All In for Virtual Visits
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Working together helps team get ahead of curve
After learning more than a year ago that patients were having trouble getting doctors’ appointments, members of the Keizer Station Family Medicine team in Oregon began exploring ways to improve service and access. Their solution? Offer more video visits.
“What we didn’t realize at the time is that this work would put us in a unique position to be ready for the pandemic, which wasn’t on anyone’s radar in fall 2019,” says Ruthie Berrell, medical office director and management co-lead for the Family Medicine/Nurse Treatment Center unit-based team.
Collaboration by the team’s frontline workers, managers and physicians has served as a partnership model for UBTs in the Northwest Region. It’s also earned the department applause for improving service and access at a critical time in health care, as teams across the enterprise adapt to the rise of virtual care.
“It wasn’t always easy,” says Molly Maddox, RN, the team’s labor co-lead and OFNHP member. “This took a lot of working out the kinks and working together.”
Overcoming resistance to change
One of the team’s earliest challenges involved staff resistance to virtual care. Worried that patients would perceive virtual visits as a “takeaway,” some staff members pushed back.
“The culture of how we delivered care was in the medical office, and people had different levels of acceptance across the spectrum,” says Caroline King-Widdall, MD, team co-lead and physician in charge.
So, team members educated their peers on the benefits of virtual care and developed scripting to help them feel at ease offering video appointments to patients.
“People are more comfortable now taking the lead and scheduling appointments,” Berrell says. Others feared that older patients were less tech savvy and would have difficulty accessing their virtual visits. In response, team members posted informational fliers in exam rooms and emailed instructions to patients before their appointments.
Building team engagement
Key to the team’s success was engaging everyone, including physicians. Medical assistants and nurses partnered with providers to review physician schedules and flag appointments they could convert to virtual visits.
Also, UBT members participated in weekly huddles “where we brainstormed new tests of change and talked about what worked and what didn’t work,” says Maddox. The team’s efforts paid off.
Patient satisfaction scores for ease of scheduling appointments jumped from 53% to 85% between August 2019 and December 2020. And because members access video visits through kp.org, website registration among the department’s patients increased by nearly 10% during the past year.
The hard work has not gone unnoticed. This past fall, the team received the region’s UBT Excellence Recognition Award for improving service and access.
Maddox attributes the team’s success to strong relationships rooted in partnership. “We know that we would not have had this success if our team didn’t work together.”
Making Moments Matter
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Helping patients with diabetes transition from hospital to home
Timing is everything when it comes to empowering patients to take control of their health.
For members of Hawaii’s Patient Support Services team, that means contacting patients with diabetes right after hospitalization.
“One of the most impressionable times to work with a diabetes patient is immediately following discharge,” explains Shelley Kikuchi, the team’s management co-lead.
By reaching out to patients during those “moments that matter,” the team has increased the number of diabetes patients with blood sugar levels under control. Their practices have proven so effective they are now part of routine treatment for patients with diabetes regionwide.
“The close follow-up with patients helps us better manage their medication and support their healthy lifestyle choices,” says Alana Busekrus, RN, the team’s labor co-lead and a certified diabetes care and education specialist who is a member of the Hawaii Nurses and Healthcare Professionals (HNHP) union.
To help patients manage diabetes, the team monitors their blood sugar levels, orders lab tests, adjusts medications and offers advice on nutrition and exercise. These interventions are important because Native Hawaiians and Pacific Islanders are among those at higher risk of diabetes, a serious chronic disease.
Overcoming obstacles
But achieving success wasn’t easy.
Early efforts to provide post-discharge care proved labor intensive and fell short of regional goals for controlling patients’ blood sugar levels, recalls Anna Sliva, RN, a care manager with the team and an HNHP member.
Health outcomes improved after unit-based team members standardized the discharge process in 2019. Nurses collaborate with Transitional Care clinical pharmacists to identify high-risk diabetic patients before they leave the hospital. Care managers follow up by showing patients how to use glucose monitors to track their blood sugar levels.
Results were significant. Within 3 months after discharge, 30% of patients lowered A1c blood sugar levels by at least 0.5 percentage points. And within 6 months, 50% of patients lowered A1c levels by at least 1 percentage point.
“Thanks to our team’s excellent work,” says Kikuchi, “the ‘moments that matter’ discharge workflow has become a standard part of our practice, benefiting some of our most vulnerable diabetic patients.”
Decreasing Diabetes Disparities
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Personalizing care improves outcomes for Latino patients
When it comes to addressing health care disparities, medical office assistant Anna Jenkins thinks her unit-based team is up to the challenge.
“I can go to my UBT members and say, ‘This is a care gap. Give me your feedback. Give me your ideas,’” says Jenkins, an OPEIU Local 30 member and labor co-lead for the Rancho San Diego Primary Care team. “Our administration listens to us. They’re very open to letting us try it our own way.”
The Level 5 team is leveraging Labor Management Partnership principles and tools to communicate, coordinate and customize care for Latino patients with diabetes. The approach has led to better health outcomes and improved service for a group disproportionately impacted by diabetes.
The unit-based team has increased the number of Latino patients ages 65 to 75 whose blood sugar levels are under control, according to recent clinical quality measures.
“That partnership between management and labor is important,” says Silvia Hernandez, RN, medical office administrator and the team’s management sponsor. “This teamwork helps us to improve patient care and quality with excellent member satisfaction.”
Adapting approaches
Key to the team’s success is partnering with Complete Care Management, a specialized strike force that monitors the health of patients who struggle to control chronic conditions, such as diabetes and high blood pressure.
To better support her Latino patients, care manager Lily Thamiz, RN, has adapted her approach. She books longer appointments for Spanish-speaking patients who need interpreters, refers others to bilingual diabetes education classes, and relies on phone calls to connect with those short on time.
“The only time we can talk is when they’re driving,” says Thamiz, a member of Specialty Care Nurses of Southern California, an affiliate of UNAC/UHCP. “These are solutions I’d never considered before.”
UBT members tailor treatment in other ways, too. To ensure continuity of care for Latino patients in their 60s and 70s, they standardized the steps needed to download and share data from glucose monitors. Providers use the devices to track patients’ blood sugar levels and adjust their medications. By consistently managing and sharing data, staff members guarantee they do not miss crucial patient information when communicating with one another.
“They make you feel like you really matter,” says Mary Hart, 71, a Latina patient who has diabetes. “They really show their concern for your health.”
Pressure Drop
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Drive-up hypertension clinic puts patients on road to recovery
Aparna Gulati, MD, was growing alarmed. Many African American patients with high blood pressure were missing their doctors’ appointments.
“Due to COVID-19 fears, many of our patients weren’t coming in for even a blood pressure check,” said Dr. Gulati, medical director of Chronic Conditions Management for the Greater Southern Alameda County area in Northern California.
“African Americans are at the highest risk for all kinds of morbidity due to hypertension.”
Nationally, more than 40% of African Americans have high blood pressure — a rate much higher than other racial and ethnic groups.
Like providers across Kaiser Permanente, Dr. Gulati is working to reduce the disparity. In November, she and her team collaborated with Coalition union members to host 2 free blood pressure fairs for African American patients with hypertension.
Cashier service receptionists, members of OPEIU Local 29, called nearly 2,000 patients to notify them about the event. Lab workers from SEIU-UHW also provided their services.
“Many of our patients have critical needs,” said receptionist Alexis Machado, who worked at both events. “They might have slipped through the cracks if they hadn’t shown up. They all seemed happy to be here and get their preventative screenings taken care of right then. It was very rewarding for me.”
Meeting patients’ needs
In all, 500 African American patients drove up to receive blood pressure checks. Flu shots, lab tests, mammograms and colorectal cancer screening kits also were available.
“We can both get our blood pressure checked without getting out of the truck,” said Kaiser Permanente member Tanya Leno, as she and husband William Leno drove through the outdoor event.
Organizers were thrilled with the turnout — and results. About 25% of patients with high blood pressure didn’t have it under control and needed their medication adjusted. They also received follow-up appointments.
“We used the opportunity to teach patients the importance of measuring blood pressure and keeping it controlled, investing in a blood pressure machine, and following up with their physician,” said Dr. Gulati. “Coming from a physician, it tends to stick more, and will hopefully increase awareness.”
A Healthy Start
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Giving Black moms and babies good beginnings
LaTisha Thompson has nothing but positive things to say about breastfeeding her 1-year-old daughter, Teigen Roberts.
“It was a no-brainer for me,” says Thompson, an on-call pediatrics nurse at Kaiser Permanente’s Capitol Hill Medical Center in Washington, D.C. “I decided to do it because of the benefits that breastfeeding gives to my baby and me.”
Indeed, breastfeeding has many health benefits for babies and mothers. But Thompson stands out among African American mothers, who are less likely to nurse their children than women of other racial and ethnic groups because of cultural beliefs that formula is more filling than breast milk. Many Black moms also lack family support and access to breastfeeding resources.
“It’s a national problem,” says Lori Franklin, RN, a lactation consultant and member of UFCW Local 400 who is working to close the gap with her colleagues at the regional Newborn Care Center in the Mid-Atlantic States.
Learning from moms
To better understand the challenges African American women face, the Level 4 unit-based team surveyed 45 Black moms as part of a “voice of the customer” project in January 2019.
The results were revealing.
“They were looking for prenatal education,” says labor co-lead Francesca Klahr, RN, a lactation consultant and UFCW Local 400 member. “We went back to the drawing board, and when we offered it, they came.”
The team doubled the number of prenatal breastfeeding classes and partnered with ob-gyn nurses to encourage African American women to enroll. The response was dramatic.
The percentage of Black mothers taking prenatal breastfeeding classes jumped from 3% to 15% between September 2018 and September 2019.
Kathleen Fulp, a mother of 2, joined the class after experiencing initial difficulty nursing her firstborn child, Savannah, now 2 years old. She’s glad she did. “I probably would have given up had I not had support.”
Such enthusiasm spells success for Nia Williams, clinical operations manager and the team’s management co-lead.
“We can empower and encourage our African American moms to push through, and that has been really successful.”
Equity for All
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Teams answer the call to address care gaps
“Everyone must put on their leadership hat. It doesn’t relate to title or overall responsibility — it’s what you control and influence from where you stand,” said Ronald Copeland, MD, senior vice president and chief equity, inclusion and diversity officer, at the National Equity, Inclusion, and Diversity Virtual Conference Series in October.
The Labor Management Partnership is designed to foster leaders at every level, to encourage everyone to use their voice and add their ideas to solving the challenges at hand. As our nation and our organization seek new ways to advance equity and diversity — including equity in health care — doing the right thing has never been more important.
“Action matters more than passion, and impact matters more than intent,” Dr. Copeland said. “It’s great to say, ‘I want everybody to achieve equity and inclusion,’ but we have to do the actions that make that occur.”
See equity in action in this issue of Hank with inspiring actions taken by 4 unit-based teams from across the organization. Together, their commitment to achieving equitable outcomes in maternal-child health, and in treating diabetes and high blood pressure, is reshaping what culturally sensitive care looks like for thousands of our members and patients.
Editor's Letter: Meeting the Moment
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Partnership advances equity amid pandemic
This past year has been filled with pain and loss, from COVID-19 to the killing of George Floyd. These crises have been immense and intense.
But thanks to the tireless efforts of our entire workforce, we at Kaiser Permanente have responded to meet the moment of today’s historic challenges.
This issue looks at how our Labor Management Partnership has addressed systemic racism amid the pandemic, advancing equity in care and in the workplace.
Kaiser Permanente and the Partnership unions believe in equity and inclusion for all, and are committed to delivering affordable, high-quality care and service. As we move along on our journey to equity for all, we’re highlighting examples of this work across our Partnership.
Our cover story focuses on unit-based teams working to minimize health care disparities for the most vulnerable among us, from improving maternal-child health to treating diabetes and high blood pressure. You’ll also find resources to foster workforce and health equity.
Read about teams cultivating an inclusive workplace. See how physicians play a key role in partnership, and how our education and training resources are expanding opportunities for employees to advance their careers.
Try our puzzles and games to explore elements of equity. View our SuperScrubs comic for a thought-provoking take on the topic. And don’t miss our back cover for an inspirational quote from our chairman and CEO, Greg A. Adams.
Let’s build on these examples and commit to actions we can take to advance equity and partnership. Kaiser Permanente, and the members and communities we serve, will be better for it.
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Joy in Work
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The antidote to job burnout
Joy in work might seem like an idea that’s superficial or unattainable — especially in a pandemic. But in times like these, it’s more important than ever.
Joy in work is about being connected with what you do and why you do it. It’s the feeling of success and fulfillment that comes from doing work that matters. It connects us with colleagues and patients through a sense of shared purpose.
Joy in work is practical and science-based, according to the Institute for Healthcare Improvement, which has taken the lead in researching the subject. Joy in work produces tangible results: Studies link it to reduced turnover, higher productivity, and improved patient experience, outcomes and safety.
It doesn’t turn every workday into a breeze. There still will be fatigue, long hours and tough days.
But cultivating joy in work creates the deep engagement that helps keep stress from turning into burnout — which was a serious issue in U.S. health care even before COVID-19 arrived on the scene.
For everyone’s benefit, let’s nurture it at Kaiser Permanente.
What brings you joy in work? Use the stories, tips and tools on these pages to explore that question — on your own and with your team. Work together to create joy in work.
The Basics
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The building blocks of partnership
What does it mean to work in partnership?
It’s a joint commitment to collaborate, enshrined in the Labor Management Partnership’s national agreements.
It’s employees, managers, physicians and dentists building on common interests to make decisions and solve problems.
It’s Kaiser Permanente and the Partnership unions finding creative, mutually beneficial solutions that result in improved care, service and affordability.
There's never been a better time than right now to shine a fresh spotlight on the basics — the team-tested tools and practices fundamental to a strong partnership, such as the Rapid Improvement Model, consensus decision making and interest-based problem solving.
Whether you’re new to partnership or well-versed in its ways, use these performance improvement tools to identify issues, test changes, solve problems, make decisions, deliver better care and service, and enhance your work life.
LMP tools are designed to help you work together when things are going well — and bridge differences when the going gets tough. This approach addresses the needs of union members and helps the organization improve performance — which ultimately benefits Kaiser Permanente’s patients, members and communities.