FRONTLINE NEWS FOR KP WORKERS, MANAGERS & PHYSICIANS · Watson Wyatt studies show that: • Highly engaged employees are twice as likely to be top performers; ... case studies in

FRONTLINE NEWS FOR KP WORKERS,

MANAGERS & PHYSICIANS

WINTER 09 | ISSUE No.18

IN THIS ISSUELMP Performance Repor

t

2008 regional highlights

What’s ahead in 2009

2 www.lmpartnership.orgHank Winter 2009 | No. 18

Published by Kaiser Permanente and Coalition of Kaiser Permanente Unions

888 LMP AT KP (888-567-2857)

CommuniCations DireCtors

Maureen AndersonStacia Hill Levenseld

eDitor Paul Cohen

Contributors

Patty Allison, Kellie Applen, Cassandra Braun, Janet Coffman, Paul Erskine, Jennifer Gladwell, Julie Light, Tyra Mead, Gwen E. Scott

Worksite Photos: Bob GumpertGraphic Design: Stoller Design Group

3 WHat We aimeD to Do in ’08

4 HoW We Got resuLts

5 WHat’s LeFt to be Done

6 WHere PerFormanCe HaPPens:

REGIONAL HIGHLIGHTS

7 SOuTHERN CALIFORNIA

8 NORTHERN CALIFORNIA

9 NORTHWEST

10 COLORADO

11 OHIO

12 MID-ATLANTIC STATES

13 GEORGIA; HAWAII

14 a sHareD FounDation: NATIONAL PROGRAMS

15 HoW PartnersHiP is FunDeD

15 GettinG better, Faster: tHe raPiD imProVement moDeL

CONTENTSWhat is LMP?The Labor Management Partnership was founded in 1997 after years of labor turmoil within Kaiser Permanente and competitive pressures within the health care industry. Kaiser Permanente and the Coalition of Kaiser Permanente Unions created the LMP as a way to transform the relationship and the organization. Today it covers 92,000 union-represented employees and some 30,000 managers and physicians. It is KP’s strategy for high performance, frontline engagement and superior ser-vice to our members and patients.

lETTER from LEADERS: Signed, sealed, deliveredYes, we can. Those words clicked with millions of Americans in the

past year. In a time of change, the country faces challenges and

uncertainty—and also a new sense of hope, confidence and urgency.

So too, at Kaiser Permanente. People across KP are thinking

and acting in new ways to fulfill our mission. Our Labor Manage-

ment Partnership is a force for that change, taking hold in ways

we’ve never seen before. This report will show how managers,

workers and physicians are making changes to help transform

Kaiser Permanente.

With the current economic crisis and resulting layoffs hitting our

members and communities, the work we began in 2008 is exactly

the right work for 2009: Putting our members and patients first.

Increasing our operational efficiency. Providing the best service

and quality for our members every day.

We’ve helped define these strategic goals for Kaiser Permanente,

embraced them as our own and developed ways to achieve them

at the front line.

We’re reducing wait times, getting more kids immunized and speed-

ing access to pulmonary, psychiatric and other specialty services.

We’re getting outpatients into exam rooms more quickly and making

our hospitals quieter and cleaner. The Value Compass keeps us

focused on systematic change, reminding us every day that we have

two jobs here at KP—to do our jobs and to figure out ways to do it

better. A new and more urgent sense of purpose is taking hold.

Our Partnership is building an infrastructure for improving perfor-

mance and transforming KP. For instance:

• Some 30,000 workers, managers and physicians formed about

900 unit-based teams (UBTs) across KP to better serve members

and patients.

• The “Case for Change” campaign explained the social and

economic pressures we face, and what we can do to protect

and strengthen our model of care.

• The Value Compass—with the member and patient always at

the center—helped focus people’s work on big, meaningful goals.

• More than 5,000 workers, managers and physicians—most

working in unit-based teams—have launched at least 80

performance improvement projects in 25 medical centers

across KP. Their focus on clinical quality improvement is

yielding measurable results.

The examples of success at the regional and local level (starting

on page 6) show that people are beginning to think and act in new

ways, moving beyond process to results. And those results could

not have been achieved without the engagement and ingenuity of

the people who do the work.

We know from People Pulse survey results (see page 5) that employees

engaged in partnership are KP’s best ambassadors and best agents

of change. Kaiser Permanente and the communities we serve face

many challenges. But we have the tools, the mission and values, the

people—and the strategy—to be the model of health care and the

workplace for the United States.

As this report will show, we’ve accomplished much, and there’s

much left to do. Can we do in 2009 what it takes to make Kaiser

Permanente the model for health care in this country? Yes, we can.

—John August, executive director, Coalition of Kaiser Permanente Unions

—Martin Gilbert, MD, associate executive director, Operations Strategy,

The Permanente Federation

—Barbara Grimm, senior vice president, Office of Labor Management Partnership

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www.lmpartnership.org 3 Hank Winter 2009 | No. 18

What we aimed to do in ’082008 GOALS RESULTS

Implementing transformation at the front line

Drive improvements at the front line in service and quality As of November 2008, 30,000 employees in 897 unit-based

teams are implementing measurable improvements in service,

quality and other local and regional goals.

Address cost structure in operations Many UBTs have achieved cost savings and process improve-

ments at the front line. However, more is needed. Cost control

will be a priority for KP in 2009.

Framing the 2005 National Agreement

Implement the 2005 National Agreement to transform

Kaiser Permanente’s culture and performance

Detailed tracking of key provisions (including attendance, service

quality, performance improvement) show 18 of 21 provisions on

track or moving in the right direction.

The Value Compass is in use across KP to focus teams on shared

strategic goals.

Framing the vision of transformation

Roll out and reinforce the Case for Change The Case for Change educational campaign reached about

10,000 employees across KP.

Teams used the Case for Change film and discussions in ongoing

performance improvement work in every region and in several

national functions.

Surveys showed positive responses to the campaign.

For instance:

• 93 percent of those surveyed understood the necessity

for major transformation within KP;

• 90 percent see how the work they do every day can affect

KP’s success;

• 87 percent will use the Value Compass to identify something

they can do differently to help set their goals for the future; and

• 61 percent understand the strategic importance of improving

team performance through unit-based teams (UBTs).

In December 2007 we set goals for 2008 in three related areas. Here’s a snap-shot of how we did in each.

Some of our measurable results in service, quality, affordability and workplace excellence are described in the Regional Highlights section of this report (see page 6).


‘ Unit-based teams and much better relationships between those who organize systems and those who work in the systems are going to be essential to any real remedy (in health care).’ —Donald Berwick, MD, president and CEO, Institute for Healthcare Improvement

Thousands of frontline workers, managers and physicians now have:

• An understanding of the business, what needs to change

and why;

• Engagement in our mission and a voice in the workplace;

• Mutual trust between our leaders, partners and co-workers;

• An environment that supports learning, reflection and

action; and

• Job security and opportunities for advancement.

That Kaiser Permanente, through our LMP, is building a more

engaging and effective work culture is evident in the 2008 People

Pulse survey.

The survey of 118,000 KP employees found our workforce to

be more involved than ever in partnership. Eighty-six percent of

employees represented by Coalition unions said they were personally

engaged in and committed to their work. That’s a two-point improve-

ment over KP’s 2007 results, 16 points higher than at other health

care organizations and 12 points higher than at high-performing

companies across all industries surveyed by human resources

consultants Watson Wyatt.

In addition, 83 percent of involved employees said they had the

decision-making authority to meet the needs of members, patients

and customers, versus 49 percent of those not involved.

That is helping to change attitudes and get results at each point

of the Value Compass—quality, service, affordability and the work

environment (see charts, next page).

“It’s clear from this survey that we have a highly engaged workforce

that’s proud to work at Kaiser Permanente,” said Deborah Konitsney,

KP director of organizational research. “Those who are involved in

LMP activities are especially engaged and proud. They feel they have

more influence, and they’re more likely to recommend KP as a place

to work and to get care.”

That level of engagement matters. Watson Wyatt studies show that:

• Highly engaged employees are twice as likely to be top performers;

• Three-quarters of them exceed performance expectations;

• They miss fewer days of work due to illness; and

• They more readily identify with the organization and its customers.

In addition, past studies found that attitudes about work were linked

to members’ attitudes: Studies in Ohio, Georgia and the Northwest

showed that in locations where KP employees said they would recom-

mend KP as a good place to get care, health plan members them-

selves were more likely to recommend KP to others or were more

likely to give more favorable patient satisfaction scores.

In 2008, unit-based teams achieved large and small wins across Kaiser

Permanente, as you’ll see in the Colorado chart (next page) and in the

case studies in the following pages.

HOW WE GOT RESULTSSustainable, continuous improvement requires culture change—new attitudes, actions and relationships in our

day-to-day work. We laid the groundwork for culture change by building a strong foundation at the front line.

Usually enough people in department to do job right

KP makes patient satisfaction top priority

Have influence on decisions affecting work

Decisions demonstrate quality is priority

Management uses employee ideas to improve care

Overall level of engagement


Where we’re going in 2009With health care reform near the top of the national agenda, we aim to establish KP as the model

and solution for health care in the United States. We’ll do so by creating greater value for the

members, customers and communities we serve.

Now more than ever, given today’s economy, our work to build a culture of performance,

value and collaboration is vital. We will:

• Break down hierarchies and organizational barriers;

• Create a safe environment for people to suggest ways to improve the way we do things;

• Create a learning environment, where intelligent experimentation, interpersonal skill and

flexibility guide our work;

• Reduce waste, boost efficiency and improve KP’s cost structure and service.

Most of this work will be done in unit-based teams. In 2009, our goal is to grow UBTs

to encompass 70 percent of KP employees by year’s end.

We’ll integrate our work more closely with regional operations, continue to focus on measurable

performance improvement at the front line and advance KP’s goals for service, quality, afford-

ability and the workplace.

We must move beyond the trivia that distracts us from our real work and set big, bold goals

that make a difference to our members.

And we must ensure the gains we achieve at the front lines are captured by our regions and

delivered to our members.

Power of engagement

QUALITY—When employees have good ideas about improving the quality of care

delivered to members, management usually makes use of them. (% favorable)

SERVICE—Kaiser Permanente makes member, patient and customer satisfaction

a top priority. (% favorable)

AFFORDABILITY—My department or work unit seeks improvements in an effort

to reduce costs. (% favorable)

BEST PLACE TO WORK—I would recommend Kaiser Permanente to a close

friend as a good place to work. (% favorable)

38%

76%

64%

88%

75%

93%

73%

92%

Number of unit-based teams* Number of employees in unit-based teams*

“Kaiser Permanente’s empowerment of unit-based teams to be part of the solution for health care is right on track,” says Alide Chase, senior vice president, Quality and Service.

“We do so many things well and we are already a national leader in several areas. Unleashing the power of our frontline workers, managers and physicians will take us even further.”

UNIT-BASED TEAMS: OuR PLATFORM FOR PERFORMANCE DELIVERY

Employees involved in UBTs since 2006 in Colorado outdo their colleagues in key measures of performance, satisfaction and engagement

+21

+18

+16

+14

+9

+12

UNIT-BASED TEAM PERCENTAGE POINT INCREASE SINCE 2006

+9

+9

+12

+7

+6

+6

REGIONAL PERCENTAGE POINT INCREASE SINCE 2006

Unit-based teams have a new model for leading

change: “We’re acting our way to new ways of thinking,

not thinking our way to new ways of acting.”

A survey of KP employees in Colorado shows that

this approach is working. The survey, conducted by

Watson Wyatt, compared People Pulse responses of

all Colorado employees with those of more than 500

Colorado employees working in UBTs since 2006.

It found that employees involved in UBTs had a

significantly more positive outlook on key measures

of performance, satisfaction and engagement

(see chart).

Furthermore, the new ways of acting championed

by UBTs are having an effect on workplace safety.

In 2007, injury rates for Colorado employees involved

in the UBTs that started in 2006 ran about 20 percent

higher than for the region overall. By 2008, the injury

rate in UBTs had fallen substantially—to a rate that

was about 19 percent lower than the region overall.

* Results as of November 2008. All regions have added uBTs since November.

LMP Involved: NO

LMP Involved: YES

1st Quarter 20073rd Quarter 20071st Quarter 20082nd Quarter 20083rd Quarter 20084th Quarter 2008

1000

800

600

400

200

0

93 239 36

5 424

442

897

1st Quarter2007

3rd Quarter2007

1st Quarter2008

2nd Quarter2008

3rd Quarter2008

4th Quarter2008

29,5

77

30,000

25,000

20,000

15,000

10,000

5,000

0 7,40

0 13,1

41 18,0

65

20,7

43

21,8

03

1st Quarter2007

3rd Quarter2007

1st Quarter2008

2nd Quarter2008

3rd Quarter2008

4th Quarter2008


We saw in 2008 that small improvements at the front line add up to big changes in KP’s culture and day-to-day operations. Here are examples of how teams delivered results in every region of Kaiser Permanente.

Where performance happens:2008 regional highlights

Problem Solution Results

Nationwide, one medication error occurs

for every day a patient is in a hospital,

according to a 2006 Institute of Medicine

study. Some 7,000 patients die each year

as the result of medication errors, and

$3.5 billion is spent each year treating

medication injuries.

Nurses, who typically are responsible

for administering drugs at the bedside,

should focus solely on the task at hand.

But interruptions and the lack of a

standardized process make that difficult.

A new protocol, dubbed KP MedRite,

was born at KP’s Sidney R. Garfield Health

Care Innovation Center and developed in

collaboration with frontline workers at three

California facilities, including West Los

Angeles Medical Center.

Nurses and others decided that when

administering drugs they needed the

equivalent of a “do not disturb” sign—

and came up with the idea of “non-

interruption wear.”

Before a nurse retrieves drugs from the

medication room, he or she dons a reflective

sash or vest that is worn throughout the

dispensing process. Other innovations

include a checklist that reminds nurses to

turn down the TV or radio in a patient’s

room, verify a patient’s identity and immedi-

ately record the medication in the electronic

health record.

Over a two-month period, the teams

using KP MedRite experienced an esti-

mated 50 percent reduction in the num-

ber of staff interruptions and a reduction

in the average time it took for nurses to

complete the medication passes.

Eventually, KP MedRite will be used

in all KP inpatient settings. So for it has

been rolled out to hospitals in Northern

California, Hawaii, and the Northwest.

The first region to roll out unit-based teams, Southern California had 10,000 employees

working in more than 175 UBTs as of Summer 2008. The region made gains in service,

quality and affordability in 2008, beating its budgeted goals for operating expenses and

operating margins. The adjacent chart shows a composite score of 19 inpatient quality

metrics tracked by The Joint Commission on Accreditation of Healthcare Organizations.

One nursing unit, profiled below, worked in partnership to contribute to those regional

gains in patient safety and clinical quality. Other snapshots of success follow.

Raising the bar on quality

‘ In the end, we had to put our concerns aside and say, ‘Well, how is it going to be better for the patient?’ We’re trying to get them in and out in a timely matter, and we couldn’t deny that this would help that.’

SPOTLIGHT ON QUALITY: A breakthrough in dispensing inpatient medication

BEST PLACE TO WORK: Riverside EVS teams reduce injuries 50 percent

The Environmental Services UBT at Riverside Medical Center has taken simple, systematic steps—including stretches at the beginning of every shift and a daily safety message—that have decreased accepted claims for injuries by 50 percent. Attendance also has improved: As of November 2008, last-minute call-ins have dropped to just 1.79 days per full-time employee.

SERVICE: Camarillo Medical Office jumpstarts service

Camarillo’s Family Medicine Targeted UBT engaged all staff in a service-improvement program that’s getting results: Courtesy

and helpfulness scores jumped from 77 percent (June 2007) to 85 percent (August 2008) for nurses and from 75 percent to 85 percent for nonmedical personnel. The unit also is on track to meet or beat its at-tendance goals, and has had no workplace injuries for at least 11 months running.

AFFORDABILITY, SERVICE: Huddles improve communication, morale and—attendance

With the help of morning huddles, the Internal Medicine Department at Harbor City saw the number of last-minute sick calls drop by about 23 percent in two months. In addition, nonmedical staff courtesy scores improved from 77 percent to 83 percent.

SERVICE, QUALITY: Turning around turnaround times

Operating room UBTs at Baldwin Park and Riverside medical centers have shaved 10 minutes or more off the time between surgeries, which can allow one extra procedure per day. For total joint replace-ments, which require the most cleanup and setup, turnover time has been cut by half. As of November, Riverside’s improved time between surgeries stood at 27.6 minutes—well below the regional goal of 30 minutes. The team also dramatically improved daily start time, or the percentage of patients in the OR before 7:30 a.m. That rating jumped from 63.3 percent in July 2008 to 87.5 percent in October. The team attributes

its success to greater engagement and collaboration with surgeons.

SERVICE, QUALITY: Radiology teams up with ER, transportation to speed service

By checking in with nurses and transporters before a patient is moved for an imaging test, radiology technicians at LA Medical Center have improved turnaround of radiology requests by Emergency Department nurses and improved the tracking and efficiency of transport workers.

The Regional LMP co-leads are Dee Dee Urdangen-Cotow (management) and Paul Rosenstein (labor)

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Overview

MORE SNAPSHOTS OF SUCCESS

94.0%

92.0%

90.0%

88.0%

86.0%

84.0%

82.0%

80.0%

Clinical effectiveness scores by The Joint Commission

06Q3 06Q4 07Q1 07Q2 07Q3 07Q4 08Q1 08Q2

Kaiser Permanente

Southern California

S|A

Sophia Garcia,

medical assistant,

Fontana Medical Center

pediatrics department

If you are not yet involved in a UBT and have performance improvement ideas, please contact your department, facility or local union leadership about what the UBT growth plan is for your facility. Or contact [email protected]

SOUTHERN CALIFORNIA


SERVICE, QUALITY, AFFORDABILITY: San Rafael laboratory: Better, faster, safer

San Rafael Medical Center’s lab department already had improved its workplace safety record when it took on three new goals for 2008:

· Reduce the number of missed meals and breaks (which can lead to fines for KP as well as grumpy staff); · Reduce their use of overtime; and · Improve attendance.

By sharing data and educating staff about the need to take scheduled meals and breaks, the unit-based team eliminated the problem. It also reduced the sick leave rate to 4.45 days per full-time employee as of the third quarter of 2008, down from more than eight days per FTE in 2007. And the lab beat its goal for overtime. In the process, the department improved its scores for service and quality—for instance, achieving 100

percent turnaround of stroke test results within 45 minutes.

SERVICE: Waiting times cut at Stockton pharmacy

Less than two years ago, members visiting the Stockton Outpatient Medical Pharmacy typically waited in long lines. Staff attendance was a concern and morale was dipping. In summer 2007, the pharmacy created a unit-based team to improve member service. The team developed a new approach to shelve prescriptions, added a greeter in the waiting room to answer members’ questions and discussed the stress workers felt when they were short-staffed. Prior to the UBT, 40 percent of members waited more than 15 minutes to pick up prescriptions. Today, only 20 percent wait 15 minutes or more for their medication. Morale and attendance have increased dramatically.

SERVICE, AFFORDABILITY, BEST PLACE TO WORK: South Sacramento Admitting turns around attendance

Early in 2008 the Admitting Department and South Sacramento Medical Center had the dubious distinction of being one of the facility’s 10 worst performing units for attendance. The department’s UBT addressed the underlying issues—including a history of low morale and poor communication between managers and staff, and frustration over scheduling. Among the solutions:

· A wall calendar tracking daily attendance scores for the group; · Weekly updates on performance; · Open dialogue on employee concerns; · Rewards and recognition.

The results: By October, morale was measurably improved, and sick calls per employee had fallen to 6.6 days per year,

down from 10 days per employee just a few months before.

BEST PLACE TO WORK: Antioch EVS reduces staff injuries

Even before the Antioch Medical Center opened its doors in November 2007, most Environmental Services (EVS) staff had received workplace safety training, which helped identify additional safety risks. That’s meant a lower than usual rate of injuries among EVS staff. In the 12-month period from October 2007, when the facility opened, until September 2008, there were only seven injuries. This best practice spread and, before the new Modesto Medical Center opened in October, all staff were trained in safety.

The Regional LMP co-leads are Ed Porter (management) and Roy Chaffee (acting; labor)


In 2007 the professional staff of Oakland

Adult Psychiatry Service heard the following

again and again: “Ninety percent of new

patients need to be seen within two weeks.

Your new patients are waiting too long to

get in to talk to someone.”

Although different methods had been tried

to ease the backlog, the access problem

kept creeping back. Each time it did, staff

morale dipped and frustration grew, and

with good reason. The unit was meeting its

goal for just 73 percent of new patients in

mid-2007.

At an Adult Service staff meeting, Robert

Fusco, MD, the new Psychiatry Depart-

ment chief, approached the team, which

includes physicians, and suggested they

work together to find a solution.

At brainstorming sessions, the staff came

up with 100 ideas, which they later rated

in a detailed online survey.

“An authentic structure of shared deci-

sion making, shared accountability and

the freedom to bluntly express views and

interests mobilized the staff to problem

solve. We felt there was a real possibility to

do something,” said Andris Skuja, Ph.D.,

a psychologist and the lead UHW-West

steward.

The staff proposed solutions by taking

time normally scheduled for staff meet-

ings and using it for patient intake. Staff

spent a month clearing up the backlog.

Two months later, the department was

seeing 90 percent of new patients within

two weeks.

But the team wanted to do more than

clear up the backlog. Working as a unit-

based team, it began to look at ways to

set up additional intake when needed,

among other changes.

The upward trend has continued.

Access climbed past the 90 percent

mark to 97 percent in February 2008,

and was still at that near-perfect mark

as of October.

As of November 2008, more than 12,000 people were working in some 450 UBTs across

the region, targeting specific goals in attendance, overtime, missed meals and breaks,

inpatient and outpatient service and more. Of these, outpatient service is the big win. As

of the third quarter, the 22 teams working on this goal achieved more than an 82 percent

overall score on staff courtesy and helpfulness, well above the target of 77 percent.

The story below shows how one outpatient department improved its service and quality

by improving patient access. Several other snapshots of success follow.

UBTs set the pace in service

‘ If I can trust an employee to extract blood from my body, take my vital signs and do an assessment on me, why wouldn’t I trust them to make business decisions?’

NORTHERN CALIFORNIA

SPOTLIGHT ON SERVICE, QUALITY: Oakland adult psychiatry improves accessS | Q


Overview

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S W

83%

82%

81%

80%

79%

78%

77%

76%

75%07Q2 07Q3 07Q4 08Q1 08Q2 08Q3

Corwin Harper,

senior VP and area manager,

Central Valley service area


UBT member/patient satisfaction average: Staff courtesy and helpfulness

Region member/patient satisfaction average: Staff courtesy and helpfulness

2008 regional target (77%)





The Sunnybrook Medical Office, about 20

miles from Vancouver’s medical office

building, opened in 2007 with a state-of-

the-art outpatient surgery center. A year

later, however, many of its surgery bays

remained empty for lack of cases. At the

same time, surgeons in Vancouver were

continuing to book surgeries for their

patients at a closer contracted hospital.

Unnecessary outside medical costs use

resources needed within our system—and

prevent members from being cared for by

KP employees throughout their experience.

Unnecessary outside referrals are also

more expensive for many KP members,

who pay higher co-pays when they use

outside facilities.

The unit-based team in Vancouver’s

General Surgery Department tackled this

challenge head on. The team worked with

patients and doctors to explain the benefits

of using the KP facility, identified the best

procedures to send patients to Sunnybrook

and developed metrics to assess results.

In March 2008, the team began by

scheduling three or four procedures

a week at Sunnybrook. From March

through July, the number of surgeries

performed there increased from 25

percent of possible surgeries to more

than 50 percent. This resulted in savings

of about $94,000, or nearly $19,000

per month in outside costs. The number

of scheduled surgeries has increased

steadily at Sunnybrook, and staff at

Vancouver are asking for additional

time there.

Making KP more affordableSavings from process improvement

‘ Health care these days is

characterized by continuous

improvement....We want

to be able to implement

changes as fast as possible

and as thoroughly as possible.

In order to do that we really

need highly functioning

(unit-based) teams.’

NORTHWEST

SPOTLIGHT ON SERVICE, AFFORDABILITY: Keeping patients close to home

As of November 2008, more than 2,000 workers, managers, physicians and dentists were working in 68 UBTs. In every department at Sunnyside Medical Center, teams were working on goals in service, quality, people, finance and market growth goals. Sunnyside exceeded its inpatient service goals by September and had also made gains in cost efficiency. Total an-nual reduced costs and/or gained capacity are projected to reach nearly $11 million. In four areas alone, including discharge planning and reduced nursing hours per patient day, UBTs have piloted innovations with potential savings of more than $9 million per year (see chart).

The story below shows how systematic teamwork is resulting in better use of the outpatient surgery center. Other snapshots show strides in affordability, quality and service.

QUALITY, SERVICE: Improving the patient experience

A cardiac telemetry unit reduced noise in high-traffic areas of the unit so patients could get more undisturbed rest.

In the mother/baby unit, the UBT imple-mented “nap time” so new moms could have a set time every day for undisturbed rest. Research showed this time would improve breastfeeding and reduce respite care requests by 75 percent. It also resulted in a decreased use of baby formula on the unit.

AFFORDABILITY, SERVICE: Professional development brings in $3 million in backlogged fees

A new career ladder, developed in partner-ship, is helping the regional claims department process a backlog of Medicare claims and

unpaid member deductibles and co-pays, bringing in more than $3.1 million in revenue in three months.

New coders, internally recruited and trained in increasingly hard-to-find skills, have reduced the backlog from a high of 60,000 down to 10,000 claims. In addition, the time it took to process a bill went down from 22 days to six days. The Professional Services Coding team has sustained an accuracy rate of 95 percent.

QUALITY, AFFORDABILITY: Preventing falls while bringing down overtime

3 South, a Med/Surg unit at Sunnyside Medical Center, developed new methods to prevent patient falls. Use of patient safety assistants (PSAs) decreased from about 300 hours per month to 30 hours per month,

with an annual savings of $60,000, while maintaining high patient safety standards. Likewise, the 1 South nursing unit tested ways to better assess patient needs and more efficiently deploy patient safety assistants. The result: an immediate decrease in PSA usage—from 549 hours in May to 32 hours in June—with no negative impact on patient safety. In August, the team reported only eight hours of PSA usage.

QUALITY, SERVICE: Changes improve service for mammography

By reviewing orders in advance, a UBT eliminated the 10 to 20 minutes it was taking per appointment to check the orders for accuracy once the patient arrived. Appointments rarely run over the scheduled 30 minutes now, so subsequent appoint-ments start on time.

SERVICE, AFFORDABILITY: Small changes make big cost impact

Sunnyside Medical Center’s MRI unit could not handle patient demand. By brainstorming new staffing schedules, the team was able to see about 15 more patients per week. This will reduce outside referrals and save about $30,000 per month.

The Regional LMP co-leads are Susan Ross-Bell (management) and Kathy Schmidt (labor)

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Overview

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$3.5 million

$2.5 million

$1.75 million

$1.5 million

$1.65 million

$10.

9 m

illio

n

Dr. Richard Olson,

chief of staff,

Sunnyside Medical Center



Internal Medicine at Skyline Medical Center

in Colorado had the worst hypertension

control rate in the region: 60 percent—

six points lower than the regional

performance goal.

Putting partnership training to work, the

third floor Internal Medicine unit-based

team used the plan, do, study, act steps of

the rapid improvement model to develop a

hypertension clinic. The clinic model allows

staff to proactively contact and monitor

patients who have had high pressure read-

ings and allows many patients to be seen

and treated more quickly, without having to

schedule a full appointment with a doctor.

“It doesn’t feel like extra work,” said Domin-

ique Spain, MA, of SEIU Local 105. “It’s just

part of our day.”

The team achieved its goal, which was

to meet the regional target by 2009,

and continues to improve beyond that

target. At its current pace, the team

expects that in five years it will save 11

lives and more than $500,000 by cutting

back on ER visits, hospitalizations and

skilled nursing facility days.

The key, said team co-lead Sean Riley,

MD, was that the idea was jointly

crafted, with a shared understanding

of the business. “If I had just given this

list of hypertensive patient names to the

staff, it would not have worked. This is a

sharing of ideas, and it opens the lines

of communications….There’s a sense of

involvement that wasn’t there before.”

Sixty percent of union-represented workers—about 2,100 people—were participating in

47 UBTs as of November 2008. Thirty of those teams were using KP’s rapid improvement

model to meet specific goals in service, including patient satisfaction and access;

affordability, including supply management, claims processing and lab and pharmacy

processing; and quality, focusing on hypertension control. Colorado’s strong advance

in composite scores for outpatient quality reflect, in part, the work of the UBTs focusing

on hypertension (see story below). Other snapshots of UBT successes follow.

Raising the bar on quality

‘ We have to jump into the

deep end, not just wade in

the shallow end. We’ve had

a national Partnership since

’98 and we’re not where we

need to be. We have to take

a leap of faith in the trust

department and accept and

recognize that we’re really all

on the same team and care

about the outcome.’

COLORADO

SPOTLIGHT ON QUALITY: A new bottom line: saved lives

SERVICE: Being there when needed

At the Telephonic Medicine Center, advice nurses and their manager agreed to be more flexible in scheduling evening and weekend shifts, to better meet members’ needs. The result: As of the beginning of 2008, patient callback times on the week-ends had dropped from 47 minutes to 11 minutes. And the changes have stuck. In a member survey done in summer 2008, 96 percent of respondents reported their experience with after hours/weekend advice as excellent or good.

QUALITY, SERVICE: Reducing lab errors

In its first small test of change, the Colorado Regional Lab developed a checklist for medical office lab assistants to follow in preparing tracking lists, which often were arriving at the lab with errors. Specimens regularly were left off the lists, which meant lab assistants had to take time to sort through and re-enter every specimen. After developing the checklist for the medical assistants, the lab surpassed its goal of reducing tracking errors by 50 percent. Skyline Medical Offices made the biggest gain, jumping from 33 percent to 100 percent accuracy. Reducing tracking errors translates into shorter turnaround times for patient lab results.

SERVICE: Walk-in days satisfy both patients and workers.

Ever since radiology teams began offering walk-in mammogram days in 2007, the program has been widely praised by radiology workers as well as patients, says Donald Rueschhoff, regional radiology director. The program has been so popu-lar that all 17 clinics now offer at least two walk-in days, and the clinics will increase to three days in 2009.

SERVICE, AFFORDABILITY: Regional pharmacy UBT success spawns other wins

Coming on the heels of a regionwide “batching” (or tracking) system that resulted

in a 75 percent drop in the number of prescriptions requiring follow-up research, the regional pharmacy UBT evolved into a sponsorship team in 2008. The team spent its time creating, mentoring and supporting 13 frontline pharmacy UBTs. These teams have seen their own successes with such projects as reducing wait times and saving thousands of dollars by no longer outsourcing the production of an IV drug administered during surgery.

The Regional LMP co-leads are Kelli Kane (management) and Dan Ryan (labor).

Q


Overview

S SS|Q

S|A

81.0%

80.0%

79.0%

78.0%

77.0%

76.0%

75.0%

74.0%

Outpatient quality: HEDIS composite scores (Health Care Effectiveness Data & Information Set)

06Q3 06Q4 07Q1 07Q2 07Q3 07Q4 08Q1 08Q2

Kaiser Permanente

Colorado

Paul Staley,

VP, operational initiatives and

performance improvement




At the beginning of 2008, only 10 percent

of members could get an appointment

with the region’s pulmonary specialty

department within two weeks of their first

request—nowhere near the regional goal

of 80 percent.

The team looked at the scheduling and

referral processes, made better use of

available slots and found ways to reduce

the number of cancellations and no-shows.

The team focused on what it could accom-

plish with the available tools and resources.

Among the approaches:

• Collaborating with member services and

primary care departments—both of which

can make appointments for the specialty

care—to ensure all departments under-

stood which appointments were appropri-

ate for which type of visit.

• Increasing capacity by having some

routine follow-up appointments handled

by primary care physicians.

• Minimizing the number of unused

appointment times caused by cancellations

by keeping a list of patients who could be

contacted and potentially moved into a

vacated slot.

The team got to work testing different

solutions. It saw immediate results—

jumping to 45 percent access after

the first month. By August 2008, the

department reported a record high of 89

percent of members being seen within

two weeks. Today the team is continu-

ing to refine its work processes and

manage the greater workload.

As of November 2008, 620 staff were working in 99 UBTs. Teams in the medicine depart-ments at 10 locations were working on an identical set of service and quality improvement goals. One of their service goals is to earn patient satisfaction ratings of 8 or higher on a 10-point scale by at least 75 percent of patients surveyed. As of September, seven of the 10 teams had met or exceeded that goal; six of those teams saw dramatic gains in just six months (see chart). Three teams lost ground, and are looking at the reasons why. In addi-tion, seven of the 10 teams exceeded another service goal, “art of medicine,” a measure of patient satisfaction with their physicians.

The case study in service (below) shows how a UBT in one specialty department tackled

a vexing patient access issue. Several UBT success snapshots follow.

Primary Care teams score on service

‘ Each of us is an integral part of the process. And for too long maybe that’s what the problem was—we didn’t realize we were partners, but we were. What one does affects the other.’

OHIO

SPOTLIGHT ON SERVICE, AFFORDABILITY: Team turns around patient access numbers

SERVICE: Lab assistants use the personal touch

A team of Ohio lab assistants once known for its hopelessly low patient satisfaction scores made a dramatic turnaround last year, improving their service scores by nearly 20 percent. Wait times are down and patients are raving about the faster and more professional services, and for the first time in recent memory, the Cleveland Heights crew went a year without receiving a single member complaint about the care experience. What made the difference? A new department manager who embraced partnership principals and an LMP consul-tant who helped the lab assistants under-

stand how their behavior around patients affected the patient satisfaction scores.

QUALITY, SERVICE: Team boosts CT scan days

Building on the success of the region’s walk-in mammography program started in 2007, the imaging department began offer-ing walk-in days for non-contrast CT scans, or CAT scans, in June 2008. One day a week patients can get prescribed CT scans without an appointment at the Cleveland Heights and Parma medical centers. As a result, wait times for non-contrast CTs went from two weeks to just two days, and number of scans produced is up.

SERVICE: Improved message turnaround time

With a lack of internal medicine providers, physicians were feeling overwhelmed juggling the twin responsibilities of responding to messages and seeing patients at the same time. The Willoughby medicine department saw one of the lowest turnaround times for physician in-basket messages. In March, only 81 percent of in-basket messages were responded to by the end of the next business day. Using the plan, do, study, act approach, the unit-based team tried a variety of small tests of change, including assigning one nurse to focus on physicians’ in-baskets. As a result of that change alone,

the percentage of messages responded to by the next day increased to 93 percent by end of October. As a result of this success, the initiative has been rolled out as a best practice to other med departments.

The Regional LMP co-leads are Belva Denmark Tibbs (management) and John Kolodny (labor)

S | A


Overview

S S

S|Q

Medicine: Avon

Medicine: Bedford

Medicine: Chapel Hill

Medicine: CHMC

Medicine: Fairlawn

Medicine: Lakewood

Medicine: Parma

Medicine: Strongsville

Medicine: Twinsburg

Medicine: Willoughby

Target (75%)

Evelyn Lumbus, LPN

Cleveland Heights

Medical Center


80%

79%

78%

77%

76%

75%

74%

73%

72%

71%

70%

69%

68%

March 08 June 08 Sept. 08



In the first half of 2008, the members

services’ call center averaged 175

unexcused absences each quarter.

Managers and workers both realized

something had to be done—fast.

A Targeted-UBT formed in April with a

focus strictly on attendance. Among other

tests of change, the team decided to have

workers track their own attendance on a

worksheet, along with the official record.

In addition, the team members began

intensive education with workers, meeting

with each employee to discuss attendance.

The effort also included a biweekly informa-

tion booth staffed with a management and

labor representative during all shifts to offer

information to workers about their individual

records.

“Just seeing your attendance in black and

white—it was a huge eye-opener,” said

UBT member Sylvia Wells.

The T-UBT also worked to improve labor

management relationships, business

understanding and accountability.

The department dropped from an

average of 175 unexcused absences

to 135 absences in the third quarter,

exceeding its goal of cutting the last-

minute call-ins by 15 percent.

The team and department know they

still have some distance to go to reach

their ultimate attendance goal of main-

taining last-minute call-ins below 10 per-

cent of the scheduled shifts for a day.

As of November 2008, nearly 3,000 people were represented in 31 UBTs. Not all had received training in the rapid improvement model, but there were some successes already. A centerwide effort at Kensington Medical Offices had increased member enrollment in My Health Manager significantly, and the facility’s neurology department had met its target for reducing its members’ “failure to keep appointment” numbers. Several teams have improved performance in another key operational goal, starting the first appointment of the day on time (see chart). Early results have shown improved service and patient satisfac-tion—and reduced overtime from the more efficient, on-time clinics.

The stories that follow include examples of the kind of service strides being made by UBTs in the region.

UBTs score on service On-time starts for first appointment of the day

‘ So much of [partnership] is, ‘How do you get people to internalize that empowerment?’ I do it by listening when they have something to say… I give them the respect of listening.’

MID-ATLANTIC

SPOTLIGHT ON SERVICE, BEST PLACE TO WORK: Call Center attends to success

QUALITY, SERVICE: Kensington neurology department improves patient access

Despite being down one physician and short on staff, the team turned around patient access by reducing no-show rates with daily calls to patients to confirm their appointments. In July, the department had confirmed 3 percent of patient appoint-ments, and saw a 12 percent no-show rate. By September, after instituting the daily protocol to call all next-day appointments, the department was confirming an average of 68 percent of appointments, and saw no-shows drop to 4 percent. As a result,

the backlog of patients waiting to be seen dropped dramatically.

QUALITY, AFFORDABILITY: Baltimore medicine department widens reach of diabetes control

As one of its clinical goals, the Woodlawn internal medicine UBT focused on treating more diabetic patients ages 55 and older— a group known for serious complications that require costly hospitalization. Through con-sistent patient education and follow-up, the team increased the percentage of diabetes patients 55 and older who followed their pre

scribed medication, diet and self-care pro-gram. In the first quarter of 2008, 20 percent of those patients were taking their prescribed medications. By the third quarter of the year, more than 32 percent of them were.

The team continues to work at improving this number and overall compliance with the course of treatment.

The Regional LMP co-leads are Brandy Starheim (management) and Pati Nicholson (labor)

S | W

Overview


S|Q

Q|A

Tom Philbrick,

hematology supervisor,

regional lab


Burke: Family Medicine

Manassas OB/GYN

Marlow Heights: Family Medicine

Camp Springs: Pediatrics

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

Aug. 08 Sept. 08 Oct. 08 Nov. 08 Dec. 08


As of November 2008, 26 UBTs, encompassing 179 employees, were in place. Several

teams in the region were focusing on service improvement—and that has had an impact.

Regionwide, member satisfaction increased steadily in 2008. And UBTs focusing on service

have set the pace. For instance, the four outpatient teams charted here set high goals for

themselves and delivered impressive results. Though one team fell short of its target, three

teams far exceeded their goals. One of those teams (the oncology unit profiled below) has

achieved 100 percent satisfaction ratings.

Teams Score on Service

‘ People at KP want to do their best with every member they encounter….When I hit a barrier, the Partnership helps me find a way through it.’

GEORGIA

HAWAII

SPOTLIGHT ON SERVICE: Team achieves perfect service scores from patients in need

AFFORDABILITY: Business team brings millions in the door

After hitting a home run in 2007—recovering more than $4.8 million in overpaid claims, $1.8 million more than the usual total—the Affiliated Health Care Operations (Claims) UBT set an even tougher target for 2008. Their goal was to collect $6 million. Though it fell short of that target, the team still

surpassed its usual total collections by at least $1 million. Department performance improved dramatically after the UBT gave staff more voice in operations and encour-aged collaborative decision making.

The Regional LMP co-leads are Dawn Bading (management) and Jenee Dixon (labor)

In June 2008, Kaiser Permanente Hawaii and the Hawaii Nurses Association agreed

to examine the benefits of joining the Labor Management Partnership—bringing

LMP to all operating regions of Kaiser Permanente. Interest-based negotiations with

HNA were completed in January 2009. The tentative agreement covered wages and

benefits for 760 KP nurses and staff represented by HNA, lays out a transition plan

for the move to Partnership and brings an “island-owned” approach to joint decision

making, problem solving and performance improvement.

* The horizontal colored lines are identified as “Team performance goal.”

S

Overview

MORE SNAPSHOTS OF SUCCESSA

Shernida Wheeler,

surgery scheduler,

Glenlake Medical Center



Patients in Infectious Disease/Oncology

at Cumberland and Southwood medical

offices complained it took too long to get

an appointment and for the department’s

advice nurses to return phone calls.

The department’s unit-based team initiated

its own service excellence program.

The first step was to monitor call volume

and response time. The team determined

that, on average, the department received

40 to 50 calls a day and that it took the

advice nurse an average of eight hours to

return them.

Then it developed a business plan to show

the service and quality benefits of hiring

three additional employees—two advice

nurses and a nurse navigator, who contacts

patients after their appointments to ensure

they understood everything the doctor

told them.

Staff also encourages members to take

advantage of KP.org.

The team’s patient satisfaction scores

jumped from 89 percent to 97 percent

as of September 2008, and peaked in

August at 100 percent. Satisfaction with

the time it takes to return phone calls

climbed from 71 percent to 91 percent.

Satisfaction with access and sched-

uling jumped from 80 percent to 94

percent—surpassing the regional goal

by 10 percentage points.

About 95 percent of the time, patients

now are able to reach an advice nurse

live. When they don’t, calls now are

returned in an average of one to two

hours. The nurse navigator has helped

ease patient anxiety, improve care and

reduce calls from the advice center.

The formation of a UBT and the

improved service scores also have had

a positive impact on staff. “They feel like

they have a voice now,” Clinical Supervi-

sor Jill Broner said. “They feel really

proud and empowered.”

100%

95%

90%

85%

80%

75%

70%

65%

60%Baseline May 08 August 08

Out

pat

ient

Sat

isfa

ctio

n

Cumberland/SW ID/ONC

Cumberland Pharmacy

Glenlake/SW GI

Gwinett Pharmacy

Cumberland Pharmacy Goal = 87%

ID/ONC Goal = 94%

Glenlake/SW GI Goal = 90%

Gwinett Pharmacy Goal = 86%


LMP provides training, coordination, communication and program

leadership in areas of interest across all regions.

Our national programs in 2008 provided staff assistance, problem-

solving tools and resources in three areas: attendance, workforce

development and workplace safety. At the national level, we

also successfully negotiated the reopener provisions in the

2005 National Agreement. Below are recaps of where we stand

in each area.

Attendance Reducing absenteeism—in particular reducing the number of

last-minute sick calls—was a major goal of the 2005 National

Agreement. Southern and Northern California, the lead regions

in tackling attendance issues, have seen successively greater

attendance gains each of the past two years.

Southern California, the first region to implement comprehensive

attendance programs, saw a 28.5 percent reduction in use of total

sick time compared with 2007, and finished the year well ahead of

its target for improvement.

Northern California saw an 18 percent reduction in sick-time

use, excluding protected leave. More than 95 percent of locations

showed improvement, with nearly half the locations achieving

a 20 percent or greater reduction from their 2007 baseline.

By the end of October, the region achieved a 1.91-day reduction

in sick-time use, excluding protected time, close to the targeted

two-day reduction.

However, serious challenges remain. Many locations in both

California regions are still far above regional goals for last-minute

call-ins.

Regions outside California started attendance tracking and

improvement programs more recently and are just beginning

to see results.

Workplace safety A safe and productive workplace is the right of every worker, and

a shared goal of workers, managers and physicians. Joint safety

teams in every KP facility have moved on many fronts.

Some of the achievements:

• Safe patient handling systems that include special equipment,

designated lift technicians and team lifting done by trained

patient care staff;

• Advance training of all employees before moving into new

medical centers;

• Padded flooring for lab workers who must stand for long hours; and

• Joint workplace safety walk-arounds to identify potential risks.

Toward the ultimate goal of a workplace free of injuries, the program

aims to lower KP’s workplace injury rate across all regions to match

the industry average. Five of seven regions saw improvement as

of the third quarter of 2008. But progress was inconsistent and is

falling short of the goal. Two regions—Ohio and Georgia—saw a

spike in injuries. Since the start of the workplace safety program in

2001, the injury rate has improved by 50 percent, with a 7 percent

improvement in the past 12 months.

In 2009, unit-based teams across KP will be using the Compre-

hensive System of Safety program to provide strong leadership,

a structure for active engagement and focused processes and

actions—such as incident investigations, safety audits, re-evaluation

and safety communication in the workplace.

Healthy workforce

Originally negotiated as part of the 2005 National Agreement,

“work/life balance” evolved into “healthy workforce,” launched in

2008 to focus on the health and wellness of our workforce. At

480,000 strong, we are the largest employee and family group

covered through the KP health plan. The program will make a real

difference for employees and their families and can be a model for

other employer-group customers.

A cross-regional work group of some 50 physicians, managers and

union representatives has studied data identifying depression and

asthma as the most prevalent chronic conditions in our workforce

and their families. In early 2009, the healthy workforce group will

launch an overcoming depression campaign. Later in the year,

the group will be urging employees to take a health assessment

program on kp.org.

Our national programs in 2008 provided staff assistance, problem-solving tools and resources in several areas. Here’s where we stand in each:

Building a shared foundation: National programs


How Partnership is funded The Labor Management Partnership is funded largely by the LMP Trust, a jointly managed

fund totaling $38.5 million in 2008. Most of the trust’s funding comes from a nine-cent-

an-hour wage diversion by partnership employees, in return for the benefits of partnership.

Kaiser Permanente contributes 35 percent of the trust’s funding and additional funds to

support partnership activities in the field, in return for a more engaged and loyal workforce

and a Union Coalition commitment to performance improvement.

Workforce development The workforce planning and development program promotes

internal mobility and employee retention by giving employees

access to career counselors and information about tuition

reimbursement, stipends and other career advancement tools.

The program improves employee morale and retention, which lowers

KP recruiting costs, and also helps ensure there are candidates

for hard-to-fill positions, boosts the caliber of KP’s workforce and

reduces outside labor costs. All of this benefits KP, our workers and

the members we serve.

More than 5,000 frontline workers in 2008 took advantage of career

counseling services or participated in programs sponsored by two

labor trusts. More than 10,000 union employees received tuition

reimbursement from KP. In addition, thousands of workers have

visited http://kp.org/careerplanning to connect with carrer coun-

selors, identify educational benefits and learn about open positions to

train for.

In addition, KP launched its first centralized database of workforce

demographic, retention and recruitment information about employees in

Northern and Southern California; much of the same data about North-

west employees also went live. That data is used to study employee life

cycles and trends, information that is crucial for workforce planning.

National Agreement reopener

Under the 2005 National Agreement, KP and Union Coalition leaders

met this summer to re-examine two issues in light of changing busi-

ness and economic conditions—across-the-board wage increases

and retiree health benefits. The bargaining team reached agreement

on those difficult issues, using the same interest-based partnership

approach that governed the 2005 negotiations.

In addition, the 2008 agreement developed a new approach

to engage employees in performance-improvement goals, and

established a Committee on Growth, led by senior leaders of the

Health Plan, Permanente Federation and the Union Coalition to

jointly shape KP strategy on membership growth, product develop-

ment and public policy. It also included an innovative use of Health

Reimbursement Accounts to supplement retirees’ medical benefits

and reward good attendance over one’s career.

Where the money comes from

Where the money goes

65%

35%

Contributions to LMP Trust by source for 2008

2008 funding to drive performance at the front line

More than half of the trust’s 2008 budget went to support frontline performance improvements.

In 2009, an even larger share of the trust budget will go to frontline and regional performance

improvement activities.

Employees

50.5%

17.5%

6.5%

10.3%

15.1%

Getting better, fasterMany UBT successes are possible because of the rapid improvement model (RIM). RIM is based

on quality improvement techniques used by the Institute for Healthcare Improvement. It is an effective

way of empowering health care workers to make continuous improvements in their departments.

The process uses a practical, four-step cycle of plan, do, study, act, or PDSA. It allows teams to

make a small change, then quickly test and evaluate it. The team either can adopt the change or

reject it if it doesn’t work. The cycle then is repeated to expand on a successful change or move

on to new areas for improvement. The process starts with three questions:

1. What are we trying to accomplish?

Clarify improvements your team wants to make and define how you want to change. Be specific.

2. How will we know that a change is an improvement?

Identify what you will measure to make sure you know whether the change truly is an improvement.

3. What changes will help us improve?

Ask what options are most likely to work. What do we think is a good idea? What have other

people done? Keep objectives in mind. Use the team’s knowledge and experience as a guide.

Implementing the vision at the front line: Drive improvements in service and quality; address cost structure in operations.

Framing the vision: Roll out and reinforce Case for Change; Help grow health plan membership and change the health care environment.

Contingency funds

Fulfilling the National Agreement: Implementation of the 2005 National Agreement consistent with the Value Compass.

Trust management

Kaiser Permanente

www. LMPartnership.com

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1_ What are we trying to accomplish?

For example, the team wants to improve patient service scores in the psychiatry department by 25% in the next six months.

2_ How will we know that a change is an improvement?

They’ll measure patient survey scores to figure out if the change is an improvement.

@

3_ What changes will help us improve?

Offering consistent information over the phone will help the team improve service.

w rkThepDsa Cycle

* remember: Keep these three questions in mind when implementing the PDSA cycle.

PDSA stands for “Plan, Do, Study, Act.” Once you have decided exactly what you want to achieve, you can use PDSA cycles

to test out your ideas developed from the third question, “What changes will help us improve?”

Plan

to

carry

out

the

cycle

and

plan

for

data

collection.

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objectives

and

predictions.

DEVELOP

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and

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Documents

FRONTLINE NEWS FOR KP WORKERS, MANAGERS & PHYSICIANS · Watson Wyatt studies show that: • Highly engaged employees are twice as likely to be top performers; ... case studies in