Su-Xian Hu and Runeet Bhasin make partnership look easy. The telemetry team co-leads at Downey Medical Center in Southern California share a relaxed rapport that belies the time, planning and occasional friction that are part of running a busy inpatient unit. 

Together for more than a year, the pair attribute the success of their budding relationship to communication and a commitment to partnership principles—especially consensus decision making. Those core values came in handy recently when a disagreement arose about the best way to educate patients about medications. 

Nurses preferred a less overwhelming one-page sheet, but managers wanted to switch to a detailed three-page form that had been adopted by other units in the hospital. 

“It was a major issue,” says Bhasin, RN, a staff nurse and member of UNAC/UHCP who is the team’s labor co-lead. “We had to come up with a solution to fulfill management’s needs and labor’s needs.”

At the time of the disagreement, UBT members turned to consensus decision making to determine next steps they all could support. A subsequent test of change resulted in a short-term fix: Nurses used the short form with patients, while the longer handout was provided as a resource guide in patient rooms.

New to partnership

Managing in partnership was a new experience for Hu when she joined the team in April 2016 as assistant clinical director and became a co-lead. She previously had overseen a Kaiser Permanente inpatient nursing unit that was not part of the Labor Management Partnership. Bhasin, a co-lead with two years of experience, served as mentor and coach.

“Runeet was wonderful with helping to bring me onboard,” says Hu, who is also an RN. 

Both say LMP training has given them a shared understanding of their roles as co-leads, the purpose of UBTs and how to use consensus decision making. A business literacy class both took proved especially fruitful: With the information they brought back, the team tackled an affordability project that reduced overtime costs by more than $95,000 last year. 

“The UBT classes,” says Bhasin, “made me realize the real meaning of partnership, the collaboration of labor and management to work toward the same goal to provide high-quality care and to have a great work environment.”

The pair’s approach seems to be working. Their 75-member UBT is at Level 4 on the five-part Path to Performance, and it has earned accolades for outstanding patient care and gains in workplace safety and affordability. 

“We want what is best for patients and for staff,” says Hu. “We might have differences, but we always come together with open and professional communication, sitting down together to solve those issues.”

Workforce Planning and Development

Key accomplishments

• Program enrollments in Kaiser Permanente’s two education trusts grew from about 3,000 in 2007 to nearly 62,000 in 2016. 
• Tuition reimbursement course applications nearly tripled, from less than 20,000 in 2008 to more than 57,000 in 2016, largely benefiting members of unions in the Coalition of Kaiser Permanente Unions.
• Critical skills training launched in June 2017 with a Digital Fluency pilot program for more than 2,000 employees.

Going forward

• A top priority will be addressing the impact of economic, social and technological changes on care delivery and future KP staffing models. (Learn more at kpworkforce.org.)

Workplace Safety

Key accomplishments

• Since program inception in 2001, KP’s injury rate has been reduced by 69 percent.
• Injuries associated with patient handling and/or mobilization have decreased by 32 percent since 2011.
• The program-wide workplace safety strategy was strengthened in 2016, based on the National Safety Council’s model.

Going forward

• The strengthened safety strategy will be implemented, with the goal of closing the gap between KP’s injury rate and the Bureau of Labor Statistics adjusted injury rate for health care.

Total Health

Key accomplishments

• More than 76,000 employees have taken the Total Health Assessment (THA) since 2014.
• Ninety percent of eligible employees completed their recommended health screenings in 2014 and 2015, earning a $40 million payout under the Total Health Incentive Plan.
• More than 3,000 UBT health and safety champions helped teams across the organization conduct 1,756 wellness projects in 2016—a 45 percent increase from 2015.

Going forward

• New awareness campaigns, including one focusing on prediabetes education, will inform and empower employees to take charge of their own health and wellness.

Joint Marketing and Growth

Key accomplishments

• Helped secure more than $108 million in revenue for Kaiser Permanente in 2016.
• Supported the 20-year growth in the number of employees represented by a union in the Coalition of Kaiser Permanente Unions, from 57,000 to 116,000, and in Kaiser Foundation Health Plan membership, from 7.4 million members to 11.8 million. 
• Since 2012, mobilized 51 union ambassadors who attended more than 300 community events and engaged more than 70,000 KP members and potential members—many of them unionized—increasing community knowledge and understanding of KP.

Going forward

• Through the expansion of health plan membership, support job security and the continued growth of the coalition.

Attendance 

Key accomplishments

• Enhanced time-off benefits to provide incentives for appropriate use of sick leave.
• Developed the Time-Off Request Tracking System to provide greater flexibility and responsiveness in managing planned time off.
• Achieved 21 percent fewer lost workdays in high-performing UBTs. 

Going forward 

• Attendance data, systems and results will continue to be assessed and improved.

Where were you 20 years ago? The three of us were each on a different path—paths that crossed in unexpected ways, and changed the way we do our jobs.

Our Labor Management Partnership often is described as a journey, for good reason. It is ever changing. It can be difficult. And you never know where it’s going to take you next. But it also has a few rules of the road that help us find our way:

Understand and respect one another’s needs and interests. Listen openly and assume the best intentions of your counterparts. Ask questions, especially, “Why?” Create an environment where people feel safe speaking up.

Over the years, that approach has gotten positive outcomes for Kaiser Permanente, our unions, our workforce and, most important of all, our members and patients.

That doesn’t mean our partnership is perfect; it isn’t. Or that we always agree; we don’t. But we’ve tried the traditional ways of working, and the trip is much better on the high road that Kaiser Permanente and the Coalition of Kaiser Permanente Unions have chosen.

Thank you for your hard work and dedication. We invite you to join colleagues in your unit, department or region this fall to celebrate your accomplishments, reflect on our challenges, and commit to creating an even better future.

Make the most of LMP Videos

Thank you for watching our video! The LMP communications team created it with the hope that you would watch and be inspired to share it with your coworkers and friends.

Videos are one of the most popular and effective ways to educate, entertain and inspire. (YouTube gets more than 1 billion unique visitors every month!)

You have the power to inspire your colleagues and help spread the word about the work that’s being done in partnership by posting a video to your Facebook page or showing it at your next meeting. 

If you are a team co-lead, show it at your next unit-based team meeting. If you are a manager, play it at your next managers' meeting. Facility and regional leaders—share it with other leaders.

Afterward, spend a few minutes asking for viewers' reactions and dicussing takeaways from the video. Are there practices that you or you team can copy?

Videos are time well spent in a meeting. You’ll engage your audience in a way that live presentations often don’t.

And you will have helped strengthened our Labor Management Partnership.

Instructions for handling zipped files

1. Click on the "Download MP4" link.
2. A "File Download" window should pop up asking "Do you want to save or open this file?"
3. Choose "Save."
4. File will be saved as "zipped" file that is your video compressed into a zip archive.
5. Right-click on the file and choose Extract All, then save that WMV file to your computer.
6. Click on WMV to play the video.

“The No. 1 reason for the success of our teams has been personal engagement,” says Alan Kroll, a primary care area administrator in Colorado who co-sponsors nine unit-based teams with his labor and physician partners. “Everyone needs to buy into the process to make partnership work.”

Building engagement and ensuring a consistent work experience have been goals of the Labor Management Partnership since the beginning. But, at the same time, there’s been a good deal of variation around these efforts from location to location across Kaiser Permanente, to the frustration of many managers, workers, and KP members and patients.

That’s why the 2015 National Agreement mandates partnership training for everyone, including the mid-level managers and union leaders who guide others. Early versions of the partnership training for mid-level leaders, which will be available this year, have gotten high marks from UBT sponsors and other leaders who have taken it. 

Consistency counts

The agreement calls for “a learning system that supports sustained behavior change, partnership and performance.” This includes joint training and refresher courses—delivered in-person
and/or online—to “achieve the same partnership and employment experience wherever one works in KP.” 

The new training for mid-level leaders will include segments on: interest-based problem solving examining the forces that support or undermine partnership core partnership behaviors and principles the strategic importance of the LMP 

Joint training is key 

The programs are designed to develop successful leaders who can model partnership and spread successful practices—and to ensure that the managers or union representatives helping teams have what they need to support those teams.

“It is very powerful for managers and union leaders to be in training together,” Kroll says. “It sends the message that everyone is important, and sets a foundation to work from when an issue gets stuck.”

The training served as a reminder that good partnership practices also are good leadership practices. 

“People want to hear from their leaders,” he says, and to “know what issues we are dealing with and that we can help remove obstacles.”

See the 2015 National Agreement, section 1.E, Education and Training (pages 31–33) for additional information.

Northern California: Staff laptops make life easier 

Even in a fast-paced Emergency Department, change doesn’t always come swiftly.

“I’m old school,” says Jacinta Laupua, a clerk and SEIU-UHW member, who was one of the last holdouts when her team decided to try using laptop computers to gather member signatures. 

“I thought of every excuse in the book. But now I love it,” she continues. “If I don’t have a laptop assigned to me, I ask other clerks if they are using theirs, because I want one. In fact, we need more.”

The laptops, provided through a regional initiative, are at the heart of a successful unit-based team project to reduce paper and copying costs in the Emergency Department at the South Sacramento Medical Center. The total savings came to more than $88,000 in 2016. 

The Level 5 UBT’s project got under way in late 2015, when clerks and the team’s co-leads—Bianca Ruff, a clerk and SEIU-UHW member, and managers Susan Velasquez, administrative services manager, and Neeta Kumar, administrative clerical supervisor—brainstormed ways to improve cost savings and efficiency. Their first goal was to save $27,820 over four months. 

Soon team members were trying out the use of laptops with signature capture pads. The technology makes it possible for clerks to register patients at their bedside and record their information and signature electronically. Not only does this eliminate the need for paper registration forms, it also increases the clerks’ mobility and efficiency.

There were many small tests of change needed before everything was working smoothly, but the project has been so successful the department has invested in nine laptops on wheels. And all Emergency Department clerks are trained on
the computers. 

“It’s almost too painful to remember how we used to process forms,” jokes Ruff.

—Tracy Lee Silveria

Northwest: Pharmacy team ‘owns’ its inventory, saves thousands

When team members at the Community Care Pharmacy in the Northwest region did a routine inventory, they were astounded at the value of their expired medications that no longer could be returned. 

“We took a $70,000 loss,” says Rob Yancey, the pharmacy’s manager. The pharmacy serves patients in extended care facilities and often fills prescriptions for costly and uncommon drugs.

Susan Luu, an inventory technician and member of UFCW Local 555, spearheaded a successful project that drew on the free-to-speak culture and collaborative spirit that helps make this a Level 5 team. 

“I knew it was too much to do by myself,” Luu says. “I felt comfortable talking with my manager, and his response was, ‘Let me see how can I can help.’” 

Different staff members “owned” a section of the pharmacy to check for outdated or slow-moving medications. By the time the team did its next inventory, losses had dropped to $7,000.

—Jennifer Gladwell

Mid-Atlantic States: Tackling unwanted side effect of a computer upgrade

When the South Baltimore County Medical Center laboratory in the Mid-Atlantic States region upgraded its computer system in December 2015, it inadvertently increased lab costs. 

The problem? While the new system has many great features, it doesn't have a way to alert staff when providers add a new test to an existing order. In May 2016, the lab missed 32 percent of these “add-ons,” a total of 30 tests, says Samuel Endalew, the lab’s lead technician, a UFCW Local 27 member and the team’s labor co-lead. 

The mistake inconveniences members, who must return to the lab to provide a new specimen. Each missed add-on costs Kaiser Permanente about $35 in extra supplies and employee time. 

The solution: a system to check the lab’s inbox for add-on tests and a team binder to track their progress. By February 2017, the team was missing only 2 percent of add-ons and saving about $1,050 a month.

Leaders from other area labs are considering adopting the process.

—Otesa Miles

Budget-savvy shoppers know you can save money by buying in bulk—even, it turns out, when you’re buying pharmaceuticals. Just ask the team members of the Zion Outpatient Pharmacy in San Diego.

The unit-based team was able to save more than $1 million over five months by buying drugs in quantity and managing specialty medications better. And, adopting a practice that would make Goldilocks happy, the pharmacy now keeps just the right amount—no more, no less—of high-cost meds in stock. Managing costs helps keep expenses down for members, and the team’s improved communication means better service for patients, whose medications are there when they need them.

Not so long ago, the financial picture looked bleak for the 24-hour pharmacy, which serves discharged hospital patients and other members at the bustling Zion Medical Center. Inventory had swollen to more than $3 million. It was a signal the pharmacy had too much stock on hand and wasn’t turning it over frequently enough. 

“We realized that we needed to do something,” says Nathan Close, outpatient pharmacy supervisor and management tri-lead of the 45-member team, which is at Level 4 on the five-point UBT Path to Performance.

Honest assessment

Team members set a five-month goal to reduce their bloated inventory by $600,000, from $3.2 million to $2.6 million, starting in January 2016. 

Their first step was to review the pharmacy’s ordering and inventory practices. Team members quickly realized they were overstocking oral chemotherapy, Hepatitis C and antiviral medications. At $10,000 a bottle, rarely used pharmaceuticals suck up resources when they sit on shelves. Worse, if they aren’t used or returned to the manufacturer before they expire, they’re a costly mistake.

To get a better handle on prescription trends, team members reached out to ambulatory care pharmacists, who are part of a different team and who collaborate with physicians to treat members with cancer or chronic conditions. By partnering with the pharmacists, the team was able to plan ahead better.

“Once we know what patients are going to need, we make sure that we have that in stock,” says Wesley Frani, a pharmacy assistant and UFCW Local 135 member who is one of the team’s labor tri-leads. 

Key to the team’s success is another labor tri-lead, Jane Corby, an inventory control assistant and also a UFCW Local 135 member. She carefully monitors stock levels to ensure that when patients present their prescriptions, the right medications are on hand.

When the Ridgeline Behavioral Health team members in Colorado decided to tackle outside medical costs, even they were surprised at how their small touch on a huge issue could result in such significant savings.

Team members identified two ways they thought they could have an impact—including finding out which of their patients were being seen frequently in the Emergency Department—while helping their patients get appropriate care. 

“We know from evidence-based medicine that if patients are seeking care in the Emergency Department for mental health issues, it’s unlikely to provide a long-term improvement in symptoms,” explains Amy Martin, manager of Ridgeline Behavioral Health. 

Team members began the project by researching which outside hospitals Kaiser Permanente prefers to have members and patients use. Armed with the new information, they created a flier explaining the options and shared it with the rest of the staff, who then shared it with patients. This way, when patients did access care, they were more likely to go to a facility that KP has a contract with and thus, cut costs.

The results were remarkable. The team’s patients’ visits to emergency departments decreased by 8.25 percent, which in turn reduced ED costs by 26 percent. The total impact for 2016: $1 million in soft-dollar savings.