Quality Improvement

A Strong Start for Unit Based Teams

The first ever UBT Co-Lead Peer-Learning event opened with SHARE Union organizer Janet Wilder thanking everyone in the room. Janet said that the newly defined relationship between SHARE members and managers is the most important language in our contract as we aim to improve the culture of our hospital. She explained that Unit-Based Teams are the cornerstone of that agreement, the most concrete and hopeful effort toward changing how it feels to work here.

Janet is the SHARE Tri-Chair of our Labor-Management Partnership Council, along with Bart Metzger, Chief Human Resources Officer, and Jeff Smith, Chief Operating Officer,

who also

kicked off the

meeting by talking about the importance of UBTs. Jeff Smith said that involving front-line staff in fixing the problem is better than the alternative: “I could give you an answer quickly, but it would be a bad solution.”

The first UBT Peer Learning Session brought together UBT Co-Sponsors and Co-Leads from SHARE, along with their management counterparts, as well as representatives from CITC, HR, and UMMC Executive Leadership. They came together to compare notes about the challenges and successes so far in the first wave of Unit Based Teams

As the hour developed, it became clear to everyone in the room that, across the board, the Unit-Based Teams are off to a productive and promising start. Each UBT has selected one or two substantial problems to tackle in their areas. They've defined their goals, and have begun measuring the effectiveness of their ideas.

SHARE Member and Lead Cardiac Catheterization Technologist, Sue Maddalena, describes how their UBT disregarded the advice that teams should avoid tackling the hardest problems first. They're seeing early successes as they work to improve the start times of their cases.   

Each UBT explained very different situations, different approaches, and different results thus far, even between the two Prescription Centers involved, on both the University and Memorial campuses. Nonetheless, common trends appeared throughout. Communication in areas with UBT's has improved, sometimes considerably. That communication is helping the day-to-day work go more smoothly, and improving the work culture.

In Primary Care, they're kicking butt and collecting data. Where employees were previously frustrated with walk-ins, they're now opportunities to collect data to fix the problem. Rita Caputo (SHARE Co-President, pictured above left) tracks the progress of their system improvements. 

SHARE member and Ambulatory Services Rep Mary Misiaszek said that, in her area, she had encountered one particularly meaningful new improvement: deeper respect. In addition, she said different parts of the clinic now "appreciate what everybody did, because we didn't know what everybody did before."

Mary noted, however, that one of the major challenges they faced was just understanding one another, since each kind of work in the hospital involves its own jargon and specialized language. As an ASR, her understanding of the distinction between words like "rapid" and "stat" differs from some co-workers, who use those words within the boundaries of defined clinical guidelines. 

The hospital's

Center for Innovation and Transformational Change

 often came up in the discussion, with participants noting the importance of the role of CITC in providing common language for discussing improvement.

SHARE member Kim Latrobe, a Technologist in the Surgical Vascular Lab, says that her co-workers are more willing to speak up about problems now, and more optimistic about the way that management will consider their ideas. 

Some in the room commented that their department staff had found it meaningful to see SHARE and hospital leadership coming together around the Unit Based Teams. Although SHARE members have experienced many different initiatives aimed at improvement over the years, this feels different. Working through issues in a process where all participants have equal voice creates mutual accountability and improved chance of continual improvement. 

Bart Metzger, UMass Memorial Senior Vice President and Chief Human Resources Officer, said that hospital CEO Eric Dickson increasingly references the importance of UBT's in meetings among hospital executives. Metzger describes the function of the UBTs toward the hospital's goals of transforming and humanizing our institution, and turning the traditional management paradigm on its head.

In the recent months, the participants in these first UBT's have learned a lot about how to launch a UBT successfully . . . much of it by trial-and-error. During the Peer Learning Session, many participants thanked the UBT Coaches and their own Co-Sponsors, who have been supporting the teams with tools and strategies for tackling big problems productively. 

Although the UBT model involves a lot of planning, there have definitely been surprises in their initial experiments. The participants recommended even more training and more planning time, and encouraged the Coaches and Co-Sponsors to begin working with the next wave of UBT's as soon as possible, even though those teams won't be launching until after Epic Go-Live. We look forward to hearing more from this first group of UBT's.

SHARE Staff Organizers Janet Wilder and Will Erickson collect ideas and advice for improving the launch of the next wave of Unit Based Teams

The hour-long meeting brought together union members and management from the University Campus and the Memorial Campus, not to mention a labor-management pair who commuted in from our hospital's Tri-River facility in Uxbridge. 

It wasn't easy to coordinate a time when so many could be away from their desks and workstations.


e know that whenever employees step away from the front lines to meet, it puts more pressure on those who remain in the departments to care for patients. We recognize those of you who are working in areas with UBT's for getting this important project started in such a strong way

. Already hundreds of SHARE members have helped move the work forward. Thank you. 

Union Member Audrey King on Unit-Based Teams at Kaiser Permanente

I met Audrey King during a recent trip to Washington DC. The visit continued SHARE's study of union-management partnership in the Kaiser Permanente healthcare network, and how participation makes things better for front-line employees.

Audrey has worked at Kaiser Permanente for 36 years. She has seen the change that Unit-Based Teams has brought to her work there. I thought Audrey had some great things to say, so I asked her if I could record her so SHARE members could hear what she had to say. (Sorry about the noise in the background of the cafeteria!)

Here's a little more about who Audrey is: She's a member of OPEIU Local 2 (one of three union locals representing employees at Kaiser Permanente in the Mid-Atlantic region). Together with the regional quality manager for the KP Labs, Audrey made a presentation to us at their Capitol Hill Medical Center about how the union and management co-sponsors help to make the UBTs successful. (It was cool that every presentation in our day-long visit was made in pairs: a union person and a manager.)

SHARE Field Report from Kaiser Permanente Capitol Hill Medical Center

In early March, eight SHARE leaders and nine UMMHC management leaders visited Kaiser Permanente's Capitol Hill Medical Center in Washington DC. SHARE has been studying the Kaiser Permanente unions’ progress in transforming culture. And we’ve been negotiating ideas from their model with our own hospital leadership.

This trip, however, was our first opportunity to see the work at Kaiser Permanente firsthand, up close, in partnership. Together, we got the chance to meet with our Kaiser counterparts (union leaders with union leaders, HR with HR, surgical and clinical management with management.) One of the key themes of the day was that partnership, and the benefits of partnership, are only as strong as its unions: "I've worked in a lot of different ways. And labor management partnership is the best," one labor leader told us. "But never forget you're a union."

At Kaiser Permanente's Capitol Hill Medical Center:
Shenita Stewart (Pharmacy UBT Co-Lead, OPIEU Local 2),
Cliff Lovett (Pharmacy Manager & UBT Co-Lead),
and Wendy Williams (Improvement Advisor, UFCW Local 27)


The cornerstone of our 2016 contract agreement, Unit-Based Teams, is based on a model that Kaiser and its unions pioneered a decade ago. We have launched our first six here at UMass Memorial in the last few weeks, and co-sponsors of those new Teams got to look under the hood at some established, long-running UBT’s in Washington.

Our contingent met directly with the co-leads of the Unit-Based Team from the Pharmacy at their Capitol Hill location. The two co-leads of the UBT, Shenita Stewart, a Pharmacy Technician and union member, and Clifford Lovett, the manager were proud of two highly successful improvement projects their department had worked on: getting prescriptions more quickly to patients, and increasing sales of Over-the-Counter drugs. For each project, their team experimented with improvements, systematically. They tried some things that didn’t work . . . and when they realized those ideas wouldn’t pan out, they quickly stopped. They landed on some things that really worked. 

Shenita told us that some of her co-workers didn't believe that UBT would make a difference at first. She acknowledged that their department still has issues to work on, but says that morale is much higher, attendance is better, and she’s seen a lot of improvement in the culture.


Some SHARE and UMass Memorial folks got to sit-in on a UBT meeting in the Pediatric Subspecialty Clinics. "It was fascinating to see consensus decision-making in action," said Bobbi-Jo Lewis from SHARE. "The co-leads went around the group, asking what each person thought, before they went forward. The group agreed to take on a project to explore sending thermometers home with families, even though it was only important to some of the sub-specialties, because they decided to support each other."


Some Kaiser Permanente UBT’s involve patients directly in their Improvement Projects. For example, they might invite a patient with a particular complaint to come talk to the department. Lu Casa, a UFCW Local 400 union member and UBT Co-Lead in the Adult Medicine Department, described her department’s efforts to manage blood pressure rates at the population-level in their community. You can see about that for yourself in the video below. It’s a fun one . . .


In DC, we learned much more about how to start a UBT on the right foot, and to ensure that it is genuinely co-led by management and labor.  We also learned about the things the Kaiser unions have been able to achieve in partnership that they were not able to do through adversarialism.  

SHARE Co-President Rita Caputo said that her biggest regret about the trip was that they couldn’t stay longer and dig deeper into how the employees there go about solving particular problems. She really appreciated how open the staff were, “They were so efficient and thorough and knowledgeable, and completely willing to let us pick their brains.” It was apparent to Rita that their experience showed them what worked. “They’re normal, like us,” she said, “and they’ve figured out for themselves how to keep making things better.”

One of the side benefits of the trip was spending so much time with our management partners.  We returned to Massachusetts with a deeper appreciation of one another’s strengths and challenges, as well as a stronger sense that we can achieve more for our members and the people they care for if we approach one another as allies rather than adversaries.

SHARE and UMass Memorial manager Co-Leads and Sponsors with Kaiser Permanente management and union leaders

Unit-Based Teams: Fixing Healthcare, Making Work Better at Kaiser Permanente

Bart Metzger (UMass Memorial Senior Vice President
and Chief HR Officer), Hal Ruddick (Executive Director,
Kaiser Permanente Coalition of Unions), and
Janet Wilder (SHARE Organizer)
Hal Ruddick leads the union side of the biggest and most successful labor-management partnership in health care, and perhaps in all American industries. He’s the Executive Director of the Kaiser Permanente Coalitions of Unions, which represents 28 local unions and 115,000 union member employees at Kaiser Permanente. (SHARE has sister AFSCME union locals that represent employees at Kaiser Permanente and are part of the coalition.)
Hal Ruddick spoke at the monthly SHARE UMass Memorial Labor Management Partnership Council meeting, so we could learn from their experience.
To Ruddick, this is about fixing healthcare in America. The goal is high quality, affordable care for all, and the Kaiser unit-based teams (UBTs) and labor management partnership are working to get there.
Ruddick added that unions face many challenges right now, and that this is one vision for strengthening unions. Continuous improvement in healthcare through partnership is the foundation for good high quality union jobs.  He says that people choose to work in healthcare to make a difference, but sometimes the experience of working in healthcare drives the passion out of people. “Your work in creating UBTs is key to sustaining a sense of meaning in these jobs.”
One LMPC member asked about the Kaiser Permanente experience with the changing roles of managers and employees with UBTs. Do managers may feel they are being asked to give up control? Hal Ruddick explained that teams have a lot of tools to try to build consensus, but in the end of the day, managers can still manage and labor can still respond. Managers begin to realize that working together with their staff they can find solutions that help reach the managers’ goals. Ruddick says it’s a change for labor too: If you are part of designing a solution, then you own the solution and have to take some responsibility for it.

Introducing the First Unit-Based Teams

SHARE is moving toward a new kind of teamwork. The Unit-Based Team (“UBT”) is the best model SHARE has found for raising the level of hospital employees’ satisfaction at work. With UBT’s, every person in a work area, or Unit, has a safe way to directly shape how the work gets done. This transition to teams means SHARE members and managers will learn to work together differently.

Co-Leads from Tri-River and Primary Care talk about their hopes and fears about UBT's with SHARE UBT Coach Marie Manna



On February 16th, the first joint SHARE-UMass Memorial UBT Training session brought together Co-Leads and Co-Sponsors from five of the first Unit-Based TeamsThe room was packed with SHARE members and their management counterparts. They spent the morning learning skills for cultivating their teams. Based on the training, they talked about what opportunities they might want to explore, and what pitfalls they could foresee to avoid.

As SHARE Organizer Janet Wilder put it, over the coming years, these first UBT departments will be doing “a little bit of guinea pigging, and a whole lot of pioneering.” We wish them luck, and look forward to using what they learn as the UBT's expand to other areas of the hospital system.

The first wave of teams includes:

  • Heart and Vascular Intervention Lab
  • Prescription Centers (from both the Memorial and University campuses)
  • Primary Care
  • Tri-River Family Health Center
  • Vascular Lab

Prescription Center Co-Leads Jackie Breeds  and Kristine Stapelfeld with Co-Sponsor Maddy Popkin in the middle

From the Cath Lab: Co-sponsor Kati Korenda, with Co-Leads Mary Hodgerney, and Kathy Girouard

University Campus Prescription Center Co-Leads Laurie Aubuchon, Cathy Gaulin, and Lorna Schulze

Prescription Center Co-Sponsors Deb Largesse and Roland Bercume

Michelle Drew and Mary Misiaszek

from Tri-River Family Health in Uxbridge

Talking About Improvement at the Front Lines in the T&G

If you missed Doug Brown’s contribution to the Worcester Telegram & Gazette’s “As I See It” column this past weekend, it’s worth catching a couple of highlights that affect us as SHARE members. His piece explains to the broader Central Massachusetts community how our hospital is applying “Lean” to patient care, and why.
Doug is President of UMass Memorial Community Hospitals and Chief Administrative Officer. He writes that, “The method employed by ThedaCare [a hospital network based in Wisconsin], commonly known as Lean, is about two fundamental principles: respect for people and continuous improvement.”
Those principles jive nicely with SHARE’s core beliefs: that the employees who do the work firsthand should be the ones who define how that work gets done. And those principles are very much at work in the new SHARE-UMass Memorial Contract Agreement. Frankly, we couldn’t have said it better than Doug Brown did in the T&G:
While seemingly simple, these principles have profound implications for how an organization is managed. Respect for people turns the traditional top-down management style on its head. It recognizes that the best ideas come not from senior leaders, but from those on the front line. That is where value is created in an organization. The job of leaders is to develop systems and tools to unleash those ideas. And then get out of the way.

You can read about more about SHARE’s firsthand impressions of ThedaCare hospital and Lean here on the SHARE blog.

Future @ Work: SHARE at the FMCS Conference 2016

SHARE leaders have travelled to Chicago this week to attend the Federal Mediation and Conciliation Services Conference. The event brings together an all-star cast of labor and industry leaders, as well as academics and facilitators.

SHARE/UMass Memorial
Interest-Based Bargaining Facilitator, 
Joel Cutcher-Gershenfeld,
moderating the Partnership Day discussion
In past years, SHARE has presented at the conference, describing our unique kind of union, as well as our successes with UMass Memorial to engage our members in improving patient experiences.

This year, the theme is “Future @ Work.” SHARE has focused its attention on the various models of union-management partnership to better understand how we can better cultivate our own union for the future. Participants at this year’s conference have been invited to:

  • Learn from distinguished labor, management, and new economy thought leaders
  • Problem Solve at workshops focused on actual situations and practical solutions
  • Network with labor relations and workplace professionals from around the country and the world
  • Prepare your organization for the future with advice from experts who are forging paths to partnership and organizational success

Former U.S. Secretary of Labor, Robert Reich,
delivering the keynote address
at FMCS 2016 Partnership Day
The FMCS is an independent agency within the Federal Government whose mission is “to preserve and promote labor-management peace and cooperation.” Their staff provides mediation and conflict and resolution services to business, government, and community groups around the country. Speakers at this year’s conference  include national labor-management and economy leaders, such as Richard Trumka, President of the AFL-CIO; Bill Ford, Jr., Executive Chairman of the Ford Motor Company; and Thomas Perez, U.S. Secretary of Labor.

We’re looking forward to hearing reports from the various panels, presentations, and workshops that our friends are attending. More to come . . .

One Kaiser Permanente Unit-Based Team, and $47,000 Worth of IUDs

The hospital workers from Kaiser Permanente that I met at IHI all seemed so proud of the work their unit-based teams are doing.

A good example are the three co-leads of a unit-based team from the OB/Gyn clinic of Kaiser Permanente Los Angeles Medical Center: Richardson, the manager; Brittanye an LVN (Licensed Vocational Nurse, like our LPNs); and Marcia, a Nurse Practitioner. Brittanye and Marcia are both union leaders, from 2 different unions.

How Unit-Based Teams Change the Day-to-Day Experience at Work at Kaiser

When I asked how the unit-based team changes work for her, Brittanye told me, “You have more input. It makes us feel better because our voice is heard. When we are asked, we feel we are going to be listened to…. It’s more collaborative, not management saying ‘this is how it’s going to be.’ We can make it better and get the job done.”

Richardson, the clinic manager, said their unit-based team collapsed the first time they tried to get it going, but now it's thriving. “Finally we have a team where we all listen to each other. We aren’t just talking at each other… We respect each other. I want our department to shine. I have pride in my department, and I trust my employees. I have pride in what we work on together. I listen to what they say. It fills me with joy to see them thinking outside the box, and to see how much they care about the patients.”

Harvesting Old IUDs to Improve Work and Patient Care

One of this unit-based teams projects was setting up a process to return unneeded IUDs, which are worth about $500 each when returned to the company. Creating a new, and smooth, process to make sure the IUDs didn’t get trashed involved the front desk, the Medical Assistants, the physicians, and the LVNs.  As Richardson said, “It wouldn’t be successful if we didn’t have the engagement of everyone.”

Over 11 months, the OB/Gyn clinic saved $47,000 by returning IUDs. Brittanye said they were able to buy 5 new ultrasound probes with the money they saved last year. “That increases access for our patients, and they have to wait less. The staff is happier and it’s not as stressful.”

Why Kaiser and the Unions Created Unit-Based Teams

The coalition of unions at Kaiser and Kaiser Permanente management negotiated to put in their contract a system of unit-based teams in every department. Unit-based teams tap into the knowledge and experience of front-line staff, managers and physicians. According to the Kaiser Permanente Labor Management Partnership website, “These teams are transforming Kaiser Permanente by changing the roles of union members and managers and creating an environment in which all employees are encouraged to think critically about problem solving and work innovations.”

SHARE and UMass Memorial senior management have invited a union and a management representative of the Kaiser Permanent Labor Management Partnership to visit UMass Memorial, to explain how their unit-based teams work. 

(The first 2 pictures show the OB/Gyn Unit-Based Team at a celebration of unit-based teams' work. The 3rd picture shows the three co-leads that I met at IHI -- Brittanye, Richardson, and Marcia.  -- Janet Wilder)

Looking at How Other Hospital Unions Are Making Work Better

One main focus of the upcoming contract negotiations for SHARE will be improving the day-to-day experience for SHARE members. To prepare, SHARE is looking at what other hospitals and unions are doing.

The annual IHI (Institute for Healthcare Improvement) conference is a great place to meet people doing innovative work. IHI is a world leader in the effort to improve healthcare, and to make good care available to everyone. The conference brings together healthcare leaders, front-line employees, nurses, doctors, medical students, administrators, and a few of us from organized labor. It was inspiring to be with over five thousand people from all over the world who are trying to make their hospitals better.

Highlights from other unions:
  • UNITE HERE, a union that represents hotel workers in Los Angeles, is running classes for their members (voluntary, of course) in self-management of chronic disease. Many members are feeling healthier, and they are keeping the costs of their health insurance down. (For more info, see link to video, link to report with health outcomes data.)
  • CIR (the Committee of Interns and Residents, a union of doctors), teaches process improvement to new doctors, who are motivated to gain those skills and experiences to use in their careers. You can read about them here, here and here.
  • I got to learn a lot more about the Labor Management Partnership at Kaiser Permanente. The best part was meeting the union & manager co-leaders of unit-based teams in their departments. Kaiser rewards the 30 best unit-based teams every year by sending the co-lead to the IHI conference.
  •  I went to a workshop from Kaiser called "Workers and Patients: A Single Culture of Safety" where they said that the best prevention for injuries is to have a good team, where workers feel free to speak up when they see something that could be improved.
The Labor Management Partnership at Kaiser Permanente is really changing the role of frontline staff at their hospitals, and we want to learn a lot more about how they are doing it. This week, we are hosting a series of meetings with a union and a management leader from Kaiser Permanente -- more on that soon.

Pictured: Maggie Ridings, LPN (right) and Jane Baxter, Nurse Manager. Maggie and Jane are co-leads of a unit-based team in the OB/Gyn department and clinic in Alpharetta, Georgia. One of their team's projects was to develop a system to help their patients be sure to pick the right hospital for their delivery, saving their patients money and helping Kaiser Permanente to keep their healthcare affordable. In another project, they built a garden to encourage healthy living for patients and staff. 

Process Improvement Spotlight: Mapping Out New Solutions in Insurance Verfication


Even routine work can get confusing quickly around here. As our hospital grows and technology advances, new complexity arises in the day-to-day. Marion Galeckas, an Insurance Verifier in Patient Access Services, has been making sense of that change throughout her twenty-two years working at UMass Memorial. She works in the Insurance Verification Department specializing in auto liability encounters, where the problems are naturally complex.
Not long ago, in the Idea Board huddle in this area, the staff recognized that they could solve some problems by changing how they communicate about them. I talked with Marion a little bit about their process. It’s a model worth sharing.

Marion is part of the team that makes sure a patient’s hospital bills get sent to--and paid by--the correct insurance plan, whether that’s the patient’s health-insurance or auto-insurance company. Marion spends a lot of time investigating accidents. She speaks with local police departments. She collects a lot of details about automobiles and their owners. She’s been at this for a while. She’s sharp. She’s learned a lot. She’s a professional, and treats her work with professional care. And still, she was frustrated.

The trouble was, the folks in Insurance Verification weren’t the only ones collecting this information. “Sometimes I didn’t know how far to take it,” Marion explained, not knowing the point where an employee in another financial department might pick up the work. In the end, the investigatory work was sometimes even being done in triplicate. And still, sometimes, something could somehow get dropped, leaving no-one in the hospital holding a particular piece of important information.


Marion was frustrated with what felt like a very uncertain and wasteful process, so she put an idea on her department's idea board to pull together all the different people involved. They would do a deep-dive into the process. This idea led the groups involved, including Billing and Care Coordination departments, to come together with for two intense, focused sessions. They mapped the workflow, who should do each piece of it, and how they would communicate about it. The result is a system that’s working much more smoothly. Multiple departments now dedicate a SharePoint site to manage each particular case. And the SHARE members who participated know that if glitches arise in their new process, they have a way to call together another meeting with other front-line employees to make corrections . . . although their new process is working well after the first few months, and they haven’t had to do so.

Marion says that she’s now more regularly satisfied with her work, knowing that she’s handling her part of the process from a clear starting point to a clear finish, and can better review a complete case for accuracy in the end.

Beyond that, it’s in describing the mapping events that Marion seems to me the most enthusiastic. Before the meetings, Marion had been speaking with many of the other participants over the phone, sometimes for years. And yet, this was the first time she’d ever seen many of them face-to-face, and understood the frustrations from their perspectives. “It was really good to have the time to do that,” she said. “We even shared some laughs.”

These personal interactions reminded Marion of the regular rounding that UMass Memorial employees once did. She enjoyed shadowing the work that others were doing, and learned by comparing experiences. She’s excited to see more of this kind of sharing again.

This process map is making big differences in the way the work gets done in Insurance Verification. And it’s only one of many conversations that together can transform our hospital. As we continue to build our network of information among members and across campuses, please let us know if you have an opportunity for improvement in your area, and stay tuned for more here on the SHARE blog.

SHARE Reps Learn to Use Lean to Improve Their Jobs

One morning in early March, over twenty SHARE leaders from all over UMMHC came together for a special, customized “White Belt” training. We even welcomed a few SHARE colleagues from UMMS who work in related jobs. Our hospital has adopted a "lean methodology," and our union wants to understand that, to know how we can make it work for us. So far, SHARE members’ experience of lean has been uneven: many SHARE members feel that their idea boards are helping make their jobs better, while some have not noticed any change.  Others wonder how to use these tools more effectively.
We began by talking about the purpose of process improvement.  A “good process” is one in which doing a great job is relatively straightforward; in a good process, it is difficult to make a mistake. A “bad process” is unnecessarily complicated, one in which it can be frighteningly easy to make a mistake, leading to high levels of stress and burnout (not to mention worse outcomes).  If you have to struggle against the system to make the right thing happen, leaving you exhausted and frustrated, you’ve got a process that needs improving.  SHARE reps’ stories of processes in need of improvement were hilarious and horrifying, sometimes at the same time.
When some organizations say “lean,” what they mean is “do more with less.” However, SHARE reps learned to substitute an idea of flow, since the point of process improvement is to keep things working smoothly, to remove barriers that get in the way, wasting SHARE members’ time.  Reps learned more about idea board best-practices; many left with ideas about how to improve their department’s board.
One highlight of the morning was a visit from Eric Dickson, CEO of UMMHC, who encouraged the SHARE Reps to "ask what is the problem we are trying to solve?". When a manager or supervisor proposes a process change that an employee is not sure will work, or doesn't understand, Dr. Dickson suggested, rather than just accepting it but being frustrated, or refusing to change, they should ask the manager to clarify the purpose of the change. Ask why. Work to agree about the definition of the problem. He pointed out that when we're on the same page about the problem to be solved, we're more likely to come to consensus about how to solve it.
At the end of the training, the SHARE reps wanted to know more about the flow and problem-solving tools involved in lean. The next step, a “yellow belt” training, is in the works!
All SHARE members can sign up for lean process improvement training (many hundreds have already attended).  You can sign up on Ournet.

Report from ThedaCare

As we prepare for SHARE’s contract negotations with UMass Memorial in 2016, we want to know what other hospitals are doing. We are looking for good ideas that could:

  • Make SHARE members’ work easier, 
  • Increase SHARE members’ “say” at work, and 
  • Improve how it feels to come to work every day.

I visited the ThedaCare hospitals in Wisconsin last week and it was quite inspiring. They believe in two main ideas:

  • Continuous Improvement: They say, “Improving the work is the work.”
  • Respect for People in everything they do.

[For another SHARE perspective on ThedaCare, see this previous blog post]

Their Friday morning "Team Report Out and Celebration" made a big impression on me. Every week, a few teams of front-line staff spend 3 or 4 full days to work on improving some process in their department. At the end of that week, in front of a couple of hundred people, the teams report on what they did. 

Last Friday there were 3 teams reporting out:

  • A PCA (ER Tech), a Respiratory Therapist, and an RN from the ED spent the week re-designing several patient rooms for higher acuity patients. By stocking more supplies in the room, staff now have to leave the room an average of twice per patient, instead of the average of 9 times they were going in and out to get supplies before the re-design. Clearly this is good for the staff and the patient. They improved respect for people, both staff and patients, further by setting up the room so that staff don’t have their back to the patient when looking at the computer, and by improving the room’s ergonomics to decrease staff injuries. 
I really like that front-line staff do the improvement work because they know their work best, and that they have time away from their regular duties for it.
  • RNs from the maternity units on two campuses worked together for the week to figure out why their number of CLABSIs (central line associated blood stream infections) were increasing. They figured out better processes (or “standard work” as they call it), and trained each other. They emphasized "respect for people" in respecting different levels of experience among the staff – with no blame – and giving people the tools and training they need to do their jobs. 
I love it: fix a bad process, don't shame and blame an employee.
  • The Root Cause Analysis (RCA) team re-designed their process to make it faster. These process improvement coaches (like the CITC coaches at UMass Memorial) are on-call for an adverse event. We heard the story of a patient having an assisted fall off an OR table. Right after it happened, a staff person was posted on either side of all OR tables to make sure it couldn’t happen again until they figured out what went wrong. The RCA team would arrive immediately to talk to people about what happened before everyone forgot. Then the RCA team leads a root cause analysis to change how the work is done to make sure that a fall like that can’t happen again.
They see a problem is an opportunity for improvement -- that's a positive outlook that I'd love to see more of at UMass Memorial.

Dr. Dickson leads trips to ThedaCare as an example of the direction he wants our hospitals to go. I agree – they have some very good ideas and it was impressive to see those ideas in action. 

As we collect experiences from other hospitals and other unions who are working to transform healthcare, I’m especially interested in the question: How do we there from here? More on that question to come...

Looking Back: An Earlier Trip to ThedaCare

“Three jumbo jets,” my co-worker, SHARE staff-organizer Will Erickson, said to me, just about a year ago. “That's how many people we kill every day in this country, despite having the supposed best healthcare system in the world.” It’s a rough quote of something that he had heard during his own trip to check out Thedacare. Now that SHARE staff-organizer Janet Wilder is just back from her visit to Appleton, I'm reminded of this conversation. I think it provides some useful context for Janet's more recent report. Here are some of Will's impressions:

KD: What is ThedaCare?

WE: ThedaCare is a mid-sized hospital system in northern Wisconsin. It's got about 5500 employees. So, it's half the size of our place, but spread out. The real reason Thedacare is interesting is because it went from being, you know, a decent hospital, and it became one of the first hospitals in the country -- in the early aughts, under the leadership of this guy John Toussaint -- to try to figure out why factories make so many fewer errors than hospitals . . . despite the fact that hospital staff are so extraordinarily well-trained.

KD: Factories?

WE: I think John Toussaint is an interesting guy. When he became CEO, he figured, you don't get to be CEO forever, so you need to pick one thing that you can work on. Basically he was to bring Lean into the hospital. He did it because he was so horrified by the degree of death and disability that our healthcare system creates. You know healthcare is the third leading cause of death in the country? You’ve got heart disease, then cancer, and then being a patient. Only so many of these are like “oopsie” medication errors. They’re system errors, times when the field of medicine knew what would have saved a person, but that thing didn’t get done.

KD: So ThedaCare’s reputation grew out of an idea that hospitals should stop allowing unnecessary deaths?

WE: Basically, yes. That's what he Toussaint kept saying over and over while we were there: three jumbo jets.  That's how many people we kill every day in this country, despite having the supposed best healthcare system in the world. That defect rate would not be tolerated in any other industry. So Toussaint figured, you don't get to work on everything--so my thing, the thing that I was gonna do--was figure out how to eliminate those kinds of errors. And we're gonna do that through our processes.

KD: Taking care of patients is different from making snowblowers. Why did they think that factory production methods would be appropriate in a hospital?

WE: Toussaint basically said, I went to my friend Don Berwick asked, ‘What other hospitals are doing this?’ And he said, ‘you could be the first one.’ So Toussaint spent some number of months touring around, looking at factories, trying to figure why their defect rates are so low. He got criticized for that. His response to that was, if only we treated patients as well as the guys down the road treat their lawnmowers, we would be saving a hundred thousand people every year in this country.

The long and short of it is that ThedaCare now, ten years later, is the safest, the cheapest, lowest-mortality hospital in the country. They are now able to see to treat twice as many patients.

KD: Don’t employees there worry they could put themselves out of a job if they’re too efficient?

Thedacare really really believes in -- they evangelize about -- their no layoff philosophy. They have a commonsensical view that the people are gonna be wary of of improving themselves out of a job, or their friends out of job.

KD: So how did they do what they did?

WE: They did all of that by focusing on three things. They're always trying to improve quality, lower cost, and engage staff. This is where John Toussaint really started to catch my attention. He said something like, You know, it's easy to work on one of those things. You can go through and make a particular system cheaper by slashing and burning, but your quality will go down, and your staff is going to be angry. Or you could, I suppose, go around and hand ice cream cones out to the staff to make them happier to work there. Maybe that would work for a little while. But the magical thing about healthcare is that as you improve quality, you lower cost. But you can't really improve quality without without engaging staff.

Your people are the same as our people. They’ve gotten into the profession for the right reasons, to come to work every day, wanting to do an awesome job, deliver great care. Shame on all of us hospital leaders for perpetuating the systems that prevent them from being able to do that, to live out their vocation. People come to work wanting to doing awesome job. They want to work in harmony with their team and their institution. They want to have meaningful work.

KD: That sounds like stuff that SHARE has been saying all along, explaining to hospital leaders that if they want to improve systems, that has to be done by the people who know the work best, the people who do it every day.  We’ve seen a lot of dud ideas from previous leaders of our hospital. They hire outside consultants, contract trainers who preach trendy customer service techniques, and fall in love with successful hospitals elsewhere, little of which has improved the work-life of SHARE members. What made you interested to go all the way to Wisconsin to check out ThedaCare firsthand?

WE: Partly, I went because I was accepting an invitation from Eric Dickson. He’s very interested in the model of healthcare that ThedaCare provides. I went with a few different VP’s and Directors from UMass Memorial. We were all scoping the place out. Going there, I knew that ThedaCare has front-line employees at the center of the decision-making, and I’m looking for any excuse to make that happen in our hospital.

Quality Improvement: A Crash Course

If you've been to Lean training, or involved in Idea Board huddles, or just heard the chatter in certain circles of the hospital lately, you're probably aware that there are a lot of new Quality Improvement concepts circulating around UMass Memorial.

In the SHARE office, we recently came across a quick introduction to the general idea of Quality Improvement. I've posted this animated video below. I get the sense that many hospital leaders and QI aficionados are forwarding this amongst themselves, and it's a fairly painless introduction to some of their lingo.  

The video includes an interesting take on curiosity by Don Berwick, founder of the Institute for Healthcare Improvement  (and candidate for Massachusetts Governor during the last election.) 

The video also discusses the IHI "100,000 Lives" campaign, which our hospital participated in. 

The whole thing is just over ten minutes long. See what you think. . . . 

Can Idea Boards and Huddles Make Work Better for SHARE Members?

SHARE is interested in hearing about your experience with idea boards and huddles:

  • Does your department use an idea board and huddle regularly?
  • If so, do the idea board and huddles help make your day-to-day work experience better?
  • Do they help you and your co-workers to improve your work processes?

Come to a SHARE lunch-time information meeting about idea boards and huddles. We'll discuss what makes them work well in some departments, and not so well in others. We'll also talk about what kinds of help are available to SHARE members who want to improve their department's idea board and huddles.

The dates and times of the meetings are listed below. Come during your lunch break, and feel free to bring your lunch with you.

Monday, Oct 20         11:30am - 1:30pm          University, room S2-351
Thursday, Oct 23       11:30am - 1:30pm           WBC, Thom McCann rm 1st floor 
Friday, Oct 24             12pm - 2:00pm                CBO, 4th floor conference room 
Thursday, Oct 30        11:30am - 1:30pm          Memorial 1 conf rm, near the caf.
Monday, Nov 3           11:30am - 1pm               Hahnemann 2nd floor conf room 
Thursday, Nov 6          11:30am - 1pm               Barre Health Center         
Thursday, Nov 13        11:45am - 1:30pm         Tri River Community room