Changing Work Changing Lives - Labor Management · PDF filefind new work is at an all ... And the health care industry overall has a long way to go in raising standards for ... 14

Changing Work Changing Lives study guide

The Changing Work, Changing Lives video and booklet were jointly prepared by Kaiser Permanente, the Permanente Federation, and the Coalition of Kaiser Permanente Unions. We hope these materials help you and your teams—workers, managers, and physicians—identify common interests and discover new ways to best serve our members and communities.

2 CHANGING WORK, CHANGING LIVES

‘ everyBody shouLd have aFFordaBLe heaLth Care. Period.’

—JEFF SIMMONS, KP member, Northern California

3CHANGING WORK, CHANGING LIVES

—JEFF SIMMONS, KP member, Northern California

Changing Work, Changing Lives

Our economy is struggling, and the cost of health care, combined with our nation’s poor health, is compounding the challenge. At Kaiser Permanente, we are leading the way to a transformed health care system where the needs of the patient come first, and every employee, in every team, is able to use his or her knowledge and skill to contribute to continuous improvement. We know how to get stronger in a time of change. We’ve done it in the past, and we can do it again. Everyone has valuable contributions to make to help us continually improve our care delivery, make getting healthy a priority and grow Kaiser Permanente. With the help of every Kaiser Permanente employee, we will continue getting better, and we will spread health in our schools, neighborhoods, and communities.

DISCUSSION QUESTION: What steps could your team take to help make our care more affordable for people like the Simmons family, featured in the Changing Work, Changing Lives video?


Jeff and Sara Simmons have had to make some tough choices since she and their older son, Owen, were diagnosed with Type 1 diabetes. They decided to sell their house and move to an area with a lower cost of living. A middle-class family with Kaiser Permanente coverage, the Simmonses wonder how uninsured families or those with lower incomes can survive such challenges.

Owen Simmons with his mother, Sara.


video disCussion questions

What was surprising, new, or important to you?

Who do you know who is like the Simmons family? Reflect on a time when you didn’t have health insurance, or when someone in your family or someone you know didn’t have health insurance.

In what ways did the video help you understand the challenges we at Kaiser Permanente are facing and actions you can take to address those challenges?


But the problem goes back further than the 2008 collapse. The wages of the middle class have been nearly flat since the 1970s, while the cost of living has continued to rise.

Worse, the cost of health care has exploded.

The result? Overall living standards have declined for most—and health care is unaffordable for millions.

The Supreme Court upheld the Affordable Care Act, which will give us a historic opportunity to care for many more people at Kaiser Permanente. But the law alone will not rein in costs—that is up to us.

our eConomy is struggLing— and heaLth Care is unaFFordaBLe

Reimbursement rates for care will be lower for the newly insured—who will be culturally and linguistically more diverse, less familiar with the health care system, and may be sicker after years without coverage. There is the potential that the cost of care for some new members will exceed reimbursements.

DISCUSSION QUESTION: How has the economic crisis affected your family or friends’ ability to get health care?

Our economy is still recovering from the economic collapse of 2008. Four million Americans have lost their homes to foreclosure, job growth remains slow, and the average time an unemployed person takes to find new work is at an all-time high.

We must find ways to make health care more affordable. This is more urgent than ever. To successfully provide care and service to these new members, we must eliminate waste, find new efficiencies, and lower costs.


The wages of the middle class have been nearly flat since the 1970s, while the cost of living has continued to rise.

1947 1952 1957 1962 1967 1973 1979 1989 1995 2000 2007 2011

$15

$10

$20

$10.67

$16.79

$18.74$18.31

$17.17 $17.08

$18.32$18.91

$19.47

+2.3%

+1.9%-.04%

-.06%-.01%

+1.4%+.05%

+.07%

( hou

rly e

arni

ngs

)

Source: Economic Policy Institute

+.02%

Hourly earnings of private production and nonsupervisory workers 1947–2011

Cumulative change in health care costs and median household income 2001-2010

( annual percent change )

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

-20%

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

( Per

cent

age

chan

ge )

Source: Economic Policy Institute

Since 2000, the cost of health care has gone up, but household income has hardly changed.

Health care costs Median household income


That’s why Kaiser Permanente believes in continuous improvement. Through the Labor Management Partnership and our National Agreement, more than 3,500 unit-based teams are striving every day to make meaningful, measurable improve-ments in service, quality, affordability, and the workplace. Teams use the Rapid Improvement Model, or RIM, to identify opportunities for improvement, try out small tests of change, and spread the ones that work.

It’s all part of our growing culture of constant innovation. Everyone has the opportunity and the responsibility to contribute ideas, analyze problems, and test solutions.

DISCUSSION QUESTION: What can you and your team do to get better at your work?

soLution 1: Be the Best at getting Better

We are proud to have won industry-leading scores on quality, service, and customer satisfaction, but we know we still have opportunities to improve. And the health care industry overall has a long way to go in raising standards for quality, safety, affordability, and employee engagement.


—JACK COCHRAN executive director, The Permanente Federation

‘ the team has to say, We are the CLosest thing there is to an eXPert on the Care that’s Being deLivered on our unit.’


We have to reverse these trends.

And as Kaiser Permanente employees, our own health directly affects our economic future: If we can improve our health as a group, we can help keep the cost of our health care and retirement benefits affordable. In doing so, we will be demonstrating that Kaiser Permanente’s model of health care can create the healthiest workforce in America.

our nation’s Poor heaLth is making the eConomy siCker

If we don’t improve our health as a group, the cost of our benefits will become unaffordable and therefore unsustainable. Getting healthier will do more than improve our quality of life—it will also help us maintain our health care benefits.

That’s why the idea of a Total Health Incentive Program was proposed by the Coalition of Kaiser Permanente Unions during 2012 national bargaining.

DISCUSSION QUESTION: Do you know anyone with a chronic disease? How have chronic diseases impacted you and your family?

The United States is seeing a huge jump in the rate of chronic disease— serious, largely preventable conditions such as asthma, diabetes, and heart disease. As a result, our children may be the nation’s first generation with a shorter life expectancy than their parents. And the costs of treating these conditions could further overwhelm the health care system.


$400,000

$350,000

$300,000

$250,000

$200,000

$150,000

$100,000

$50,000

$0

2008 2013 2018

( mill

ions

)Total U.S. obesity-related direct health spending 2008-2018

Source: Kenneth E. Thorpe, 2009

our Biggest heaLth risks are PreventaBLe

HIGH CHOLESTEROL EXCESS WEIGHT

SMOKING HIGH BLOOD PRESSURE

These risk factors are the key drivers of one-third of the cost of our employee health care claims.

Projected obesity rates Holding obesity rates constant


There are dozens of Kaiser Permanente Healthy Workforce programs to support us, and we can participate in those programs not just as individuals but as teams. Our teams can take on projects like getting every team member to take the total health assessment or hosting

soLution 2: make good heaLth a team sPort

a monthly salad bar lunch for the department. By supporting each other and working together, we will create an environment where the healthy choice is the easy choice.

As a healthy workforce, we can help reduce health care costs and demonstrate the benefits of Kaiser Permanente’s total health model to employers and other customers. This will support our efforts to grow membership.

We can also take the message of Total Health to our families and communities. We can talk to our children about eating healthy food and getting fit, and we can work with KP’s Thriving Schools program to make local schools healthier places.

DISCUSSION QUESTION: What Healthy Workforce programs have you participated in?

We are committed to Total Health—including a healthy and safe work life for KP employees as well as the members, patients, and communities we serve.


If you haven’t already done so, sign up for kp.org. Have your medical record number (from your membership card) handy. Go to “register now” under “members sign on.”

You will be prompted to answer a few questions to verify your identity. After you answer the questions, you can choose a password and start accessing the online features immediately. If you can’t or don’t want to complete the process online, you can do so by mail. Questions? Call web support at (800) 556-7677.

To take the THA, go to kp.org/hwf. Knowing some key numbers can help you get a more customized action plan from the total health assessment. Before you begin, it’s helpful to have the following information handy:

[ ✓ ] Total, HDL, and LDL cholesterol (taken within the last 5 years)

[ ✓ ] Triglycerides (taken within the last 5 years)

[ ✓ ] Blood pressure (taken within the last 12 months)

[ ✓ ] Glucose (blood sugar)

[ ✓ ] Waist measurement

[ ✓ ] Height and weight

[ ✓ ] Immunization history

If you’re a KP member, you can view most lab results, immunizations, and past office visit information via My Health Manager on kp.org. If you don’t have this information, you can still complete the assessment. Your action plan will just be less personalized.

Get started today: Take the total health assessment (THA) at kp.org/hwf and keep your health screenings up-to-date. If you are healthy, stay healthy and support co-workers and UBT health actions.


After the war, Harry Bridges, president of the International Longshore and Warehouse Union (ILWU), asked Kaiser to keep the health plan open—and brought in all the members of his union.

In the 1950s, KP physicians stood strong when subjected to hostile treatment from those who thought the prepaid plan “socialistic.” KP flourished and grew dramatically over the next three decades.

But in the 1980s, another crisis hit. New industry financial pressures set unions and management against each

We knoW hoW to get stronger in a Crisis

other. Job actions, strikes, and acrimony grew. By 1996, the disputes threatened to undo Kaiser Permanente and many of the gains its unions had made. Out of this crisis, the Labor Management Partnership was born—and the changes made KP stronger again.

Today, our crisis is the unsustainable cost of health care.

Every time we’ve faced a crisis, we have transformed the way we deliver care and become a stronger organization in the process. We can do it again.

DISCUSSION QUESTION: What ideas do you have about how we can respond to the current health care crisis the way our predecessors stepped up to the crises of their times?

Kaiser Permanente grew out of a national crisis more than 70 years ago. With much of the U.S. naval fleet destroyed at Pearl Harbor, World War II created a desperate need for new American ships—fast. By 1943, the workers at the Kaiser shipyards in Oregon and Richmond, California, were turning out a new ship every other day! Henry Kaiser and physician Sidney Garfield provided the workers with prepaid preventive health care—and Kaiser Permanente was born.


—HENRY J. KAISER

Longshoremen loading ship (left); union workers on strike (below).

‘ ProBLems are onLy oPPortunities in Work CLothes.’


1. Learn and use simple service-improve-ment tools like AIDET and A-HEART to enhance the member experience. (Use the search box on LMPartnership.org

to find the tools.)

2. Use KP HealthConnectTM to identify new members and give them special attention, because positive experiences in the first year are key to member retention. New members who are introduced to Kaiser Permanente through health care reform may need even more orientation than others, because they may have had gaps in care, limited preventive medicine, and may be unfamiliar with the health care system in general.

3. Talk with your friends and neighbors about the value Kaiser Permanente provides.

soLution 3: suPPort our groWth

When Kaiser Permanente grows, we all do well—we provide quality, affordable health care to more people, while providing more jobs for our communities and growing our unions. You and your team can do things every day to keep our members happy and loyal to KP, and to attract new members. For example:


aWards and reCognition

Working together, we’ve improved our service and quality—and we’re getting the credit we deserve. Share the news with friends and family members!

J.d. PoWer and assoCiates

[ ✓ ] CA, CO, GA, MAS and NW rated highest in member satisfaction in health plans

mediCare quaLity rankings

California ★ ★ ★ ★ ★

Colorado ★ ★ ★ ★ ★

Georgia ★ ★ ★ ★ ★

Hawaii ★ ★ ★ ★ ★

Mid-Atlantic States ★ ★ ★ ★ ★

Northwest ★ ★ ★ ★ ★

Ohio ★ ★ ★ ★ ★

toP hosPitaLs in nation: 17 oF 53 are kP

#1 in the nation For many

“eFFeCtiveness oF Care” sCores


employees reporting discomfort dealing with difficult callers

BeFore aFter

11%

59%

CLiniCaL ContaCt Center

Percent of duplicate medications per office visit

BeFore aFter

15%

46%

CLiniCaL ContaCt Center

Patients who meet criteria for malnutrition and are then diagnosed with it

BeFore aFter

52%82%

CLiniCaL nutrition

average wait times in minutes for injections

BeFore aFter

3.26

oBstetriCs/gyneCoLogy

To help staff members deal with their own stress and frustrations, this Silver Spring, Md.,

team created a series of fun, healthy diversions: “crazy hat day,” a ’70s costume

contest, and lunch-time karaoke.

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.

Members of this team at the Cumberland Medical Office Building in Atlanta started by

manually cleaning up patient charts. Then they instituted a new process for

checking medications.

Dietitians in this Roseville, Calif., UBT adopted several changes that led to more assertive communication with physicians about patient assessments.

Guided by the Value Compass, more than 3,500 UBTs are helping to improve Kaiser Permanente


the vaLue ComPass

Our Value Compass illustrates the way we create value for our patients, members, and communities. We tap the knowledge and experience of every employee, in every team, to constantly create new ways to deliver the best quality and service, provide the most affordable care, and create the best place to work.

Each of the four points of the Value Compass is equally important. We don’t improve in one area at the expense of another.

The Value Compass reminds unit-based teams that collaboration produces greater value than individual efforts alone. And by putting the member at center, it reminds us we always put the needs of our members first—it is our members for whom we are creating value.

Unit-based teams are the platform for performance improvement across Kaiser Permanente. A team includes all the participants in a natural work unit or department, including supervisors, union stewards and staff members, physicians, dentists, and managers. The team supports the regional business strategy and goals for performance, service, quality, efficiency, and growth. Because teams increase consistency and standardization of treatment, they improve care.


hoW Can We Change?

The Changing Work, Changing Lives video encourages all of us at Kaiser Permanente to continually improve our care delivery, make getting healthy a priority, and work to grow KP. But how can we make these changes?

Rapid Improvement Model

The Rapid Improvement Model is a simple approach to improvement that anyone can use. It offers the following benefits:

» Allows participants to reduce risk by starting small

» Provides a systematic way to plan, develop, implement, and sustain change

» Allows team members to achieve big gains from small, rapid tests of change

» Makes efficient use of time

» Assists the team in achieving the department’s goals and improving its performance

The Plan, Do, Study, Act (PDSA) cycle is part of the Rapid Improvement Model and provides a quick way to test change in the work setting—plan a change, try it, observe the results, and act on what is learned. These small tests of change are a tested, scientific method for action- oriented learning. When running PDSA cycles, keep these three questions in mind:

» What are we trying to accomplish?

» How will we know that change is an improvement?

» What changes can we make that will result in improvement?

Systems thinking

Systems thinking helps break down silos by looking at the interaction of all the parts in a system. It takes account of how improvements and changes in one area of a system can adversely or beneficially affect another area. Leaders and sponsors of teams can coach team members to incorporate systems thinking into their day-to-day work and small tests of change.


identiFy the ProBLem

Step back and consider the problem within the bigger system.

Focus on patterns of behaviors over time, rather than a single event.

Focus on the specific system within the organization’s control that is responsible for performance issues.

Look for the cause of the problem or inefficient workflow.

Brainstorm soLutions

Understand the feedback loop and ongoing process that reinforces the problem.

Take advantage of the collective brainpower of the group to solve the problem.

Create a list of different possible solutions.

do a reaLity CheCk

Evaluate the solutions to see whether they are realistic.

Conduct small tests of change to see whether an improvement can be made.

PLan

deveLoP a Change

Make objectives and predictions. Plan to carry out the cycle.

Plan for data collection.

study

imPLement a Change

Analyze data. Compare results to predictions. Summarize what was learned.

do

test a Change

Carry out the plan. Document the observations.

Record the data.

aCt

sPread a Change

What changes are to be made? What is the next cycle?

Three steps of systems thinking

Plan, Do, Study, Act (PDSA) improvement cycle


summary disCussion questions

What are your key interests as a physician, manager, union member, or unrepresented employee? (Interests are your needs and concerns.)

Do your interests align with other members of your team? If not, discuss how you can achieve alignment.


aCtion CheCkList

Be the Best at getting Better

[ ✓ ] Look for ways you and your team can reduce waste and increase efficiency.

[ ✓ ] Get trained in the Rapid Improvement Model (RIM).

[ ✓ ]Speak up about problems in your department and your ideas for solving them.

MY IDEAS:

get heaLthy

[ ✓ ] Take the total health assessment (THA).

[ ✓ ] Challenge your team to take on a Healthy Workforce project.

[ ✓ ]Walk or engage in another healthy activity 30 minutes a day, five days a week—on your own or with your team.

MY IDEAS:

suPPort our groWth

[ ✓ ]Encourage members to sign up for kp.org, and work with your UBT or department team to incorporate sign-ups into daily workflow.

[ ✓ ]Provide a “wow” experience to KP members on their first visit— and every visit.

[ ✓ ]If you are a union member, contact your local to get involved in being a union ambassador for health in your community.

MY IDEAS:

this BookLet is a study guide to aCComPany the video

Changing Work, Changing Lives

kp.org/video | LMPartnership.org/changing

1. Continually improve care delivery and service through our teams—unit-based teams and other work units—and take waste and unnecessary cost out of the system.

2. Get healthy and work with our teams, our families, and our communities to improve health.

3. Help us grow so we can provide quality, affordable health care to more families and communities.

Everyone who is a part of Kaiser Permanente has something to contribute to these three priorities:

Documents

Changing Work Changing Lives - Labor Management · PDF filefind new work is at an all ... And the health care industry overall has a long way to go in raising standards for ... 14