“Dexter” Janet Borrowman is an operational excellence coach for performance improvement in the Southern California Region. She recently spoke with LMP Communications manager Sherry Crosby about the importance of rounding conversations for managers and frontline workers. Building a workplace culture where everyone’s voice matters is key to our Labor Management Partnership.

What is rounding?

Rounding is an evidence-based practice that relies on purposeful conversation and observation to drive workplace engagement and insights. Direct report rounding involves conversations between a team member and that person’s supervisor, manager or leader.

How does rounding benefit managers and frontline workers?

When done well, rounding helps managers build trust with staff, gain insights into workplace challenges and recognize employees, which fosters joy in work. Frontline workers benefit by having a chance to connect individually with their managers, share ideas, express concerns and find deeper purpose in their everyday work.

What evidence shows rounding is an effective practice?

Rounding is one of the most effective ways for managers to spend their time. And the more they consistently round, the greater the impact. According to People Pulse, departments where rounding is routinely practiced achieve more meaningful levels of engagement, better patient care outcomes, fewer workplace injuries and improved attendance.

How can frontline workers get the most out of rounding conversations?

Sometimes employees don’t see the benefit of direct report rounding; they just see it as helping the boss complete their checklist. It’s totally missing the point! Rounding is your chance to discuss what you need to be successful and the support you need. This is all about you!

How can managers get the most out of rounding conversations?

Rounding is one of the best tools that managers have for proactively surfacing and addressing issues which can create safer, more efficient and productive teams and environments. Use rounding to connect with your team members. People need to feel that their life and work has meaning, and that they are personally supported and cared for as a complete person. People need a personal touch, especially during difficult times, and rounding can help with that.

How can managers use rounding to build trusting relationships?

Your direct reports need to feel that what they’re saying is important and that you’re following up with action. Circle back to that person who brought up the issue with you. Go to the huddle and follow up with the whole team. We build trust by following up after a rounding conversation. We break trust by not following up.

What advice do you have for those who want to enhance their rounding practice?

If we are doing rounding the right way, if we’re doing it consistently, if we’re doing it authentically, then we will discover what matters most to our people and we’ll be able to better support them and the work they do.

Union leaders crunched the numbers, and they didn’t like what they saw.

At the beginning of February, less than 50% of SEIU-UHW members at Kaiser Permanente were vaccinated against COVID-19. It was even worse for employees in the Emergency Department at Downey Medical Center in Southern California, where Gabriel Montoya works as an emergency medical technician. There, only 40% of his fellow union members got the shot.

Montoya and his fellow union members — working with physicians and managers — wanted to raise those rates, so they pulled together labor-doctor huddles. And by mid-April, 64% were vaccinated. 

“We did it in partnership,” says Montoya. “The labor partners led the huddles and introduced the doctors. I can’t imagine that happening in a nonunion hospital or even a non-Partnership hospital.”

Going live

SEIU-UHW members set up a phone bank to call — in Spanish and English — members who worked in housekeeping, food service and central supply departments, where vaccination rates were lowest. The union also hosted a Facebook live event where Black and Latino KP doctors answered questions.

Those proved so popular that they wondered, why not do this live at the facilities?

Angela Glasper loved the idea. The chief shop steward at Antioch Medical Center in Northern California got frustrated when she talked to fellow union members who were conflicted about getting vaccinated.

“I listened, but I couldn’t address their concerns,” says Glasper, who works in optical sales and needed someone with the clinical expertise to answer their questions. “Wouldn’t you rather hear it from a doctor than me?” she asks, with a hearty guffaw. “People would say to the doctors, ‘Labor has been telling us about it, but you answered our questions.’”

One of the most popular doctors at the huddles in Antioch was Jeffrey Ghassemi, MD, an anesthesiologist. He shared his harrowing stories about working on the COVID units and was, in Glasper’s words, “patient and gentle.” With a newfound confidence, employees signed up for vaccine appointments during huddles.

Building trust

Pediatrician Carol Ishimatsu, MD, who volunteered to talk at a huddle in Downey, has given children shots to prevent measles, mumps and chickenpox for more than 2 decades.

“Vaccines are our most important intervention,” says Dr. Ishimatsu.

To build trust, Dr. Ishimatsu emphasized her shared experience with SEIU-UHW members as warriors on the front line.

“I told the employees: I do the same thing you do after work,” she says, describing her ritual of removing her clothes in the garage and putting them directly in the washing machine before entering the house. “We are in different professions, doing the same thing.”

Joel Valenciano, an Environmental Services manager at Downey, helped organize huddles at outlying clinics.

“I encouraged the staff to be honest, relate their fears and doubts, anything holding them back,” he says. “And they really opened up.”

The trust and open communication cultivated by working in partnership were key to building vaccine confidence.

“Working in partnership has intensified during the pandemic,” says Valenciano, “because people realize we need to work together.”

Dr. Ishimatsu agrees. She was involved with the Labor Management Partnership when it started more than 20 years ago. “At the time, I wasn’t sure it would evolve,” she recalls. “It treats us like one big family, instead of segments. The thing that keeps one person safe, keeps everyone safe.”

The training and education resources negotiated by Kaiser Permanente and the Partnership unions are helping employees advance their careers. These opportunities are making KP’s promise of a diverse and inclusive workplace come to life. Learn more from employees, managers and leaders who shared their stories during the first virtual Workforce Development Week.

Addie Darby, UFCW Local 1996, quality control, Health Information Management, Georgia

With the help of the Ben Hudnall Memorial Trust and encouragement of manager Sophia Wilson, Darby has earned an associate degree in business management, a bachelor's in health administration, and a master's in health technology and education. She’s not stopping there. Darby is enrolled in a doctorate program and plans to graduate this year (2021).

Sadao Nakachi, UNAC/UHCP, emergency room nurse, Southern California

After leveraging workforce development opportunities to become an RN and earn a bachelor’s degree in nursing, Nakachi went on to get a master’s in business for veterans. He holds numerous professional certifications and connects fellow nurses to educational opportunities. “I always try to find courses that’ll overall maximize my potential at KP,” he says. Follow him on Instagram @NurseScholar.

Crystal Muir, OPEIU Local 2, clinical assistant, Mid-Atlantic States

Muir is using tuition reimbursement to pursue her bachelor’s degree in nursing. She’s also used the Ben Hudnall Memorial Trust’s Individual Stipend Program to attend school once a week, which she says, “I've been fortunate to do with trying to balance school, work and life being a mom.” She aims to graduate in 2022.

Sophia Wilson, supervisor, Health Information Management, Georgia

“I encourage all my staff to pursue education to stay marketable and relevant,” Wilson says. “I tell managers, ‘Please do not be so rigid as to make it harder for your employees to soar.’ If you put the resources into your staff, it can be nothing but a win-win.”

Philidah Seda, director, Specialty Care, Georgia

Not only does Seda encourage her staff to use workforce development resources, but she herself is studying for her doctoral degree. “The health care environment is getting more and more complex,” she says. “For us to prepare the workforce of the future, we have to invest in their learning.”

Eula Smith, SEIU-UHW, medical assistant, Northern California

Ask Smith why she wanted to work in health care, and she will bluntly tell you she didn’t. She started at KP as a shuttle bus driver. When that department was outsourced, Smith was offered the opportunity to train as a medical assistant with the help of the SEIU UHW-West & Joint Employer Education Fund. She has overcome her initial reluctance to deal with patients, saying “I love it now.”

Ingris Solares, SEIU Local 105, medical lab technician, Colorado

Solares began her career at KP as a phlebotomist before getting trained in her current field in an apprenticeship program with the help of SEIU Local 105 and the SEIU UHW-West & Joint Employer Education Fund. She intends to get more education to become a clinical lab scientist. “I knew I wanted more because I'm the first generation here in the United States,” she says. “My parents came from Guatemala, so I always felt like I needed to make the trip here worth it.”

Michael Brown, senior vice president, HR Consulting, National Functions

Before embarking on a career path that would bring him to KP as an HR leader, Brown went to law school. His father was frank with him: As a Black man, he needed an advanced degree to position himself for the same opportunities that others had.

“Before I even started working, I knew that education was going to be the equalizer.” That’s why he encourages KP employees to use workforce development programs and cultivate learning agility by trying different shifts, joining different departments and seeking informal leadership roles.

Kerrin Watkins, manager, Dental Office, Northwest

It's hard to lose top performers, but amazing to see them grow. “Invest in your employees and let them know you want to see them succeed,” Watkins says. “This will benefit you in the long run, because you will have employees that will feel more valued. If you take care of your employees, your employees will take care of your business.”

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.

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.” 

Timing is everything when it comes to empowering patients to take control of their health. 

For members of Hawaii’s Patient Support Services team, that means contacting patients with diabetes right after hospitalization. 

“One of the most impressionable times to work with a diabetes patient is immediately following discharge,” explains Shelley Kikuchi, the team’s management co-lead. 

By reaching out to patients during those “moments that matter,” the team has increased the number of diabetes patients with blood sugar levels under control. Their practices have proven so effective they are now part of routine treatment for patients with diabetes regionwide. 

“The close follow-up with patients helps us better manage their medication and support their healthy lifestyle choices,” says Alana Busekrus, RN, the team’s labor co-lead and a certified diabetes care and education specialist who is a member of the Hawaii Nurses and Healthcare Professionals (HNHP) union. 

To help patients manage diabetes, the team monitors their blood sugar levels, orders lab tests, adjusts medications and offers advice on nutrition and exercise. These interventions are important because Native Hawaiians and Pacific Islanders are among those at higher risk of diabetes, a serious chronic disease.

Overcoming obstacles 

But achieving success wasn’t easy. 

Early efforts to provide post-discharge care proved labor intensive and fell short of regional goals for controlling patients’ blood sugar levels, recalls Anna Sliva, RN, a care manager with the team and an HNHP member. 

Health outcomes improved after unit-based team members standardized the discharge process in 2019. Nurses collaborate with Transitional Care clinical pharmacists to identify high-risk diabetic patients before they leave the hospital. Care managers follow up by showing patients how to use glucose monitors to track their blood sugar levels. 

Results were significant. Within 3 months after discharge, 30% of patients lowered A1c blood sugar levels by at least 0.5 percentage points. And within 6 months, 50% of patients lowered A1c levels by at least 1 percentage point. 

“Thanks to our team’s excellent work,” says Kikuchi, “the ‘moments that matter’ discharge workflow has become a standard part of our practice, benefiting some of our most vulnerable diabetic patients.” 

When it comes to addressing health care disparities, medical office assistant Anna Jenkins thinks her unit-based team is up to the challenge. 

“I can go to my UBT members and say, ‘This is a care gap. Give me your feedback. Give me your ideas,’” says Jenkins, an OPEIU Local 30 member and labor co-lead for the Rancho San Diego Primary Care team. “Our administration listens to us. They’re very open to letting us try it our own way.” 

The Level 5 team is leveraging Labor Management Partnership principles and tools to communicate, coordinate and customize care for Latino patients with diabetes. The approach has led to better health outcomes and improved service for a group disproportionately impacted by diabetes. 

The unit-based team has increased the number of Latino patients ages 65 to 75 whose blood sugar levels are under control, according to recent clinical quality measures. 

“That partnership between management and labor is important,” says Silvia Hernandez, RN, medical office administrator and the team’s management sponsor. “This teamwork helps us to improve patient care and quality with excellent member satisfaction.” 

Adapting approaches 

Key to the team’s success is partnering with Complete Care Management, a specialized strike force that monitors the health of patients who struggle to control chronic conditions, such as diabetes and high blood pressure. 

To better support her Latino patients, care manager Lily Thamiz, RN, has adapted her approach. She books longer appointments for Spanish-speaking patients who need interpreters, refers others to bilingual diabetes education classes, and relies on phone calls to connect with those short on time. 

“The only time we can talk is when they’re driving,” says Thamiz, a member of Specialty Care Nurses of Southern California, an affiliate of UNAC/UHCP. “These are solutions I’d never considered before.” 

UBT members tailor treatment in other ways, too. To ensure continuity of care for Latino patients in their 60s and 70s, they standardized the steps needed to download and share data from glucose monitors. Providers use the devices to track patients’ blood sugar levels and adjust their medications. By consistently managing and sharing data, staff members guarantee they do not miss crucial patient information when communicating with one another. 

“They make you feel like you really matter,” says Mary Hart, 71, a Latina patient who has diabetes. “They really show their concern for your health.”

Aparna Gulati, MD, was growing alarmed. Many African American patients with high blood pressure were missing their doctors’ appointments.

“Due to COVID-19 fears, many of our patients weren’t coming in for even a blood pressure check,” said Dr. Gulati, medical director of Chronic Conditions Management for the Greater Southern Alameda County area in Northern California.

“African Americans are at the highest risk for all kinds of morbidity due to hypertension.”

Nationally, more than 40% of African Americans have high blood pressure — a rate much higher than other racial and ethnic groups.

Like providers across Kaiser Permanente, Dr. Gulati is working to reduce the disparity. In November, she and her team collaborated with Coalition union members to host 2 free blood pressure fairs for African American patients with hypertension.

Cashier service receptionists, members of OPEIU Local 29, called nearly 2,000 patients to notify them about the event. Lab workers from SEIU-UHW also provided their services.

“Many of our patients have critical needs,” said receptionist Alexis Machado, who worked at both events. “They might have slipped through the cracks if they hadn’t shown up. They all seemed happy to be here and get their preventative screenings taken care of right then.  It was very rewarding for me.”

Meeting patients’ needs

In all, 500 African American patients drove up to receive blood pressure checks. Flu shots, lab tests, mammograms and colorectal cancer screening kits also were available.

“We can both get our blood pressure checked without getting out of the truck,” said Kaiser Permanente member Tanya Leno, as she and husband William Leno drove through the outdoor event.

Organizers were thrilled with the turnout — and results. About 25% of patients with high blood pressure didn’t have it under control and needed their medication adjusted. They also received follow-up appointments.

“We used the opportunity to teach patients the importance of measuring blood pressure and keeping it controlled, investing in a blood pressure machine, and following up with their physician,” said Dr. Gulati. “Coming from a physician, it tends to stick more, and will hopefully increase awareness.”

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.”