0 Labor Management Partnership: Kaiser Permanente’s strategy for frontline engagement and performance March 2014

Our Labor Management Partnership Largest and most comprehensive labor-management partnership in the country 27 local unions representing 100,000 KP 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

Growth of high-performing teams 6 3,345 unit-based teams were in place as of year-end ,675 teams, about 50 percent, were high performing.

Rapid Improvement Model: Plan, do, study, act

8 What teams are working on Efficiency and Cost Reduction is the single largest category of projects. Two years ago it was 12%. More than 7,200 UBT projects were launched in 2013.

Ambulatory Surgery Recovery, Moanalua Medical Center, Honolulu Cutting costs, clutter in the OR RESULTS: The team saved nearly $10,000 per month by reducing duplicate and overstocked supplies for medical center’s operating room. WHAT THEY DID: Team members created a more organized supply room by clearly labeling shelves and supplies, helping them keep better track of their inventory. They are also maintaining the inventory on a computer.

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 HAPUs

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

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. RESULT Average daily wait time (minutes) BEFORE AFTER

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