1. SNAPSHOTS OF CHANGE How UBTs are getting results Examples of operational success January - September 2012

2. SNAPSHOTS OF CHANGE Inpatient Transportation, Southern California Transporting patients on the fast track WHAT THEY DO This team moves patients around and out of the San Diego Medical Center faster and easier by: » positioning gurneys and wheelchairs where needed on various floors » cleaning and preparing equipment immediately after each use » using downtime to check the equipment and put fresh sheets and blankets on gurneys » designating a staff member to ensure equipment is in its proper place Visit LMPartnership.org for ideas and tools for your team.

3. SNAPSHOTS OF CHANGE Landscape Maintenance, Northern California Team overcomes barriers to complete KP’s health assessment WHAT THEY DID This Oakland Medical Center UBT overcame barriers by: » helping team members with limited English language and computer skills sign up at KP.org » highlighting the health benefits of completing KP’s total health assessment (THA) » emphasizing that completing the THA is a wellness goal of Northern California’s Performance Sharing Program (PSP) Visit LMPartnership.org for ideas and tools for your team.

4. SNAPSHOTS OF CHANGE Better workflow helps control blood pressures WHAT THEY DID This UBT in Largo, Md., got more hypertensive patients’ blood pressure under control by: developing specialized scripts for the clinical nursing assistants (CNAs), who manage the schedule for blood pressure checks and make outreach calls to patients with hypertension developing scripts for the receptionists, who make appointment reminder calls sending patients with elevated blood pressure to nurse practitioners for management referring patients with complex blood pressure medication management for additional consultation Visit LMPartnership.org for ideas and tools for your team. Primary Care, Mid-Atlantic

5. SNAPSHOTS OF CHANGE Lab, Vancouver, Northwest Saving money one needle at a time WHAT THEY DO Phlebotomists at the Orchards Medical Office are monitoring themselves to reduce the use of butterfly needles. They used to use the needle— which costs nearly $1 more than a standard one—on most patients. Two other labs in the region have followed suit. Visit LMPartnership.org for ideas and tools for your team.

6. SNAPSHOTS OF CHANGE Team nets $10 million in Medicare reimbursement WHAT THEY DID Members of this UBT discovered a technical issue with Kaiser Permanente’s partner hospitals in the region that resulted in incomplete physician signatures on patient charts. This glitch prevented KP from submitting bills for hospital stays and procedures to Medicare for reimbursement. After the error was corrected, the team reviewed 26,000 hospital inpatient notes for 2010. Since then, the team has captured more than $10 million in reimbursements. The team attributes its ongoing success to: quick huddles, holding each other accountable and transparent communication. Visit LMPartnership.org for ideas and tools for your team. Medicare Risk Business Services, Colorado

7. SNAPSHOTS OF CHANGE Fighting the flu face-to-face WHAT THEY DID This facility-wide UBT in Orange County encouraged employees to get vaccinated by: distributing fliers and emails to tell employees about the vaccines, vaccinations and where to get them conducting face-to-face discussions with co-workers and physicians about the safety of the vaccine providing free and easy access to vaccinations via a mobile flu cart with an assigned LVN during all shifts offering the FluMist ® alternative for employees who don’t like needles Santa Ana Medical Office Building UBT, Southern California Visit LMPartnership.org for ideas and tools for your team.

8. SNAPSHOTS OF CHANGE Improved label printing saves money WHAT THEY DID Pharmacy technicians in Cumberland, Ga., now get the medication off the shelf before typing in the prescription or passing the prescription on to a pharmacist. This helps them select the right product from the National Drug Code database and increases the likelihood that labels will not need reprinting. They also found a way to clearly identify which prescription drug containers have been opened, improving inventory control and preventing delays. Visit LMPartnership.org for ideas and tools for your team. Clinic Pharmacy, Georgia

9. SNAPSHOTS OF CHANGE General Surgery, Ohio Communication improves patient satisfaction WHAT THEY DO A new whiteboard in the nurses’ station of the Cleveland Heights surgery department in Ohio shows which providers are on duty that day—and any appointment delays. A nurse communicates that information to waiting patients. Visit LMPartnership.org for ideas and tools for your team.

10. SNAPSHOTS OF CHANGE “Shot nurse” takes the pain out of waiting WHAT THEY DID Members of this team at the Honolulu Clinic shortened the average wait time for injections by: Designating a “shot nurse,” whose main duty for the day is to give patients injections. Using a whiteboard to communicate who is the day’s shot nurse and who is the floor nurse (who directs patients to the shot nurse and helps with shots when needed). Using Lotus Notes Sametime instant messaging to alert clinic nurses when a patient checks in. Visit LMPartnership.org for ideas and tools for your team. Obstetrics and Gynecology, Hawaii

11. SNAPSHOTS OF CHANGE Frederick Medical Center UBT, Mid-Atlantic Clinic makes KP.org sign-ups easy for members WHAT THEY DO Instead of having receptionists, clinical assistants and providers all taking time to register members on KP.org during appointments, this Mid-Atlantic States team has receptionists or clinical assistants collect member email addresses. Then they begin the on-line registration process for members during their downtime, thus avoiding long lines and clinical delays. Members who use kp.org are more satisfied with their care and more likely to stay with KP. Visit LMPartnership.org for ideas and tools for your team.

12. SNAPSHOTS OF CHANGE Bolder communication helps diagnose malnutrition WHAT THEY DO To improve the identification and diagnosis of hospital patients who are clinically malnourished so they can receive treatment, this Roseville, Calif., unit-based team: uses key phrases in their patient assessments and bolds the recommended diagnosis, to better catch the physician’s attention sends messages with the dietitian’s evaluation and recommendation directly to physician verbally communicates with physicians when clinical dietitians see they are available Visit LMPartnership.org for ideas and tools for your team. Clinical Nutrition, Northern California

13. SNAPSHOTS OF CHANGE Teams spread successful practices via webinars WHAT THEY DO EVS workers in the Northern California region connect bimonthly up via webinars to keep with the region’s goals and to share practices. Some of the practices that have been adopted as a result include: tent cards and “right words at the right time,” used by workers to identify themselves and better communicate with the patients whose rooms they clean standardized room and cart set-ups new ways of communicating, identifying and recognizing safe work practices Environmental Services, Northern California Visit LMPartnership.org for ideas and tools for your team.

14. SNAPSHOTS OF CHANGE Team takes on health assessment goal with workshops and Zumba WHAT THEY DO This Fontana, Calif., unit-based team: provides onsite Healthy Workforce training on how to take the total health assessment (THA) provides a healthy activity—a monthly Zumba-style exercise class, for example—and in conjunction with the activity, provides time to complete the assessment RESULTS Healthy living is catching on! Employees are wearing pedometers to see how many steps they can take in a day as they work, and they now are taking quick walks together every day during lunch. Visit LMPartnership.org for ideas and tools for your team. Ophthalmology, Southern California

15. SNAPSHOTS OF CHANGE Collaboration gets teams top patient satisfaction WHAT THEY DID UBTs in two Sunnyside Medical Center departments —Labor & Delivery and Women & Newborn Care— worked together on the same service goals. They focused on key drivers of overall satisfaction, including hospital quiet and good communication. As a result: Nurses try to respond to all call lights within three dings, regardless of which nurse is assigned to the patient. Use of the Nurse Knowledge Exchange and patient rounding have minimized interruptions, reduced noise levels and improved communication. The unit’s report rooms, where staff noise levels tend to be higher, now have doors that close automatically. Visit LMPartnership.org for ideas and tools for your team. Women and Newborn Care, Northwest 57%

16. SNAPSHOTS OF CHANGE Ambulatory Surgery Center, Colorado Missed antibiotic orders greatly reduced WHAT THEY DO Before patients at the surgery center in Colorado are sent to an operating room, a pre-operative nurse and an OR nurse together review a checklist that includes last-minute orders from physicians. Previously, only one nurse reviewed the list. The team rarely misses antibiotics orders now that two nurses review the list. Visit LMPartnership.org for ideas and tools for your team.

17. SNAPSHOTS OF CHANGE Morale and service go hand in hand at busy call center WHAT THEY DO This Silver Spring, Md, team manages high volumes of anxious members seeking medical attention or advice. To help staff members deal with their own stress and frustrations, the team created a series of fun, healthy diversions: “crazy hat day,” a ’70s costume contest and lunch-time karaoke, among other things. Clinical Call Center, Mid-Atlantic Visit LMPartnership.org for ideas and tools for your team.

18. SNAPSHOTS OF CHANGE East Bay Scanning Center, Northern California Cross-training speeds entry of medical records WHAT THEY DO Employees are trained to do all jobs in the department, so any member of the team can jump in when and where needed to prepare and review paper records, scan and index records, and do any of the other tasks involved in the scanning process. Visit LMPartnership.org for ideas and tools for your team.

19. SNAPSHOTS OF CHANGE Positive Choice Wellness Center, San Diego Attendance improves with wellness campaign WHAT THEY DO Hosts a monthly gourmet salad potluck Opens the clinic earlier so that staff members can have more time during lunch to exercise Encourages staff to sign up for kpwalk.com Educates staff members about the Family and Medical Leave Act and the LMP attendance program, which includes life balance days and vacation time. Visit LMPartnership.org for ideas and tools for your team.

20. SNAPSHOTS OF CHANGE Sleep Apnea Team, Colorado Sleep clinic reduces rework, wait times and waste WHAT THEY DO By tracking sleep studies that had to be redone and standardizing the procedures for attaching the apnea machine to patients, team members at the Skyline Medical Office were able to isolate the problem: the locks that fastened the device around a patient’s torso weren’t working properly. The manufacturer then replaced the locks. Fewer repeat studies means patients can get appointments faster. Visit LMPartnership.org for ideas and tools for your team.

21. SNAPSHOTS OF CHANGE Optical team making fewer corrections to glasses WHAT THEY DID To curb the growing number of times that members’ prescription glasses needed to be fixed or replaced, staff members at the Optical Center in Redlands now: Log each redo in a tracking book. Troubleshoot service gaps and address them with a newly created “redo monitor” and lead optician taking primary responsibility. Use KP HealthConnect to identify possible factors contributing to vision problems. Collaborate with optometry and ophthalmology units in problem solving. Counsel patients on eye health and manufacturing warranty limits. Visit LMPartnership.org for ideas and tools for your team. Vision Essentials Optical Center, Southern California

22. SNAPSHOTS OF CHANGE Health Information and Management, Northern California Data helps team boost service WHAT THEY DO » Team members at the Fresno Medical Center regularly review customer satisfaction survey responses » Disability clerk now sits at the front desk to better serve members » Restaurant-style pagers allow members the freedom to move around the facility while they wait » A new sign directs members with disability questions to one window Visit LMPartnership.org for ideas and tools for your team.

23. SNAPSHOTS OF CHANGE Radiology, Colorado No-show rate cut in half WHAT THEY DO The Ultrasound UBT at the Lakewood Medical Office in Colorado found that when staff members call and remind patients of their appointments, the likelihood of them not showing up is greatly reduced. No-shows impact patient access because when appointments are rescheduled, other patients wait longer. Visit LMPartnership.org for ideas and tools for your team.

24. SNAPSHOTS OF CHANGE Collaboration reduces medication delays WHAT THEY DID Members of the Redwood City pharmacy team worked across departments to reduce the percentage of medications given late to hospital patients by: Posting laminated cards at each med station with information about which medications are stored there and where to find drugs that are delivered and stored elsewhere. Delivering drugs to the Med-Surg department 15 minutes before they are scheduled to be administered to a patient. Giving pharmacy staff members the nurses’ cell phone numbers, allowing them to call a nurse when a patient’s medication is ready for pick up. Establishing color-coded bins to distinguish patients’ newly prescribed medications from drugs that the physicians have discontinued for that patient. Visit LMPartnership.org for ideas and tools for your team. Inpatient Pharmacy, Northern California

25. SNAPSHOTS OF CHANGE Supply team cuts annual linen costs WHAT THEY DID Members of this Panorama City, Calif., team reduced annual linen costs in the Maternal Child Health department by educating other hospital staff about the true costs of buying and washing linens. The team created and used storyboards, which provided a confidence-boosting roadmap for staff members who are inexperienced at public speaking. Visit LMPartnership.org for ideas and tools for your team. Materials Management, Southern California