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

2. Inpatient Transport, San Jose Medical Center Transporters Improve Response Times 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. WHAT THEY DID: Moved from a decentralized inpatient transport system to a centralized dispatch system. 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, Northwest Squeezing wasted time out of inpatient PT/OT sessions RESULTS: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. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

4. Out-patient Pharmacy, Parma, Ohio Ohio 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, Honolulu Cutting costs, clutter in the OR Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. Labor co-lead: Avis Yasumura, RN, Hawaii Nurses Association, OPEIU Local 50 Management co-lead: Janet Lundberg, RN, procedural sedation manager RESULTS: The team saved nearly $10,000 per month by reducing duplicate and overstocked supplies for medical center’s operating room. 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.

6. FEATURED TEAM: Internal Medicine, Hidden Lake Medical Office, Colorado New division of labor slashes patient wait times Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. Labor co-leads: Cindy Agan, SEIU Local 105 and Tanya Ball, UFCW Local 7 Management co-lead: Shannon Martinez, nurse manager Physician co-lead: Angie Martinez, MD RESULTS: The team went from an average wait time of 19 minutes to less than 11 minutes. 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.

7. FEATURED TEAM: Inpatient Pediatrics, Panorama City Medical Center No way! Hospital food that kids like? Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. Labor co-lead: Judith Bowers, RN, UNAC/UHCP Management co-lead: Shukla Sen, interim department administrator 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.” 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.

8. FEATURED TEAM: Pediatrics, South San Francisco Teamwork gets more kids vaccinated Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. Labor co-lead: Steve Levi, medical assistant, SEIU UHW Management co-lead: Sue Sorensen, pediatric manager RESULTS: Over nine months’ time, the percentage of children ages 2 and younger who are current on their immunizations rose: 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.

9. FEATURED TEAM: Oncology, Redwood City Medical Center Taking all calls RESULTS: MPS scores for overall phone service increased 26.8 percentage points over the last year. WHAT THEY DO: To boost its low phone service scores, team members: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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.

10. FEATURED TEAM: General and Plastic Surgery, Fontana Medical Center Wait times irritating members? Here's a solution RESULTS: Positive patient responses for staff communications for the two clinics (combined) 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. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

11. FEATURED TEAM: Laboratory, Anaheim Medical Center Doing blood work in time for morning rounds 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. WHAT THEY DO: To speed up the processing of blood draws: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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.

12. FEATURED TEAM: Financial Counselors, Northwest Easing patients’ financial pain RESULTS: The team reduced the application processing time from 30 days in February to 10.75 days in May. 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. 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 Center Mastering Medicare claims RESULTS: MSPQ accuracy improvement 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: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. Increased training, self-audits and teamwork. Works with regional auditors. Conducts daily department-wide and self-audits.

14. FEATURED TEAM: Diagnostic Imaging (Radiology), South San Francisco Medical Center and Daly City Medical Office Building Radiology team uncovers sources of absenteeism RESULTS: The department's average number of annual sick days per FTE: 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. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.

15. FEATURED TEAM: Admitting, Anaheim Medical Center Co-pay collection pays off 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. WHAT THEY DID: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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

16. FEATURED TEAM: Neonatal Intensive Care, Downey Medical Center Neonatal unit’s ‘Three Cs’ for outstanding service WHAT THEY DID Comfort, creativity, communication Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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. 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 Center Easing the Pain for babies and families RESULTS Percent of families that agreed with the statement, “I was taught the pain scale and how my infant’s pain would be managed.” WHAT THEY DO Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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.

18. FEATURED TEAM: Outpatient Main Pharmacy, South San Francisco Medical Center Proactive customer service reduces pharmacy complaints RESULTS In 2010, member service complaints were down 32 percent from the year before, and overall complaints were down 45 percent. 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: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. Clerks focus on being attentive to members. Pharmacy techs assist clerks when lines get long. Supervisors assist members with concerns or complaints

19. FEATURED TEAM: Labor and Delivery, Moanalua Medical Center, Honolulu Nurses help newborns get closer to moms RESULTS The percentage of newborn babies spending at least 60 minutes with their mothers in skin-to-skin contact right after birth: WHAT THEY DID Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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.

20. FEATURED TEAM: Inpatient Pediatrics, South Bay Medical Center Cute kids inspire clean hands RESULTS Percent of staff members observed by peers to follow good hand-hygiene practices: WHAT THEY DO To boost low scores on hand-washing observation surveys, staff members: Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org. 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.

21. FEATURED TEAM: Food and Nutrition, Panorama City Medical Center How a contest can lead to safety 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. 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. Read more about the teams work and other successful practices on the Labor Management website, www.LMPartnership.org.