Various interventions have been implemented to increase the rate of colon cancer screenings, including at-home Fecal-Immunochemical Tests or FIT kits. These kits are mailed or handed to patients identified as age- or risk-appropriate and can be completed in the privacy of the member’s own home.

The FIT kit doesn’t require a doctor’s appointment and is returned directly to the lab in a prepaid envelope. Patients who have positive FIT kit results for occult blood are referred for further testing.

“A long time ago, there was no way to track these people,” Kari Russitano, medical assistant, SEIU UHW, says. “Kaiser has done a lot to improve cancer screenings.”

But getting members to take and return the test remains a problem.

In 2009, the Union City Medical Center fell short of its 71 percent return rate goal for colorectal screenings. Kaiser Permanente routinely mass mails the kits to members identified through the electronic medical records database. But many members either don’t return the tests or the ones they return aren’t legible.

“Thirty percent were thrown away because we couldn’t read their name or the medical record number,” Deborah Hennings-Cook, RN, manager, Internal Medicine, says.

Clinical coordinator, Vimi Chand, Department of Internal Medicine, adds, “Obviously mailing alone wasn’t working, so we decided to contact members by phone or secure email. And it worked.”

Of the 1,754 members contacted, more than 63 were referred for further screening. 

Having the medical assistants and receptionists make the calls was a hard sell at first, but their peers in the unit-based team stressed the preventive nature of the test.

“It didn’t seem like extra work, because we collaborated together and educated each other to think of it as if ‘this could be your family member,’” Sophia Opfermann, receptionist, OPEIU Local 29, says. “A lot of staff didn’t know what the FIT kits were for, so we educated them about that, too.” 

Then frontline staff came up with the idea for the note cards—bright fluorescent notes that read: “This test detects early signs of COLON CANCER.”

“Knowing that many people don’t understand the importance of the test, they made the verbiage strong about ‘saving lives’ and ‘help us help you,’" Hennings-Cook says. "It was something they wanted to do, and it worked.”

One challenge was adding the phone calls and emails to the medical assistants’ existing workload. Lists of patients who hadn’t responded were provided to medical assistants but some had more than others.

“We heard a little bit of flak when the lists first came out and some MAs had huge lists, but they helped each other and just did it,” Chand says. 

In the end, the bottom line was helping patients.

“By collaborating together and educating each other, we are helping to saving lives,” Opfermann says.

The team in the Head and Neck Surgery/Audiology department at the South Bay Medical Center had been compiling monthly reports about missed second blood pressure checks.

And this can be a critical point for a patient’s care because high blood pressure is often called “the silent killer.” Those who have it often don’t exhibit symptoms until it’s extremely high, and untreated hypertension can lead to heart disease, stroke and kidney problems.

But the team reviewed the numbers without a follow-up plan.

So, they decided to have morning huddles several days a week to explain the screenings and follow with plans of action.

“We discuss why this is important and what it means to our members, that it can save lives, especially for those who haven’t been diagnosed,” says Kathy Malovich, the department administrator. 

UBT leaders provided team members with their individual performance scores on administering needed second blood pressure tests. They customized training and other follow-up plans, including coaching the team on procedures for Proactive Office Encounters (a process that takes advantage of a member’s visit to ensure the member gets any needed tests or appointments).

At huddles, they discussed the importance of controlling high blood pressure for patients. They emphasized that not only was it a strategic clinical goal but a Performance Sharing Program (PSP) goal for the medical center.  

“People think they’ve done the second test because they know they should have,” says Leroy Foster, who was the department administrator when the test of change began. “Maybe they got distracted by any number of things.” Foster said the hard data helped motivate the team. 

With a low of 35 percent for second blood tests, each team member jumped to 92 percent or better in a year. Four of the six team members hit 100 percent. In 10 months, team scores for second blood tests went up from 84.8 to 92.1 percent.

Huddling was also a key to success.

“I used to think, ‘you guys have way too many meetings,’” Jennell Jones, the union co-lead, says. “But now I see how meeting keeps people connected.”

The medical/surgical staff at Fontana Medical Center had a problem with pressure ulcers. The 59-bed unit averaged about 10 of these hospital-acquired bed sores a quarter.

It's painful for the patient and costly for the hospital, which can average about $43,000 per incident. But pressure ulcers are also preventable, and that can lead to shorter hospital stays and improved patient satisfaction scores. Reducing the rate of pressure ulcers can also eliminate inquiries from the California Department of Health Services.

Based on recommendations from the UBT, the staff implemented an education program and provided one-on-one training on how to spot, rate and reduce bed sores.

The team established a strict regimen that included rating patients on the Braden Scale, which helps identify those at risk for pressure ulcers. They performed morning assessments, and used waffle mattresses and moisture-protective barriers for at-risk patients.

They also rounded hourly for turning and got patients out of bed three or four times a day to decrease their risks. This allowed patients to use the restroom and to keep them clean.

“It’s pretty much a collaborative effort among nurses, nutritionists and wound specialists,” says charge nurse and UBT co-lead Toni Leonen. “The nurses are receptive to implementing the various methods we use to prevent pressure ulcers.”

In a span of two years, the new process helped the team reduce the number of bed sores to 0.

“We’ve created this environment where the staff thinks safety and thinks patient comfort,” Kathy Smith, RN, assistant department administrator says. “It’s automatic. They just come in and make sure patients are turned. Nobody has to remind them.”

Coming up with a new process to combat pressure ulcers helped the team build a sense of unity and staff satisfaction, but they also know the work continues.

“Sustaining our success is the biggest challenge because you can revert back to old practices,” Smith says. “You have to keep emphasizing what we’re doing and what the reasons are. Make sure they know you appreciate them so they continue to do well.”