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You Gotta Learn

Deck: 
A psychologically safe environment is essential to teamwork and innovation

Story body part 1: 

The theme of the 2012 Union Delegates Conference was “You Gotta Move”—and Amy Edmondson’s advice for the delegates was “you gotta learn.”

The Harvard Business School professor studies what she calls “learning environments.” To support innovation and teamwork, it’s essential the Labor Management Partnership and unit-based teams foster learning environments throughout Kaiser Permanente.

Imagine the ideal learning environment: People feel free to take risks. They feel psychologically safe. They believe they won’t be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. “Without that kind of psychological safety, it’s very hard for an organization to learn,” says Edmondson.

Now imagine the opposite of a learning environment, one where no one speaks up. “Nobody ever got fired for being silent,” says Edmondson. “And yet many bad things happen as a result of silence. Silence is a strategy for individuals to stay safe, but not necessarily for patients to stay safe or for organizations to stay vibrant.”

Creating a learning environment is up to leaders—to those people with influence, whether or not they have a formal leadership role.

“Leaders have to go first,” Edmondson says. They “have to be willing to ask questions themselves, invite participation, acknowledge their own fallibility, and to explicitly state we don’t know everything yet.” These behaviors help an environment where others can take the risks of learning.

But, she cautions, “The learning environment doesn’t live at the ‘organization’ level. For the most part, there are pockets of learning environments.…In a large, complex system, answers don’t come from central headquarters or the CEO. The answers come from the people at the front line doing the work.”

A labor management partnership like the one at Kaiser Permanente “is an important foundation” for building a learning environment, says Edmondson. “A true partnership is completely consistent with the context for mutual learning.”

Both management and union UBT co-leads can help create a learning environment by articulating the unit’s or department’s purpose and goals “in a meaningful way that touches hearts and minds, that motivates and encourages,” she says.

They can—and must—also reduce the fear people experience that makes them reluctant to speak up. The LMP helps develop and support people, helping them be their best and most courageous, Edmondson says.

TOOLS

PowerPoint: The Power of Teaming

Format:
PPT

Size:
11-slide deck

Intended audience:
Sponsors, UBT co-leads, trainers, facilitators, stewards

Best used:
Harvard Business School Professor Amy Edmondson delivered this presentation, "The Power of Teaming," at the March 2012 Union Delegates Conference to explain her research on how nimble, successful organizations and projects increasingly rely on teaming rather than stable, unchanging teams. She demonstrates how leaders can create a culture of teaming by fostering psychologically safe learning environments where innovation can flourish. Use to help build a culture of teaming, or "teamwork on the fly," and foster productive collaboration among UBTs and across departments.

Related tools:

Bolder Communication Helps Diagnose Malnutrition

Deck: 
Dietitians play a key advocacy role for at-risk patients

After Northern California began a regional push in 2009 to improve the identification and diagnosis of malnourished patients, the Roseville Medical Center sought to put the plan to action.

The clinical nutrition team was partifcularly concerned because diet plays a key role in the body’s recovery.

This can be especially true for the elderly and patients with diabetes —two groups at the highest risk for malnutrition. Mary Hart, director of clinical nutrition for Roseville and Sacramento medical centers, says a lack of proper proteins and vitamins affects their ability to recover and heal.

And short hospital stays can be particularly challenging because most patients don’t stay in the hospital very long.

After sifting through the electronic charts of all admitted patients, the dietitians must spot patients “at risk” for malnourishment and reach them in time for a full evaluation and treatment—all before the patient is discharged.

While physicians are the only ones who can make an official diagnosis, they rely on clinical dietitians to assess the patient and alert the physician.

“We keep track of the number of patients who have met the criteria for clinical malnutrition, communicate that to the physician and follow up to see if (the patient) has actually been diagnosed,” Hart says.

The dietitians at Rockville put their assessments and recommendations into a patient’s electronic chart, but everyone did so a little differently.

So they standardized their process and language, which included bolding notes to doctors and speaking directly to them about potentially malnourished patients. Those simple steps made it easier for physicians to know what to look for, and diagnose accordingly.

“It helps because we can see them sooner and start nutritional management sooner and figure out how to refer them to outpatient care after they are discharged,” says labor co-lead and registered dietitian, SEIU UHW, Jennifer Amirali.

The team also piloted a KP HealthConnect tool that made it easier and quicker for clinical dietitians to identify at-risk patients. It pulls data from electronic medical records, and color-codes assessments, recommendations and final diagnoses between dietitians and physicians.

“There was more recognition (among physicians) of what a dietitian does other than just ‘serve food,’” Amirali says.

Hart agreed.

“(Physicians and administration) now see the important role of dietitians in the care team and what we can contribute to the organization and the health of the patient.”

For more about this team's work to share with your team and spark performance improvement ideas, download a poster or powerpoint.

TOOLS

Poster: Transporting Patients on the Fast Track

Format:
PDF (color and black and white)

Size:
8.5” x 11”

Intended audience:
UBT members, co-leads and consultants

Best used:
Posted on bulletin boards, in break rooms and other staff areas, t
his poster highlights a transport team that improved turnaround times.

 

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TOOLS

Poster: Reduce Patient No-Show Rates

Format:
PDF (color and black and white)

Size:
8.5” x 11”

Intended audience:
UBT members, co-leads and consultants

Best used:
Post on bulletin boards, in break rooms and other staff areas to demonstrate
 how reminder calls can reduce patient no-shows.

 

Related tools:

TOOLS

Poster: Addressing Complaints Improves Service

Format:
PDF (color and black and white)

Size:
8.5” x 11”

Intended audience:
UBT members, co-leads and consultants

Best used:
This poster describes how the Fresno Health Information Management UBT used directional signs and restaurant pagers to improve customer service. Post on bulletin boards, in break rooms and other staff areas.

 

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Better Monitoring Fast-Tracks Medi-Cal Payments

Deck: 
Attention to detail improves the billing process

The Business Office at the Redwood City Medical Center in Northern California was letting some of their bills slip by.

Specifically those billed to Medi-Cal and the Northern California region asked facility business offices to improve the turnaround time for filing those treatment authorization requests.

They wanted to improve the reimbursement rate for care provided to Medi-Cal patients because that initiated payment to Kaiser Permanente. So, the region asked facilities to file the authorizations within five days from the day a Medi-Cal patient was discharged.

But apart from the one-year time limit on billing, a lot of business departments didn’t monitor the number of days it took to file those requests. Sometimes it might take 30 days, other times perhaps just two days. They needed a consistent turnaround time. 

“A dollar devalues the longer it’s out there,” says Pattie Murphy-Kracht, director of the admitting and business office. “So an outstanding bill loses its value the longer it’s unpaid.”

The Redwood City team decided to monitor the electronic work queue that tracks patient billing to look for Medi-Cal patients. They also monitored the electronic list of Medi-Cal hospital patients, so the team could anticipate their discharge.

In two months, the number of days to file a treatment authorization request dropped from 21 to two days. 

The team said being open to change was a big reason for their success.

“We’re good at trying different ways of doing things,” union co-lead Jessica Garcia says. “Change isn’t always easy, but we’re not stuck on one way.” 

TOOLS

10-Minute Tool to Build Trust and Confidence

Format:
PDF

Size:
8.5" x 11"

Intended audience:
Frontline teams

Best used:
Share these tips in team meetings and training to learn ways to boost patients' and members' trust and confidence in our caregivers, teams and organization.

 

Related tools:

TOOLS

Inspire Change: A Storytelling Workbook

Format:
PDF (color and black and white) and DOC

Size:
16 pages, 8.5" x 11"

Intended audience:
UBT co-leads and team members

Best used:
This workbook, developed by LMP Communications for storytelling workshops, features simple steps to outline your story. Use it to spread best practices by unit-based teams through presentations, storyboards and newsletters. Download, print out and share with your teams.

Related tools:

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