It was a vicious cycle: As last-minute sick calls surged, so did overtime costs and burnout among staff working extra shifts in Urgent Care at Panorama City Medical Center in Southern California.

The sick calls “impacted our entire team on multiple fronts,” said Fisayo Bhebe, department manager.

So UBT members came up with a plan. They realized that people were more likely to call in sick when work was stressful. So they urged employees to schedule time off in advance and save their sick days for illness. 

Department leaders were then able to plan and maximize staffing resources – reducing stress and burnout for workers. They also rewarded those with outstanding attendance.

And, after realizing patient volumes were rising, they reviewed the budget and hired more staff. Over 10 months, last-minute sick calls dropped 40%, from an annual average of 4 days to 2.5 days per full time employee.

“Every member of the team contributed to the success of this project,” said Rosimar Carpenter, an LVN and Coalition union partnership representative. “You can definitely see how proud they are.”

A two-pronged approach

The Level 3 team includes employees represented by the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions. They staff Urgent Care, a fast-paced department that can receive as many as 300 patients a day, 7 days a week.

Sick calls mean paying overtime to employees available to fill staffing gaps and take on extra shifts. When replacements can’t be found, staff members work short-handed as patients keep coming.

“It can be a continuous loop,” said Javier Barrios, RN, a member of UNAC/UHCP. “When people are out you carry a heavier load and it makes the day feel a lot longer.”

In 2022, challenged by last-minute sick calls, members of the unit-based team began exploring ways to reduce such calls and ensure staff members got time off. They took a two-pronged approach: partnering with leadership to bring in per-diem workers to plug staffing gaps and focusing on last-minute sick calls during UBT meetings.

Team co-leads ─ Jeanelle Concepcion, RN Supervisor, and Teresita “Tita” Obusan, an LVN and SEIU-UHW member ─ were sympathetic to the team’s struggles. They encouraged team members to plan time off in advance to avoid last-minute staffing scrambles. They also recognized workers for outstanding attendance.

Excited to work

The strategy worked. The team met its 6-month target to reduce last-minute sick calls from an annual average of 4 days to 3 days per full time employee.

What’s more, success came despite surging service demands. Member visits to the department increased by 20% in 2022 over the previous year. After reviewing the budget, the department received authorization to hire 3 new part-time licensed vocational nurses to handle the increased patient volume.

Last-minute sick calls continue to drop. In November 2022, the team recorded an annual average of 2.5 days per full time employee – a 40% reduction over 10 months.

Even better, the sense of burnout has waned. Said Obusan, “We feel less burdened and are excited again to come to work.” 

At the Spine Center of Excellence in the Northwest market, team members strive to connect patients to treatment as quickly as possible.

But the Level 5 team struggled when it came to providing timely access to care for Medicaid members.

Before receiving treatment, Medicaid members must undergo a state-mandated pain evaluation administered by the team’s registered nurses. The nurses’ workload, however, meant patients sometimes waited as long as 37 days to be evaluated.

To improve access to care, everyone on the team began screening Medicaid members. In 4 months, they reduced wait times from referral to consultation by 35%.

“When you’re dealing with acute or chronic pain, quicker access to treatment means happier patients,” says Kali Dailey, RN, an OFNHP Local 5017 member and the team’s labor co-lead.

Coordinating spine care

The Spine Center, based at the Sunnybrook Medical Office in Clackamas, Oregon, is part of Kaiser Permanente’s coordinated approach to spine care. Across markets, spine centers help members with neck and back pain find the right treatment programs or surgeries in an expedited way.

In the Northwest, Spine Center staff are represented by the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions. They gather information through questionnaire calls and follow an evidence-based treatment plan for members based on their responses.

Previously, only registered nurses were responsible for completing the questionnaires. They did so during the intake call they conduct with all members to consider which treatments – including injections and surgery – are appropriate.

But the nurses’ workload meant there was a lag time between referral and intake call. Before the team overhauled its evaluation procedures, the wait time averaged more than 37 days.

For members experiencing acute or chronic pain, that’s a long time to wait for a first intervention.

“Some of these patients were feeling like they had been forgotten,” says Jodi Lippmann, the team’s licensed practical nurse and a member of SEIU Local 49.

Fast tracking patients

To connect Medicaid members to care faster, the team obtained permission from Northwest practice leaders to allow its licensed practical nurse and medical assistant to complete the questionnaires.

The team’s new “fast track” system for Medicaid members meant wait times decreased by 35% -- from 37 days to 24 days – from March through June 2021.  This far exceeded the team’s original goal to reduce the wait time to 32 days.

The revamped approach continues to pay dividends – with wait times for all Spine Center referrals continuing to drop. Market leaders have taken notice, too. They recognized the team for improving service access, holding it up as a model for others to follow.  

“Everyone on our team came together on this project,” says Sophia Le, the team’s management co-lead. “The result is better service to our patients.”

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.”