After learning more than a year ago that patients were having trouble getting doctors’ appointments, members of the Keizer Station Family Medicine team in Oregon began exploring ways to improve service and access. Their solution? Offer more video visits.

“What we didn’t realize at the time is that this work would put us in a unique position to be ready for the pandemic, which wasn’t on anyone’s radar in fall 2019,” says Ruthie Berrell, medical office director and management co-lead for the Family Medicine/Nurse Treatment Center unit-based team. 

Collaboration by the team’s frontline workers, managers and physicians has served as a partnership model for UBTs in the Northwest Region. It’s also earned the department applause for improving service and access at a critical time in health care, as teams across the enterprise adapt to the rise of virtual care. 

“It wasn’t always easy,” says Molly Maddox, RN, the team’s labor co-lead and OFNHP member. “This took a lot of working out the kinks and working together.” 

Overcoming resistance to change 

One of the team’s earliest challenges involved staff resistance to virtual care. Worried that patients would perceive virtual visits as a “takeaway,” some staff members pushed back. 

“The culture of how we delivered care was in the medical office, and people had different levels of acceptance across the spectrum,” says Caroline King-Widdall, MD, team co-lead and physician in charge. 

So, team members educated their peers on the benefits of virtual care and developed scripting to help them feel at ease offering video appointments to patients.

“People are more comfortable now taking the lead and scheduling appointments,” Berrell says. Others feared that older patients were less tech savvy and would have difficulty accessing their virtual visits. In response, team members posted informational fliers in exam rooms and emailed instructions to patients before their appointments. 

Building team engagement

Key to the team’s success was engaging everyone, including physicians. Medical assistants and nurses partnered with providers to review physician schedules and flag appointments they could convert to virtual visits. 

Also, UBT members participated in weekly huddles “where we brainstormed new tests of change and talked about what worked and what didn’t work,” says Maddox. The team’s efforts paid off. 

Patient satisfaction scores for ease of scheduling appointments jumped from 53% to 85% between August 2019 and December 2020. And because members access video visits through kp.org, website registration among the department’s patients increased by nearly 10% during the past year. 

The hard work has not gone unnoticed. This past fall, the team received the region’s UBT Excellence Recognition Award for improving service and access. 

Maddox attributes the team’s success to strong relationships rooted in partnership. “We know that we would not have had this success if our team didn’t work together.” 

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.