Do teams get better results when frontline workers are engaged, free to speak and can influence decisions? Yes, say the people who know best — Kaiser Permanente workers and managers themselves.

Recent People Pulse surveys confirm that unit-based teams get positive results for health plan members and patients, the organization and workers themselves.

For instance, the 2017 People Pulse survey of more than 155,000 KP employees showed that when union-represented employees are highly involved in UBT activities, they get 29 percent higher scores on measures of their willingness to speak up — a key driver of patient and workplace safety and satisfaction. They also get 33 percent higher scores on questions regarding workplace health and wellness.

Improved safety and satisfaction

Further analysis, included in the 2016 People Pulse survey, showed that teams with high employee involvement have:

• 18 percent fewer workplace injuries
• 13 percent fewer lost work days
• 4 percent higher patient satisfaction

“Our findings show that employees who are highly involved in their unit-based teams feel more able to speak up and more encouraged to take care of their health,” says Nicole VanderHorst, principal research consultant with KP Engagement & Inclusion Analytics. “That makes them more likely to have better performance outcomes.” 

A better way to work

Workers’ greater propensity to speak up and look after their health when they’re involved in team activities covers several questions (see chart below). For example, workers who are highly involved in their UBTs are far more likely to say:

• The Labor Management Partnership has helped improve organizational performance and working conditions.
• They can influence decisions affecting their work.
• They’re comfortable voicing differing opinions.
• Management uses their ideas to improve care.
• They’re encouraged, and encourage others, to take care of their health.

Click to enlarge.

Roots of workforce engagement

All these factors contribute to a better employee experience as well as performance. And UBTs reflect KP’s unique history with the labor movement.

“Henry Kaiser was perhaps the 20th century’s most worker-friendly industrialist. He supported organized labor and knew that people step up when allowed to exert their job experience, as they do with UBTs,” says KP archivist and historian Lincoln Cushing.  “He trusted employees to make decisions that benefitted themselves and their organizations.”

If you belong to a unit-based team — and most union-represented employees do — talk with a team co-lead about ways to get more involved.

How would you want your mother or grandmother to be treated if she came in for an outpatient appointment at Kaiser Permanente? That’s how we want to treat all of KP’s members. Thousands of unit-based teams are working to make sure every KP member receives top-notch service, from the first phone call to the visit with the care provider to the member’s departure from the facility. Providing great service will make our members’ lives better.

1. Review patient/member satisfaction survey responses with the entire team at weekly meetings and huddles.
2. Connect with patients by making eye contact and addressing patients by name.
3. Keep patients informed by explaining everything you’re doing and all of the next steps.
4. Update patients every 10 to 15 minutes on wait times if there’s a delay.
5. Thank patients and members for choosing Kaiser Permanente for their care. Always ask, “Is there anything else I can do for you?”
6. Provide a “wow” experience during a new member’s first visit.
7. Address wait times by trying changes like an “all hands on deck” approach, so when wait times hit a certain threshold, all available staff members drop what they’re doing and help reduce long lines.
8. Make sure phone calls are answered and messages are returned as quickly as possible.
9. Encourage members to sign up for kp.org.
10. If a patient is upset or has had a bad experience, offer a sincere apology and ask, “What can I do to make this better for you?”

Who hasn’t experienced the frustration of a long wait to get a prescription filled or a lab test done, or to see a physician who’s running behind schedule? To help keep Kaiser Permanente patients and members happy, many unit-based teams are tackling this issue and finding ways to reduce wait times.

1. Raise awareness of the problem by sharing data about the department’s wait times and patient satisfaction scores with unit-based team members.
2. Help your co-workers understand it is everyone’s responsibility to be attentive to members who have been waiting for long periods of time — and recognize co-workers who do this well.
3. Inform patients of delays by having the receptionist let them know if a physician is running late.
4. Provide members and patients who have been waiting for extended periods of time with individual attention and updated information by “rounding” in the waiting area.
5. Put a focus on wait times by posting patient arrival times on exam room doors or having pharmacists call out the wait time in the pharmacy.
6. Utilize an “all hands on deck” approach, so when wait times hit a certain threshold, all available staff members drop what they’re doing and help reduce long lines.
7. Consider shifting employees’ schedules to ensure adequate staffing during peak hours and at the start of the day, so you don't fall behind from the beginning.*
8. Promote alternatives to in-person visits such as prescription refills by mail or email, phone or video consultations with doctors.
9. Rethink who does what if part of the reason for long wait times is that only employees in particular job category are allowed to do a certain task.*
10. Create a quiet zone in pharmacies to reduce distractions for the primary filling technician.

*  Consult with local unions to ensure proposed changes are in line with the contracts.

When we help Kaiser Permanente membership grow, we help make KP stronger and our jobs more secure. One of the best ways to grow KP membership is to provide great service to every member we serve — especially to new members during their first interactions with Kaiser Permanente. Here are some ways to enhance the member experience and keep new members with KP for the long haul.Engage the entire unit-based team in providing a “wow” experience during a new member’s first visit.

1. Use tools like the New Member Identifier in Kaiser Permanente HealthConnect® to flag new members and give them a little extra TLC during their visit.
2. Provide new members with information packets (with, for example, important phone numbers, a facility map, pharmacy hours) that will help them access all of KP’s services.
3. Make every member’s visit special with a warm welcome. Take time to answer questions about KP, or even offer a mini-tour of the facility before or after an appointment.
4. Follow up on first visits with a thank-you card or survey to find out how the visit went and how it could be improved.
5. Sign members up for kp.org while they are waiting in the reception area or exam room. Take time to explain the benefits of using kp.org—for instance, the ability to refi prescriptions by mail or manage a child’s care online.
6. Create a friendly competition in your department to see how many members a staffer can get to try mail-order refill or KP.org.
7. Use service-improvement tools that help your team connect with members. Check with your UBT consultant or regional LMP Council for suggestions.
8. Improve access to KP services by working with your team to reduce the time members must wait for appointments.
9. Help new members get to know their care providers by providing a physician biography or a brief introduction about the nurse or pharmacist they will be seeing that day.

Unit-based teams encourage employees to make wise use of the National Agreement's sick-leave provisions, which help ensure that individuals have income in the event of a long-term illness or disability. Absences can also create hardship on other employees and affect member service and care. Here are some tips for improving attendance in your department: 

1. Survey your unit or department to determine if there’s confusion about the use of sick time. If needed, find ways to educate staff on sick leave, tardiness and clocking in and out.
2. Create an “attendance star” board to recognize staff members with great attendance.
3. Encourage colleagues to schedule routine appointments during off-hours or in conjunction with lunch or breaks when possible.
4. Track call-outs and use anonymous surveys to test for reasons why they are occurring.
5. Use cause-and-effect tools such as fishbone diagrams to address unforeseen circumstances, morale, physical environment, workload or personal reasons.
6. Engage staff with frequent conversations and be alert for — and respond to — indications of unhappiness or tension.
7. Recruit an attendance champion to be on the lookout for opportunities to coach others on the importance of banking sick leave.
8. Help employees track sick-leave usage by printing out and distributing the attendance calendar.
9. Use the attendance scorecard to learn about the six essentials of good attendance and to see how your team rates. Then  develop small tests of change to address the weak spots identified by the scorecard.

Beep! Beep! Beep! The electronic sound of Cary Brown’s alarm clock wakes him at 5 a.m.

The Kaiser Permanente member rises to shower and make breakfast, careful not to disturb his sleeping wife, Elissa, who is recovering at home after surgery on a broken leg at the Woodland Hills Medical Center in Southern California.

On top of completing household chores, the retired Hollywood TV director spends his day making sure Elissa is comfortable and pain-free.

The experience has taken a toll on him.

“The hours of staying awake and the repetitive nature of it—and not having any life at all outside of home—is very difficult,” says Brown, who worked on the hit TV series Doogie Howser, M.D.

Now he’s part of an ambitious effort by the Southern California region to enhance support for caregivers, who play a vital role helping to heal and comfort patients outside the hospital. By reducing caregivers’ social isolation, integrating them into the hospital care team and addressing their health needs, regional leaders hope to improve patient safety and quality in the home.

‘Human-centered design’

Under the initiative, frontline workers, physicians and managers are partnering with KP members and their families to design the ideal in-home care experience for patients and caregivers. Participants are using a creative approach to problem solving known as human-centered design, which starts with the people you’re designing for and ends with solutions that are customized to their needs.

“It’s a way to engage the folks who are most affected from day one,” said Dr. Nirav Shah, senior vice president and chief operating officer for Clinical Operations in Southern California. “No program that I could ever design will be as good as one that had the people who are most affected design it with us. It’s about empathy and understanding.”

Human-centered design is also an ideal tool for unit-based teams to use on performance improvement projects. It delivers on the fundamental concept of the Value Compass—to put the member and patient at the center of decision making—and both frontline workers and Labor Management Partnership leaders, from management and the Coalition of Kaiser Permanente Unions, have been supporting the caregiver project.

Reducing the overwhelm factor

At a meeting in Pasadena, the participants—patients and caregivers, KP employees and physicians—gathered in small groups to share personal tales and draw storyboards to help identify barriers, come up with potential solutions and provide insights to regional Home Health leaders.

Shawna Wallace, a senior physical therapist for Home Health and member of UNAC/UHCP, said the experience was eye-opening.

“I’ve gone into homes where caregivers really care about their loved ones, and they are extremely overwhelmed,” she said. “This is a great opportunity for us to see where we can make better programs for our caregivers and members in these scenarios.”

Brown is hopeful that the approach will give caregivers—and their loved ones—the emotional and physical support they need to thrive.

“If you take care of the family as a unit,” Brown says, “you make it possible for each individual in the family to be better.”

“You have two ears and one mouth for a reason,” television’s Judge Judy frequently says, quoting an ancient Greek philosopher. “You should listen twice as much as you talk.” Successful co-leads realize that making a partnership work requires listening and learning from one another. 

Caroline Masikonde, RN, had been a management co-lead with the urgent care team at Largo Medical Center in the Mid-Atlantic States, an experience that helped her understand the importance of valuing her partner’s input. But when she accepted a new role as clinical operations manager in Northern Virginia Audiology in January 2016, she didn’t have any experience in audiology. So she’s relied heavily on her new labor co-lead, Lynn M. Reese, Au.D., a UFCW Local 400 member. Masikonde has learned why audiology UBT members escort patients outside (so they can try out new hearing aids in different conditions)—and her willingness to listen helped the co-leads bond quickly. 

“Lynn is very experienced,” says Masikonde. “I lean on her even now.” 

Reese, on the other hand, was new to the unit-based team structure, since the audiology UBT had just formed. That’s where Masikonde’s expertise came in. “We fit together pretty well,” says Reese. “Caroline is very open to listening and learning new things.”

Reese, too, expanded her knowledge, growing into an appreciation that she and Masikonde have equal say on what’s now a Level 4 UBT. “Everyone contributes,” says Reese. The ability to speak up led to Reese and the rest of the team requesting and receiving approval for an additional booth to test patients’ hearing. 

Relationship tested

Their new relationship was tested when a member—after waiting more than 12 weeks for a refund on a hearing aid that had cost more than $1,000—alerted them, loudly and angrily, to the problem. 

Instead of pointing fingers, UBT members figured out the issue: The refund request had to be processed through a department in Southern California, but the team had no way to follow up once the request was submitted. 

“This lady forced us to look at this and do better for our members,” Masikonde says. “It prompted us to come up with a better workflow,” and now the team has names and contact information for the people who work on the refunds.

“Even though it was a bad situation, she made us want to improve,” Reese says. 

Because the co-leads already were accustomed to relying on and listening to each other, they were able to quickly and calmly handle this tense situation with the unhappy member.

“We really learned our lesson,” Masikonde says. “Recently, we did a refund on a Monday—and by Friday, the member had the check. Lynn and I know our parts and do our dance.”

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.