unique in that, for now, one union (Hawaii Nurses Association/OPEIU Local 50) is in the Coalition of Kaiser Permanente Unions, while other unions are not. Although that can be challenging, consultants say teams still focus on the patient and want to do improvement work. “We help each other work through obstacles with our teams and understand the data,” says Lisa Kane, UBT consultant and project manager.

Mid-Atlantic States

In February, when home health orders came in to Health Information Management Services Northern Virginia, the average turnaround time was 4.4 days. By creating red folders for the orders, adding a cover sheet that says “stat” and date stamping the order as soon as it arrives, the team cut turnaround time to three days by April 2015—even as the number of orders went up from 673 in February to 747 in April. “This was important to the workflow, because when home health agencies called to follow up on the orders it interrupted our work,” says LaShawnda Powell, a senior health information management assistant in Woodbridge, Virginia, and member of OPEIU Local 2. “We have determined that our new process is successful and we’ve adopted it.” 

Northern California

Last year, unit-based team consultants and union partnership representatives formed a regional UBT to work on issues related to consistency and accountability for Northern California’s 1,300 frontline teams. Now the group has established three subgroups to review the 2015 National Agreement, which includes new provisions for UBTs. Each subgroup has a distinct focus area: sponsorship, UBT validation and assessment, and tools to support contract expectations. The subgroups will develop recommendations for review by a committee of labor members and management representatives. The regional co-leads will submit final recommendations to the regional LMP Leadership Council by year’s end.

Northwest

UBT Resource Team members have been busy refining the region’s new process for assessing teams on the Path to Performance. Co-leads and sponsors of 415 unit-based teams in the Northwest work with their consultant to ensure each team advances or sustains high performance throughout the year. Improvement Advisors help co-leads create action plans and provide direct training to move teams along or refer them to the appropriate subject matter experts. A majority of teams at Levels 2 and 3 will advance to high performance within the next 90 days due in large part to the work of the UBT Resource Team.

Southern California

Playing games at work usually is considered taboo. But that’s exactly how a group of regional UBT staff members spent a recent afternoon when they learned to play the “Leading Innovation Game.” Created by Kaiser Permanente’s Innovation and Advanced Technology team, the board game is designed to help employees overcome challenges that can doom the best ideas. Starting this fall, regional UBT staff will train team co-leads and sponsors, who will share the game with unit-based teams at their facilities. “Most teams come up with great ideas but they aren’t always aware of potential pitfalls,” says Rosalyn Evans, UBT practice leader for Southern California. “This board game gives them hands-on experience to develop innovation in a risk-free environment.”

You say your unit-based team has reached Level 5 on the Path to Performance? Great, everyone take the rest of the week off!

Your UBT is stuck at Level 1 and has been for years? Just hide in a dark corner and hope no one notices.

Not so fast.

Teams soar. Teams stumble. And we need them all to stay in the game.

Unit-based teams are Kaiser Permanente’s platform for improving performance. They’re also the union coalition’s instrument for amplifying workers’ voices in the workplace. All of which has paid off for KP members and patients, through UBTs’ efforts to improve quality, service and affordability. None of which is easy for teams to pull off.

Enter union partnership representatives and UBT consultants. They are recruited from frontline positions in union and management, so they know firsthand what it takes to deliver high-quality health care. They also receive special training that enables them to coach and mentor unit-based teams.

Our leaders knew teams would need such support. But it’s a balancing act. The tightrope for these folks is to gradually build the skills and confidence among team members, then step back at the right time so teams can fly on their own.

Few of us can truly go it alone. We all benefit from coaching—someone to hold up a mirror and offer frank advice (diplomatically delivered!) on how to improve in our jobs. A consultant’s most important skills are listening and observing. Those are skills we’d all do well to improve.