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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 1 Level 2 Level 3 Level 4 Level 5

Pre-Team Climate

Foundational Transitional Operational High-Performing

Learningwhat a UBT is and how it works.

Establishingstructures andnorms.

Demonstratingprogress.

Jointleadership,improved performance.

Full collaboration and measurablesuccess.

Roadmap for team development

Growth of high-performing teams

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3,345 unit-based teams were in place as of year-end 2013.

1,675 teams, about 50 percent, were high performing.

Rapid Improvement Model: Plan, do, study, act

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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.

RESULTSReportable 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.

RESULTSFalls 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.

RESULTAverage 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 KochanInstitute for Work and Employment Research Sloan School of Management, MIT