Creating a UBT Culture June 24, 2013

Welcome

Lisa Schilling, Vice President

Center for Health Systems Performance

Rancho Cordova Eye Surgery CenterGot Errors?

Our Team

Name Title/Classification/Union

Dawnell Grant Certified OR Tech, SEIU-UHW, UBT member

Teresa Lee RN, staff nurse III, subject-matter expert

Steve Metzger RN Manager, managementco-lead

Lisa Wilson UBT Co-Lead, Central Processing Tech

Jenee Mateo UBT member, OR Tech

Vicki Green UBT member, Surgery Scheduler

Nit Kharka UBT member, OR Tech

Our SMART Goal

Rancho Cordova Eye Surgery Center will identify, share and evaluate at least five errors per month that could have led to patient harm or injury, by November 30, 2012.

Our Team Culture Was…

• Efficient and safe • Lacked transparency in the department and among

each other• Awareness suffered as a result• In a year period, had one never event and two near

misses

Motivating questions

• How many errors potentially happen daily?

• What do we do to prevent near misses?

• How do we increase staff awareness?

Our Small Tests of Change

Test of Change Results

Created and used the citation form to record errors

In four months, prevented:

•5 potential wrong-site surgeries

•3 patient identity issues

•3 potential medication errors

•1 surgical time-out issue

Challenges

Staff reluctant to use form for various reasons: •“Flavor of the week”•Busy•Why mess with a good thing? •Punitive

• Depersonalized the event • Education• Awareness • Testing “good catch” theme

Overcoming challenges

Our Team Culture Now…

• Increased awareness• Better understanding of the project• Enhanced team work• Better communication• More transparency• Staff feel more empowered

Our Key Learnings

• Teamwork + awareness=safety • Education is key• Trust is essential • Use a safe word or phrase • Always room to improve

Our NQC Experience

• Involvement of entire staff is key to culture change.

• Partnership and standardization plays a leading role in quality and service.

• The everyday work you do has great impact on quality and patient satisfaction

Emergency Department, Sunnyside Medical Center (Northwest)

Our Team


Jay Ravarra Manager

Ally Degatata RN, OFNHP

Our SMART Goal

Kaiser Sunnyside Medical Center Emergency Department will decrease the patient length of stay from a baseline of 2.7 hours to a goal of 1.5 hours by the end of the year (2012) .

Our Team Culture

• High physician and management turnover

• Low morale and low service scores

• Non-functional UBT



Locate triage area and fast track team together

Adopt

Develop new fast track criteria Adopt

Patients receive focused assessment; brought to X-Ray quickly

Adopt

Patients are only in treatment rooms while being treated

Adopt

Fast track rooms protected for fast track patients only

Adopt



Trial medical office beds Abandoned – didn’t like the beds

Trial paper rolls to cover beds Abandoned – preferred linen for patient comfort

Fast Track Results

Standardizing Rooms

Sort: Bins for each item, label each item, conduct regular inventory

Set in Order: Establish permanent home for specialty carts, IV cart prototype

Shine/Sweep: Rearrange room set up, develop cart checklist

Standardize: Clear roles for RNs and techs

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Standardizing Rooms

23

ToFrom


• More satisfied patients • More open environment for offering ideas for

improvement, as demonstrated in improved responses to key People Pulse question

• Those initially most resistant to change became the biggest champions of change

Our Key Learnings

• What worked: holding offsite meetings to establish our new vision, hiring new managers, electing new UBT co-leads, redesigning patient rooms and stock rooms

• Early wins are important• Must clarify expectations and roles, have process

owners with clear accountability • Physician engagement is crucial

Voice of the Customer

Staff Perspective

Our NQC Experience

• Working in a unit-based team and becoming high performing is hard work. Once you reach your goal, it isn’t over. You have to continue to work on improvements and re-build when people leave or processes change.

Histology Department

(Northwest)

Our Team


Saundra Ellis Supervisor

Kristen Mose Histology Tech, OFNHP-Technical

Mary Kilo, MD Chief of Pathology

Our SMART Goal

KP Northwest regional histology lab will improve slide turn-around time from a baseline of 68.6 percent in 2011 to a goal of 90.0 percent by the end of 2012.

Our Team Culture Was…

• Plagued by inefficient workflows

• Pathologists did not feel supported by the staff

• Did not focus on quality assurance

• Low People Pulse scores on Work Unit Index measures

Specimen Life-Cycle

Specimen Collection

Transportation

Accessioning

Gross Exam

Processing

Embedding

Microtomy

Staining

Case Match/Case Assembly

Recuts, Specials, Immunohistochemistry

Path Review

Case Sign-out

Storage/Archive



Visual notification system In progress

Added TAT and quality reports to daily huddles

Adopted

Weekly project team meeting Created engagement with sponsors

Surveys of Pathologists and staff satisfaction

Performed quarterly surveys for 18 months then transitioned to People Pulse and Physician Work-Life Balance surveys

Performance Improvement Tools


Measures Results

Turnaround Time (TAT)

Improved from 68.8% to 80.6% April 2013

Staff Satisfaction Average favorable rating increased from 40% on 2011 People Pulse survey work unit index to 70% on 2012 People Pulse survey work unit index

Pathologist Satisfaction

Increased overall satisfaction from 11% on 2010 Pathologist Work life Survey to 58% on 2012 Pathologist Work life Survey

Our Key Learnings

• The UBT identified, planned and executed all PDSAs.• Strengthened alliance between Histology and Pathology, and

the active involvement of Pathologists• Resources (time, money, expertise) vary in supply and pose

barriers• Labor-to-labor communications strengthened engagement and

commitment to the project.• Given adequate information, the UBT knows what

improvements will make a difference.

Our NQC Experience

• Opportunity to learn from other teams• Sharing the journey of our team with others• Recognizing engaged sponsors, physicians and

UBT team members as the key to success

Closing Thoughts

Lisa Schilling, Vice President

Center for Health Systems Performance

Creating a UBT Culture June 24, 2013

Documents

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