0 Labor Management Partnership: Kaiser Permanente’s strategy for frontline engagement and performance August 2015

Our Labor Management Partnership Largest and most comprehensive labor-management partnership in the country 28 local unions representing more than 105,000 workers (including nurses, technicians, clerical and service employees) The partnership reflects a business strategy to: Improve organizational performance Deliver high quality care and service to our members Involve the union and individual workers in decisions that affect the workplace Make KP the best place to get care and best place to work

Core Principles of Partnership “Health care services and the institutions that provide them are undergoing rapid change... Now is the time to enter into a new way of doing business…to unite around our common purposes and work together to most effectively deliver high quality health care and prevail in our new, highly competitive environment.” - National Partnership Agreement, 1997

Unit-based team: A natural work group of frontline workers, physicians and managers who solve problems and enhance quality for tangible results. UBTs work together to: Set goals Review and evaluate performance Identify and solve problems Contribute to decisions on budget, staffing and scheduling What’s a Unit-Based Team?

KP Value Compass

UBT Path to Performance Level 1Level 2Level 3Level 4Level 5 Pre-Team Climate FoundationalTransitionalOperationalHigh-Performing Learning what a UBT is and how it works. Establishing structures and norms. Demonstrating progress. Joint leadership, improved performance. Full collaboration and measurable success. Roadmap for team development

Rapid Improvement Model: Plan, do, study, act

7 What Teams Are Working On

Membership Administration, Mid-Atlantic States Reducing the Hassle and Cost of Lost ID Cards Visit LMPartnership.org for ideas and tools for your team. RESULTS Cards destroyed per quarter and associated costs WHAT THEY DID To improve service and save money, this UBT reduced the number of member ID cards being sent to incorrect addresses—and ultimately destroyed. Team members: Corrected member addresses by conferring with members, employer groups and KP departments R ed original cards rather than issuing duplicates Worked with call center colleagues to prevent replacement cards from again going to an incorrect address

Oncology Pharmacy, Woodland Hills, Southern California Smart Scheduling Reduces Waste Visit LMPartnership.org for ideas and tools for your team. WHAT THEY DID To reduce waste of expensive medication, team members: Schedule back-to-back appointments for patients getting infusions of the same drugs, to avoid discarding unused medication Use smaller vials of two commonly used drugs RESULTS Average weekly waste of medication was cut in half, for savings of more than $114,000 a year

Respiratory Care, San Jose Medical Center Getting to zero pressure ulcers WHAT THEY DID To reduce reportable hospital-acquired pressure ulcers (HAPUs), the team set a goal of sustaining at least a 90 percent completion rate for patient skin assessments. They did this by: Conducting four skin integrity assessments per patient during each 12-hour shift Documenting observations in patient charts Electronically tracking assessments weekly Auditing assessments monthly Posting results with names of corresponding respiratory therapists Providing counseling and encouragement for those not meeting the goal. Visit LMPartnership.org for ideas and tools for your team. RESULTS Reportable Pressure Ulcers BEFOREAFTER

Telemetry, San Diego Medical Center Patient safety: No one walks alone Visit LMPartnership.org for ideas and tools for your team. WHAT THEY DID By viewing every patient — not just some — as a fall risk, this telemetry UBT successfully piloted a falls- reduction initiative that has drastically decreased falls hospital-wide. RESULTS Falls in a month Past hospital average Team outcome

Infectious Disease/Oncology (Northern California) Lab gets quicker on the draw WHAT THEY DID To shorten wait times for blood draws, this Gilroy Medical Offices UBT: Shifted staff schedules so the lab opens earlier Staggered lunch breaks to spread out the loss of staff on the floor Educated physicians to improve the clarity of lab orders and reduce duplicative orders Cross-trained staff members so everyone can register patients and process specimens as well as draw blood. If eight or more patients are waiting to have blood drawn, the team goes into “all hands on deck” mode. Visit LMPartnership.org for ideas and tools for your team. RESULTS Average daily wait time (minutes) BEFORE AFTER

Neonatal Intensive Care Unit, Downey Medical Center, Southern California Giving Patients a Voice WHAT THEY DID To better integrate parents into the caregiving and information sharing for their newborns, this team: Created “quiet time,” when parents listen and jot down notes while the outgoing nurse updates the incoming nurse Devised a discreet signal if nurses needed to step away to discuss sensitive information out of the parents’ earshot Visit LMPartnership.org for ideas and tools for your team. RESULTS Patient satisfaction scores rose from 74 percent to 88 percent one year later.

A Model for Health Care “Kaiser Permanente is forging a strategy that brings together a comprehensive model of care, uses technology sensibly… produces high quality health care and at the same time empowers employees. “We know from other industries that you can’t have high quality services in a service-oriented industry with a demoralized workforce. The LMP is showing there’s a better way, and that way could be a model for health care.” Tom Kochan Institute for Work and Employment Research Sloan School of Management, MIT