What can your team do to better manage your inventory? What else could you do to save money and keep KP affordable for members and patients?
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See how taking simple steps to reduce waste in your department can make you a superhero at Kaiser Permanente.
What can your team do to improve its own business literacy? And help patients make better decisions about their care?
What can your team do to manage your inventory better? What else could your team do to save money?
Learn how KP workers and leaders are lowering costs and improving care, and how your team can, too.
Plus: "Meet Your National Agreement," puzzles and games and great comics that will inspire you to lower costs and improve care.
You can also visit the Q2/Q3-2017 Hank web page in the Gallery section to read the issue online or download a PDF of it.
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The word “affordability” can be a lightning rod. Union members often think it is a code word for layoffs and cutbacks. They might question why it is suddenly up to them to sweat every paper towel and latex glove and wonder if higher-ups are pitching in.
Managers might wonder how in the world they are supposed to squeeze more out of their already-tight department budgets.
If everyone suits up for battle every time the word is mentioned, then progress on saving money becomes harder, if not impossible.
Luckily, at Kaiser Permanente, our values create value. After all, Henry J. Kaiser and Dr. Sidney Garfield founded KP to be an affordable (there’s that word again), high-quality health plan for working families, with incentives to keep our members healthy (rather than profit when they got sick or injured).
With the advent of the Labor Management Partnership 20 years ago, we cemented another core value: Listening to the voices of frontline workers, managers and physicians, who do the work and are closest to the patients. They know where the waste and inefficiencies are. And addressing inefficiencies goes hand in hand with improving care.
In 2005, the National Agreement negotiated by KP and the Coalition of Kaiser Permanente Unions further refined these values by laying the groundwork for unit-based teams. UBTs emphasize performance improvement and, more importantly, ensure everyone at every level of the organization has access to PI methods and tools so they can contribute.
Read this issue of Hank, and make peace with “affordability”—confident that our values create value.
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
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
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.
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.
