How UBTs are getting results Examples of operational success

1. How UBTs are getting results Examples of operational success March – December 2011

2. Inpatient Transport, San Jose Medical CenterTransporters Improve Response Times WHAT THEY DID: Moved from a decentralized inpatient transport system to a centralized dispatch system. • RESULTS: • Transporters completed 68% more patient trips per day and arrived at a patient location within five minutes of the call 90% of the time. • The average response time went from 4 minutes to 2.5 minutes. • The change is saving an estimated $200,000 annually from overtime that had been incurred when nurses and other technicians did some of the transporting. • Workplace injuries have decreased, from seven in 2008 to one in 2010. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

3. Physical Therapy/Occupational Therapy, Sunnyside Medical Center, NorthwestSqueezing wasted timeout of inpatient PT/OT sessions WHAT THEY DID: The UBT found that more than half of the time they spent with patients was wasted—either because of the frequent interruptions during a session or because patients weren’t ready for treatment when the therapist arrived. The team decided to post signs on the doors of patient rooms and to improve communication with the nurses on the floor. RESULTS: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

4. Out-patient Pharmacy, Parma, OhioOhio UBT improves service time • WHAT THEY DID: • Developed a customer service survey for technicians to ask members about their experiences and wait times. • Services representatives round regularly in the wait area to look for members who may have been waiting a half-hour or longer. RESULTS: From the fourth quarter of 2009 to the third quarter of 2010, Parma Pharmacy improved the following scores: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

5. FEATURED TEAM: Ambulatory Surgery Recovery, Moanalua Medical Center, HonoluluCutting costs, clutter in the OR WHAT THEY ARE DOING: Team members created a more organized supply room by clearly labeling shelves and supplies, helping them keep better track of their inventory. They are also maintaining the inventory on a computer. RESULTS: The team saved nearly $10,000 per month by reducing duplicate and overstocked supplies for medical center’s operating room. Labor co-lead:Avis Yasumura, RN, Hawaii Nurses Association, OPEIU Local 50 Management co-lead:Janet Lundberg, RN, procedural sedation manager Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

6. FEATURED TEAM: Internal Medicine, Hidden Lake Medical Office, ColoradoNew division of labor slashes patient wait times WHAT THEY DID: To reduce wait times, medical assistants take patient vitals, a job that licensed practical nurses used to exclusively handle. The team also huddles twice daily. RESULTS: The team went from an average wait time of19 minutes to less than 11 minutes. Labor co-leads:Cindy Agan, SEIU Local 105 and Tanya Ball, UFCW Local 7 Management co-lead:Shannon Martinez, nurse managerPhysician co-lead: Angie Martinez, MD Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

7. FEATURED TEAM: Inpatient Pediatrics, Panorama City Medical CenterNo way! Hospital food that kids like? • WHAT THEY ARE DOING: • Cutting back on wasted food and staff members’ time by allowing children to choose their meals from a kid-friendly nutritional menu. • Giving kids restaurant-style menus decorated with smiling giraffes, hippos and other happy animals. RESULTS: Percentage of the parents surveyed who agreed with the statement, “When my child felt well enough to eat, the flavor of the food was satisfactory.” Labor co-lead:Judith Bowers, RN, UNAC/UHCP Management co-lead:Shukla Sen, interim department administrator Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

8. FEATURED TEAM: Pediatrics, South San FranciscoTeamwork gets more kids vaccinated • WHAT THEY ARE DOING: • Children get injections in the exam room, rather than in the injection clinic • Physicians have two versions of the same vaccine to choose from instead of several • Medical assistants and physicians huddle once or twice a day to determine which of their incoming patients need vaccines. Medical assistants then have shots ready for those patients. RESULTS: Over nine months’ time, the percentage of children ages 2 and younger who are current on their immunizations rose: Labor co-lead:Steve Levi, medical assistant, SEIU UHW Management co-lead:Sue Sorensen, pediatric manager Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

9. FEATURED TEAM: Oncology, Redwood City Medical CenterTaking all calls WHAT THEY DO: To boost its low phone service scores,team members: RESULTS: MPS scores for overall phone service increased 26.8 percentage points over the last year. • Route calls from call center directly to the department. • Wear wireless headsets so staff can answer calls while away from the main phones. • Installed a new voicemail system for the department. Medical assistants review and return calls hourly. • Corrected phone number listing in the Patient Member Handbook. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

10. FEATURED TEAM: General and Plastic Surgery, Fontana Medical CenterWait times irritating members? Here's a solution WHAT THEY DO: To keep patients informed about wait times, schedulers and receptionists pair up for one-hour shifts during the predictably busy times in the department's two clinics (plastic surgery and general and vascular surgery). Working together, each pair observes the waiting room and checks in with patients who are experiencing delays. RESULTS: Positive patient responses for staff communications for the two clinics (combined) Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

11. FEATURED TEAM: Laboratory, Anaheim Medical CenterDoing blood work in time for morning rounds WHAT THEY DO: To speed up the processing of blood draws: RESULTS: Between August and November 2010, blood work was processed by 9 a.m. 93 percent of the time, up 20 points from when the project started in February 2010. • Lab assistants pick up blood specimens on the 6th and 7th floors of the hospital at 6 a.m., rather than having a runner deliver them. • Lab assistants drop off specimens every half-hour throughout the day, instead of a runner delivering them. • Clinical lab scientists from other lab department help process blood in the morning. • Clinical lab scientists start work at 6 a.m. instead of 9 a.m. on the weekends. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

12. FEATURED TEAM: Financial Counselors, NorthwestEasing patients’ financial pain WHAT THEY DO: To respond more quickly to financial aid applicants, financial counselors at clinics throughout the region help each other process applications--so if one counselor is backed up, a counselor with fewer pending applications will pitch in. Counselors report workload statuses at weekly huddles, which are conducted via Sametime on Lotus Notes. RESULTS: The team reduced the application processing time from 30 days in February to 10.75 days in May. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

13. FEATURED TEAM: Admitting, Redwood City Medical CenterMastering Medicare claims WHAT THEY DO: To ensure they are obtaining correct and complete primary insurance information for Medicare fee-for-service patients through the approved Medicare Secondary Payer Questionnaire (MSPQ), the admitting department team: RESULTS: MSPQ accuracy improvement • Increased training, self-audits and teamwork.Works with regional auditors. • Conducts daily department-wide and self-audits. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

14. FEATURED TEAM: Diagnostic Imaging (Radiology), South San Francisco Medical Center and Daly City Medical Office BuildingRadiology team uncovers sources of absenteeism WHAT THEY DID: To address a high number of employee sick days, employees filled out an anonymous online survey, which showed confusion about leave eligibility. The UBT then developed new guidelines covering sick leave, tardiness and clocking in and out. Employees who meet the newly defined targets are invited to a celebratory luncheon. RESULTS: The department's average number of annual sick days per FTE: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

15. FEATURED TEAM: Admitting, Anaheim Medical CenterCo-pay collection pays off WHAT THEY DID: RESULTS: The percentage of monthly point-of-service hospital co-payment collections increased by 15.6 percentage points over seven months, from a baseline of 57 percent in January 2010 to 72.6 percent in July 2010. • Trained a group of master trainers, who then coached and trained their peers about the importance of co-pay collection, the collection process itself and how to ask patients for money. • Educated inpatient nursing and frontline staff about the importance of collecting co-payments and about the availability of financial counseling for patients. • Hired a new financial counselor and stationed her where she can easily answer questions during the admitting process and interview patients in need of financial assistance. • Moved and Admitting clerk to the Emergency Department to collect co-payments Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

16. FEATURED TEAM: Neonatal Intensive Care, Downey Medical CenterNeonatal unit’s ‘Three Cs’ for outstanding service WHAT THEY DID Comfort, creativity, communication • Encourage parents to hold their babies, skin to skin, on their chests, sometimes for several hours at a time. • Provide a quiet, private room for parents, giving them a chance to rest, shower and make difficult decisions about their child’s care. • Converted a crash cart into a craft cart so parents can make a personalized tag for their baby’s crib. • Offer scrapbooking workshops to give babies’ parents and siblings a creative outlet and informal venue for interacting and supporting one another. • Created a parent handbook that consolidates the many one-page handouts parents received. • Care providers from all related departments regularly round to prevent gaps and delays in care. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. RESULTS Percent of patients who agreed with the statement, “I would prefer to return to Downey Medical Center if care is needed.”

17. FEATURED TEAM: Neonatal Intensive Care Unit, Panorama City Medical CenterEasing the Pain for babies and families WHAT THEY DO RESULTS Percent of families that agreed with the statement, “I was taught the pain scale and how my infant’s pain would be managed.” • Educate parents about pain management at admission to NICU instead of waiting until an issue arises. • Use a script to educate parents about the type and severity of pain their newborns might experience and what steps healthcare providers would take to manage it. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

18. FEATURED TEAM: Outpatient Main Pharmacy, South San Francisco Medical CenterProactive customer service reduces pharmacy complaints WHAT THEY DID The team identified the main customer service complaints based on data collected from Member Services, alerted employees to problem areas and involved the whole team in addressing them. Changes include: RESULTS In 2010, member service complaints were down 32 percent from the year before, and overall complaints were down 45 percent. • Clerks focus on being attentive to members. • Pharmacy techs assist clerks when lines get long. • Supervisors assist members with concerns or complaints Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

19. FEATURED TEAM: Labor and Delivery, Moanalua Medical Center, HonoluluNurses help newborns get closer to moms WHAT THEY DID RESULTS The percentage of newborn babies spending at least 60 minutes with their mothers in skin-to-skin contact right after birth: • The team created a baseline measure by tabulating instances of skin-to-skin contact for each patient in a spreadsheet, using KP HealthConnect data. • Members of the representative UBT did one-on-one education with fellow nurses and other staff members • The team communicated in different ways, including informal conversations, bulletin board posters and handouts. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

20. FEATURED TEAM: Inpatient Pediatrics, South Bay Medical CenterCute kids inspire clean hands WHAT THEY DO To boost low scores on hand-washing observation surveys, staff members: RESULTS Percent of staff members observed by peers to follow good hand-hygiene practices: • Tabulated peer observations of hand-hygiene practices • Hung posters outside patient rooms featuring photos of cute kids, reminding staff members and visitors to wash their hands or clean them with sanitizing gel. • Mounted sanitizer dispensers outside and inside patient rooms. • Began a practice of talking to patients while cleaning hands to raise their awareness of the issue. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

21. FEATURED TEAM: Food and Nutrition, Panorama City Medical CenterHow a contest can lead to safety WHAT THEY DO The department randomly divided into two teams, which then engaged in a friendly competition to see which team would have the fewest workplace injuries. This motivated—and liberated—staff members to approach their colleagues who might be performing a task unsafely and suggest an alternative approach. RESULTS An 11-month stretch between July 2010 and June 2011 without any accepted claims for workplace injuries, after being one of the top 10 most injury-prone departments at Panorama City. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.