Spurred by nationwide protests against racism and social injustice, unit-based team members are launching cultural  competency projects aimed at delivering more equitable outcomes for their patients by looking closely at their own beliefs. 

Mid-Atlantic psychotherapist Erin Seifert knows that big change often involves many small steps. Delivering equitable care is no different, she says. 

“To give our patients the support and resources they need, we have to start with ourselves and our own biases and cultural competence,” says Seifert, labor co-lead for the North Baltimore Behavioral Health team and a member of UFCW Local 27. 

Team members, who are represented by unions belonging to the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions, began a monthly lunch-and-learn series about bias awareness in November. Activities include a pre- and post-evaluation and guided learning exercises that stimulate conversation about differences. 

“It’s very informative,” says Regina Foreman, a mental health assistant and member of OPEIU Local 2. “I’ve learned a lot, especially about implicit bias. The training is helping me be more aware of my own biases.” 

Such responses are encouraging, says Kristin Whiting-Davis, operations manager and the team’s management co-lead. 

“We need to be able to talk about our own privileges and our own biases,” Whiting-Davis says. “I hope it will help people practice having those discussions that, ultimately, will translate into the work we do with our members.

Welcoming all

Eager to protect their young patients from the effects of racism, members of the Southwood Pediatrics team in Jonesboro, Georgia, began by educating themselves. They held listening sessions for staff and read about the impact of intolerance on children.

Their efforts informed discussions on ways to create a more welcoming environment for patients, families and each other. Ideas include a coloring contest featuring uplifting images, adding diverse artwork to the department and creating resources for families coping with racial biases.

Next steps call for staff members to vote on the most promising proposals for further action.

“We want all cultures and races to feel welcome when they come to our pediatrics unit,” says Stephanie Henry, MD, physician co-lead of the Southwood Pediatrics team. “We all have biases. We need to be open and honest about how to confront them. Then we can build bridges to start having conversations about the patient’s health.”

With reporting by Brenda Rodriguez and Tracy Silveria.

LaTisha Thompson has nothing but positive things to say about breastfeeding her 1-year-old daughter, Teigen Roberts.

“It was a no-brainer for me,” says Thompson, an on-call pediatrics nurse at Kaiser Permanente’s Capitol Hill Medical Center in Washington, D.C. “I decided to do it because of the benefits that breastfeeding gives to my baby and me.”

Indeed, breastfeeding has many health benefits for babies and mothers. But Thompson stands out among African American mothers, who are less likely to nurse their children than women of other racial and ethnic groups because of cultural beliefs that formula is more filling than breast milk. Many Black moms also lack family support and access to breastfeeding resources.

“It’s a national problem,” says Lori Franklin, RN, a lactation consultant and member of UFCW Local 400 who is working to close the gap with her colleagues at the regional Newborn Care Center in the Mid-Atlantic States.

Learning from moms

To better understand the challenges African American women face, the Level 4 unit-based team surveyed 45 Black moms as part of a “voice of the customer” project in January 2019.

The results were revealing.

“They were looking for prenatal education,” says labor co-lead Francesca Klahr, RN, a lactation consultant and UFCW Local 400 member. “We went back to the drawing board, and when we offered it, they came.”

The team doubled the number of prenatal breastfeeding classes and partnered with ob-gyn nurses to encourage African American women to enroll. The response was dramatic.

The percentage of Black mothers taking prenatal breastfeeding classes jumped from 3% to 15% between September 2018 and September 2019.

Kathleen Fulp, a mother of 2, joined the class after experiencing initial difficulty nursing her firstborn child, Savannah, now 2 years old. She’s glad she did. “I probably would have given up had I not had support.”

Such enthusiasm spells success for Nia Williams, clinical operations manager and the team’s management co-lead.

“We can empower and encourage our African American moms to push through, and that has been really successful.”

After government stay-at-home orders derailed their plans for a patient support group, members of Kaiser Permanente’s Marlow Heights Behavioral Health team in Maryland set up a video chat for vulnerable individuals sheltering in place.

“With the COVID-19 pandemic, we had to be open and receptive to connecting with our members in a different way,” says Dawn Anderson, a psychotherapist with UFCW Local 400 and union co-lead for the Level 4 unit-based team. “This way we’re still supporting patients with serious health issues.”

Propelled by the global pandemic, Behavioral Health teams across the Mid-Atlantic States are using partnership principles and tools to transform how and where patients seek care — resulting in changes likely to outlast the crisis.

Connecting with patients

Therapists are working from home and counseling patients via telephone and video. Unit-based team members are meeting virtually, too, using collaborative digital tools to identify challenges and solutions.

They’re also using such tried-and-true performance improvement tools as the Rapid Improvement Model to reveal the best ways to connect with patients by telephone and video.

“Sometimes I will connect with patients on video, then after 5 minutes something will cause a disruption and I’ll have to ask if we can connect via telephone,” says Anderson. “We are still adapting to telehealth technology.”

Adapting quickly

The rapid-fire changes haven’t been easy for team members, who are conducting assessments with patients by phone instead of in person because of social distancing requirements.

“We’ve done things in this pandemic season that we normally would not have done,” says Reuben Steele, Behavioral Health operations manager and management co-lead. “That has caused some initial anxiety but, ultimately, the team has been able to adapt and adjust quickly.”

Being heard

Team members agree having a voice in decisions about ways to deliver care is helping them cope with change. A key feature of the Labor Management Partnership is involving frontline workers and union leaders in decision making.

“The LMP is a great way to think outside of the box and figure out what we can do to meet people’s needs,” says Lindsey McDaniel, a psychotherapist, UFCW Local 400 member and labor co-lead for the Silver Spring Behavioral Health team, a Level 4 UBT in Maryland.

Anderson agrees.

“We’re able to ‘check egos at the door’ and come forth with ideas and suggestions. That’s what I love about the UBT setting,” she says. “Our UBT consultant and manager support us and are open to feedback on team projects and goals. This is the forum where I feel my colleagues and I are being heard.”

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.