Unit-Based Teams Get Results: 2018 How UBTs Are Improving Quality, Service and Affordability for Kaiser Permanente Members and Patients February 2018

QUALITY AND AFFORDABILITY: Educating Patients on Standards of Care Regional Nephrology Team (Georgia) To reduce the time dialysis patients spend on chest catheters, this team: educated patients on the preferred method of treatment fast-tracked patients for the necessary procedure reduced time spent on chest catheters by 13 percent RESULTS $400,000 Projected annual savings from fewer infection-related hospitalizations

SERVICE AND AFFORDABILITY: Surgery Patients Get Quicker Nursing Care Post-Anesthesia Care Unit, Moanalua Medical Center (Hawaii) Delays in the PACU, where surgery patients recover before being admitted to a nursing unit, create backlogs and stress. This team reduced patients’ average time in the unit by 27 percent—to less than 60 minutes—by fine-tuning their work processes and adapting uniform care guidelines. RESULTS $175,000 Estimated annual cost savings

SERVICE AND AFFORDABILITY: Lab Saves Time and Money Tualatin Clinic Lab Team (Northwest) Lab orders that are dropped in the course of patient care cause rework, expense for teams and inconvenience for patients This team reduced missing orders by 37 percent by: Assigning a point person to work with physicians and departments to ensure patients have the needed lab orders Coordinating efforts across the multiple departments that engage in a patient's treatment Assigning a backup assistant to ensure the point duties are covered RESULTS $216,000 Projected annual cost savings across 21 labs by reducing missing orders

SERVICE: Open Communication Breeds Better Service Sacramento Outpatient Pharmacy (Northern California) Pharmacies in the Sacramento Service Area have some of the highest patient satisfaction scores in the region. Looking for ways to do even better, the teams shared ideas and developed a concierge-style service. Patients check in when they arrive and no longer have to wait in two lines to drop off and pick up their prescriptions. Most waits are less than 10 minutes. RESULTS 96% Patient satisfaction jumped from 90 percent to 96 percent in 10 months.

BEST PLACE TO WORK: Helping People Feel Free to Speak Food and Nutrition Services, Los Angeles Medical Center A team with low engagement and poor morale took steps to encourage the free expression of ideas and concerns. Efforts included: Meeting icebreakers to build trust and participation Rewards and recognition for ideas and actions that contribute to the team’s work Quick, visible implementation of suggestions to improve the work environment Eleven of 12 measures of the People Pulse Speak Up Index showed improvement, including the item at right. RESULTS 87% Team members who say they are encouraged to suggest better ways of doing things — an 8-point bump in 12 months.

Affordability: Business Smarts Bring Big Savings National Claims Service This 39-member, Oakland, California-based team is responsible for collecting fees and processing claims from service providers outside the Kaiser Permanente network. Looking for ways to reduce these charges, the team arranged for fast payment of outside providers’ bills, in return for a discount. Savings have totaled more than $6 million over three years. RESULTS $6 million Savings achieved as of Q2 2017 by asking outside providers to reduce their charges in return for prompt payment.

Service: Reducing Revisits and Rework South Baltimore County Medical Center Lab (Mid-Atlantic States) Due to systems issues, lab staff were missing up to 32 percent of test requests that physicians added to existing orders. This caused return visits and inconvenience to members, and rework for staff. Team members introduced a simple step in their workflow to review and track all incoming orders. The miss rate fell quickly. As of December 2017 the lab had zero missed orders for five months running. RESULTS Add-on orders missed for five months running.

Service: Smoothing Patient Flow Boosts Satisfaction East Denver Internal Medicine Medical Offices (Colorado) As part of a region-wide focus on patient and member satisfaction, this unit-based teams developed a collaborative model of service. Changes included: regular huddles and process improvement discussions a dedicated “flow captain” to oversee patient needs sharing what worked with other units Results included fewer bottlenecks, improved communication and improved member, patient and staff satisfaction across the facility. RESULTS 12-point Jump in overall patient satisfaction, from 58 percent to 70 percent, in one year.

Best Place to Work and Affordability: Reducing Overtime Spells Relief Telemetry, Downey Medical Center (Southern California) With more patients to care for, the team sought to break the habit of covering shifts exclusively with overtime hours. Here’s what got results: Identifying causes of overtime Reviewing the department budget, revamping workflow and coordinating schedules to better cover RNs on break Encouraging staff to clock in and out on time and to notify managers two hours before the end of shift if they expect to work overtime  RESULTS $95,174 First year savings in overtime costs, with improved staff satisfaction.