Creating a UBT Culture June 24, 2013

Welcome Lisa Schilling, Vice President Center for Health Systems Performance

Rancho Cordova Eye Surgery Center Got Errors?

Our Team NameTitle/Classification/Union Dawnell GrantCertified OR Tech, SEIU-UHW, UBT member Teresa LeeRN, staff nurse III, subject-matter expert Steve MetzgerRN Manager, management co-lead Lisa WilsonUBT Co-Lead, Central Processing Tech Jenee MateoUBT member, OR Tech Vicki GreenUBT member, Surgery Scheduler Nit KharkaUBT member, OR Tech

Our SMART Goal Rancho Cordova Eye Surgery Center will identify, share and evaluate at least five errors per month that could have led to patient harm or injury, by November 30, 2012.

Our Team Culture Was… Efficient and safe Lacked transparency in the department and among each other Awareness suffered as a result In a year period, had one never event and two near misses

Motivating questions How many errors potentially happen daily? What do we do to prevent near misses? How do we increase staff awareness?

Our Small Tests of Change Test of ChangeResults Created and used the citation form to record errors In four months, prevented: 5 potential wrong-site surgeries 3 patient identity issues 3 potential medication errors 1 surgical time-out issue

Challenges Staff reluctant to use form for various reasons: “Flavor of the week” Busy Why mess with a good thing? Punitive

Depersonalized the event Education Awareness Testing “good catch” theme Overcoming challenges

Our Team Culture Now… Increased awareness Better understanding of the project Enhanced team work Better communication More transparency Staff feel more empowered

Our Key Learnings Teamwork + awareness=safety Education is key Trust is essential Use a safe word or phrase Always room to improve

Our NQC Experience Involvement of entire staff is key to culture change. Partnership and standardization plays a leading role in quality and service. The everyday work you do has great impact on quality and patient satisfaction

Emergency Department, Sunnyside Medical Center (Northwest)

Our Team NameTitle/Classification/Union Jay RavarraManager Ally DegatataRN, OFNHP

Our SMART Goal Kaiser Sunnyside Medical Center Emergency Department will decrease the patient length of stay from a baseline of 2.7 hours to a goal of 1.5 hours by the end of the year (2012).

Our Team Culture High physician and management turnover Low morale and low service scores Non-functional UBT

Our Small Tests of Change Test of ChangeResults Locate triage area and fast track team together Adopt Develop new fast track criteriaAdopt Patients receive focused assessment; brought to X-Ray quickly Adopt Patients are only in treatment rooms while being treated Adopt Fast track rooms protected for fast track patients only Adopt

Our Small Tests of Change Test of ChangeResults Trial medical office bedsAbandoned – didn’t like the beds Trial paper rolls to cover bedsAbandoned – preferred linen for patient comfort

Fast Track Results

Standardizing Rooms Sort: Bins for each item, label each item, conduct regular inventory Set in Order: Establish permanent home for specialty carts, IV cart prototype Shine/Sweep: Rearrange room set up, develop cart checklist Standardize: Clear roles for RNs and techs

23 Standardizing Rooms 23 To From

Our Team Culture Now… More satisfied patients More open environment for offering ideas for improvement, as demonstrated in improved responses to key People Pulse question Those initially most resistant to change became the biggest champions of change

Our Key Learnings What worked: holding offsite meetings to establish our new vision, hiring new managers, electing new UBT co-leads, redesigning patient rooms and stock rooms Early wins are important Must clarify expectations and roles, have process owners with clear accountability Physician engagement is crucial

Voice of the Customer

Staff Perspective

Our NQC Experience Working in a unit-based team and becoming high performing is hard work. Once you reach your goal, it isn’t over. You have to continue to work on improvements and re-build when people leave or processes change.

Histology Department (Northwest)

Our Team NameTitle/Classification/Union Saundra EllisSupervisor Kristen MoseHistology Tech, OFNHP-Technical Mary Kilo, MDChief of Pathology

Our SMART Goal KP Northwest regional histology lab will improve slide turn- around time from a baseline of 68.6 percent in 2011 to a goal of 90.0 percent by the end of 2012.

Our Team Culture Was… Plagued by inefficient workflows Pathologists did not feel supported by the staff Did not focus on quality assurance Low People Pulse scores on Work Unit Index measures

Specimen Life-Cycle Specimen Collection Transportation Accessioning Gross Exam Processing Embedding Microtomy Staining Case Match/ Case Assembly Recuts, Specials, Immunohistochemistry Path Review Case Sign-out Storage/ Archive

Our Small Tests of Change Test of ChangeResults Visual notification systemIn progress Added TAT and quality reports to daily huddles Adopted Weekly project team meetingCreated engagement with sponsors Surveys of Pathologists and staff satisfaction Performed quarterly surveys for 18 months then transitioned to People Pulse and Physician Work-Life Balance surveys

Performance Improvement Tools

Our Team Culture Now… MeasuresResults Turnaround Time (TAT) Improved from 68.8% to 80.6% April 2013 Staff SatisfactionAverage favorable rating increased from 40% on 2011 People Pulse survey work unit index to 70% on 2012 People Pulse survey work unit index Pathologist Satisfaction Increased overall satisfaction from 11% on 2010 Pathologist Work life Survey to 58% on 2012 Pathologist Work life Survey

Our Key Learnings The UBT identified, planned and executed all PDSAs. Strengthened alliance between Histology and Pathology, and the active involvement of Pathologists Resources (time, money, expertise) vary in supply and pose barriers Labor-to-labor communications strengthened engagement and commitment to the project. Given adequate information, the UBT knows what improvements will make a difference.

Our NQC Experience Opportunity to learn from other teams Sharing the journey of our team with others Recognizing engaged sponsors, physicians and UBT team members as the key to success

Closing Thoughts Lisa Schilling, Vice President Center for Health Systems Performance