Improving performance and engagement in healthcare “Value and productivity is with the workers”

I’m working on a question and need guidance to help me study.
Read in the PDF file that I have attached below and answer all the following question:

1.Why did KP adopt a performance improvement model? Has it had positive results?

2. Were there risks in attempting performance improvement? If so what?

3. What aspects of KP’s approach do you think have helped foster success?

Lessons from Kaiser Permanente
Improving performance and engagement in healthcare
“Value and productivity is with the workers”
On 15th June representatives from Acas, the IPA, NHS Acute Trusts and PCTs, NHS
Employers, Royal Colleges and Universities took part in a Workplace Innovation Workshop
which focused on a question of key relevance to the future of healthcare: “how do you
involve and engage NHS staff in ways that lead to tangible benefits in patient care and
organisational performance?”
Guest speaker John August (Executive Director, Coalition of Kaiser Permanente
Unions) led a lively and informative discussion on how collaborative working relationships
between management, unions and staff at US healthcare provider Kaiser Permanente create
sustained improvements in quality of patient care.
KP has received a great deal of attention within the NHS for its high standards of patient
care, particularly in the integration of primary and acute services. Less widely reported in the
UK is the high level of trade union and employee involvement that underpins these
achievements, driving the introduction of multidisciplinary teamworking and other service
innovations. Similar stories can be found in several parts of mainland Europe, but in the UK
only a small number of NHS Trusts have begun to build systematic approaches that link
union and employee involvement to quality improvement and performance. This is despite a
growing body of research demonstrating an intimate relationship between quality of patient
care and working practices which fully engage frontline health staff in learning, improvement
and multidisciplinary teamworking.
Kaiser Permanente – Everybody has a responsibility for business outcomes
Kaiser Permanente is the largest non profit health care organisation in the US. KP’s Labor
Management Partnership (LMP) involving managers, workers and physicians is the largest
and most comprehensive agreement of its kind. The Labor Management Partnership was
formed in 1997 after years of labour turmoil within Kaiser Permanente combined with
growing competitive pressures in the sector. Two years earlier, 26 local unions representing
KP workers had joined together in the Coalition of Kaiser Permanente Unions to coordinate
bargaining strategy more effectively. Kaiser Permanente and the Union Coalition created the
LMP as a means of transforming their relationship and the organisation as a whole. Today it
covers more than 92,000 union employees, including some 20,000 managers and 16,000
physicians across nine states and Washington D.C.
Value creation begins at the frontline based on commitment, ownership and loyalty.
Kaiser Permanente aims to fully deploy a team based approach across the whole
organisation as the operating model that will distinguish them from their competitors and
consistently deliver high-quality, affordable service and care. This is based on the following
value principles:
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 Kaiser Permanente members and patients emerge as the focus of improved care.
 Frontline providers see their experience and knowledge at work when they engage in
collaborative decision making and offer innovative solutions to issues of care.
 Stewards and union co-leads are growing into work-unit leaders.
 Physicians are supported in providing high-quality, compassionate, patient-centred
care.
 Managers expand their skills in workplace collaboration, coaching and mentoring.
On a day-to-day basis partnership means that workers, managers and physicians
engage in joint decision making and a problem-solving process based on common
interests.
Kaiser Permanente’s Value Compass
John August spoke of KP’s Value Compass, originally formulated by the LMP to set the
direction for improving organisational performance by focusing on subscribing members of
the public and patients. The Value Compass is now driving the Corporate Agenda, based on
the concept of the balanced score card to maximise performance and so create value.
Value Compass V=Q/C Value is Quality divided by Cost :
The four points of the Value Compass place patients and insured members as the central
focus:
 Quality – through health outcomes
 Affordability – through cost efficiencies
 Best place to work – through employee voice
 Service quality – the experience of patients and users.
The Value Compass:
 is a decision-making and problem-solving tool, reminding teams to put the patient
and his or her needs at the centre of their work;
 provides clarity for the performance improvement efforts of unit-based teams in every
region;
 helps small teams support their department’s goals and helps departments align with
KP’s regional and national goals;
 reminds teams to focus on metrics – achieving measurable progress allows sharing
of best practices.
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Unit Based Teams as the platform for performance improvement
August argues that the KP structure can be seen in terms of three levels: the strategic and
policy level provides a platform for whole systems change and continuous improvement,
the meso level is the locus for union representation and management, and the
microsystems level comprises Unit Based Teams (UBTs) as the basic building block. At
this level there is an expectation that everyone will contribute to building the vision for the
future direction of the business, meeting the needs of the people through Inclusion Control
and Openness. Unit Based Teams tap the creativity, skills and experience of their members
in a process that consistently engages frontline workers in improving performance.
Unit Based Teams were introduced in 2005 and provide the platform for performance
improvement across Kaiser Permanente. A team includes all the participants in a natural
work unit or department, including supervisors, union stewards and staff members,
physicians, dentists and managers. The team supports the regional business strategy and
goals for performance, service quality, efficiency and growth. Because teams increase
consistency and standardisation of treatment, they also improve care. A dramatic reduction
in sepsis has been attributed to the introduction of UBTs, as has the success of the design
and implementation of the integrated IT electronic patient record system.
More than 90,000 employees now work in 3400 unit-based teams—collaborative work
groups that improve performance as part of their ongoing work. The arrangement has been
credited not only with improving patient care and satisfaction, but in making Kaiser
Permanente a better place to work.
The basic process elements of Unit Based Teams
Framing – creates a consciousness and responsibility within the Unit Based Teams. The
case for change centres on understanding the need and consequences of change, and local
level partnership is a key factor in creating such a culture. The co-leaders of the UBT
comprise a medic, manager and trade union representative who drive process improvement
and outcome improvement.
Learning – continuous learning enables psychological safety for asking challenging
questions which are encouraged and supported.
Data – all data is honest, transparent and available to use as a teaching tool across KP.
Open and accessible data is fundamental to creating improvements. All patient involvement
survey data and feedback is delivered to the teams weekly to enable them to track goals.
Improvement work is based on patient outcomes.
Reflection – time to reflect on data is an expected part of day to day activity in all UBTs.
Goal Setting leading to improvement in through-put and targets is agreed at local level by
asking ― Can we improve throughput without compromising safety‖.
RIM / PDSA – resistance to the mechanistic adoption of Six Sigma and Lean from the union
side lead to the formulation of KP’s Rapid Improvement Model and PDSA (Plan, Do, Study,
Act) as drivers for whole system sustainable change. These embed daily activity within each
UBT around the question “how do we know we have improved?”
Members of a unit-based team work collaboratively as partners and participate in:
 Planning and designing work processes.
 Setting goals and establishing metrics.
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 Reviewing and evaluating team performance.
 Budgeting, staffing and scheduling.
 Identifying and resolving problems.
UBTs work on:
 Day-to-day operations.
 Work environment.
 Improving performance.
 Initiatives such as workplace safety.
 Work flows and design.
UBTs do not work on:
 Changing Kaiser Permanente’s strategic direction.
 Scope of practice.
 Labour relations or contractual issues.
 Legal or regulatory issues.
As more UBTs focus on performance improvement work, they make changes to processes
and procedures that have a ripple effect throughout the organisation. An essential part of a
leader’s role within whole systems thinking is the ability to step back, look at the big picture
and assess the impact of decisions and changes on other parts of the organisation. Doing so
promotes organisational learning and breaks down silos.
KP believes that significant improvements can be achieved in health care when Unit Based
Teams consider how changes affect the entire system. Leaders of Unit Based Teams can
coach teams to incorporate systems thinking into their small tests of change and their dayto-day work.
Conclusion
Participants at the workshop spent considerable time and energy debating why, if
partnership such as that at KP actually produces better outcomes for patients, organisations
and staff, everyone isn’t doing it.
Lack of knowledge amongst all the main stakeholders, NHS managers preoccupied with
targets and short term thinking, union officials fighting an endless succession of
disciplinaries and attacks on employment rights, and “experts” obsessed with the latest
management fads all share the blame.
Meanwhile much of the knowledge, experience and public service ethos amongst frontline
workers remains untapped as a resource for improving the quality of patient care – and for
securing the future of the NHS. Employees at Kaiser Permanente were a catalyst for change
saying ―Make where we work a place that I can do my job!‖. NHS employees need to have
their voice heard.
Rosemary Exton
UKWON / Workplace Innovation Limited
June 2011