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)

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. 

We 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. 

SHARE Member in the Spotlight: Debra Clark

Deb Clark, standing for a strong contract
on the University Campus

As we come up on SHARE's 20th Anniversary, we're reflecting on how far our union has come.

After our most recent contract negotiations, I sat down with Deb Clark, a long-term UMass Memorial employee and SHARE union leader. She’s got a unique perspective on our contract and negotiations. Deb is a veteran negotiator and member of the SHARE Executive Board. Incidentally, in the past, she’s also been laid off from the hospital three times, and has intimate familiarity with SHARE’s work-security policy.

SHARE’s been working to improve UMass Memorial for twenty years, and, in spite of our successes, our hospital often isn’t a happier place. What does Deb Clark think about that? Is there reason to be more optimistic now?

As she points out, one optimistic note is that the hospital’s commitment to working with SHARE to improve the culture for employees is now spelled out in our contract: “We have their full support to make sure that these things happen. They are committed to doing it,” she said.

I interviewed Deb because I wanted to know, from her perspective, now that our new contract is being implemented: what does she think of the work that we’re doing? Where does it go from here? If you know her, you won’t be surprised that Deb has her own ideas about SHARE’s outlook in the years to come. Here’s our full conversation . . .

Kirk Davis

SHARE Staff Organizer

KD: Debbie Clark! Where do you work and what do you do all day?

DC: I work in Lakeside A, the CDU [Clinical Decision Unit]. I'm the unit clerk, and we're pretty busy down there. We're constantly busy, moving, doing something different every minute.

KD: I don't see how it would be anything else there. You and I have been on the SHARE negotiating team at least a couple of times before. How many negotiations have you been in?

I think this is my third negotiations that I've been in, so . . . three.

KD: Since you've been in negotiations before: what were you expecting this time around?

I really didn't know what to expect this time around. They [the Interest-Based Bargaining principles] were all new ideas to us, that we had been trained in and worked with, and it was a kind of learn-as-you-go kind of experience, so we weren't really sure what we were in for.

KD: We did learn . . . we had formal training and a great facilitator in Joel Cutcher-Gershenfeld, is that the kind of thing that you're getting at?

Yes.

KD: We've always attempted to have a kind of informal Interest-Based negotiation approach, and every time we negotiate with the hospital it's different. We're always negotiating with a different negotiating team . . . a different CEO, for example, and different leaders in Labor Relations. And we've had varying levels of success with that approach. What would you say about past negotiations that would make you expect one thing or another?

Well, I think past negotiations were pretty cut-and-dried. It was "yes, no." "Yes, no." It was pretty formal. You proposed what you proposed, and they said "no." You know? SHARE tried again, management said "no." It was pretty discouraging, but by your second set of negotiations, you kind of knew that that's how it pretty much went.

This one here, we were very hopeful that it was going to be different, and it turned out to be great compared to the beginning, the very beginning, what I thought it would turn out to be. I didn't have much hope at the beginning. I knew our team was doing a great job, but I didn't have much faith that the other side really believed in it very much. That was my first opinion of it.

KD: That makes a lot of sense . . . I mean, we hadn't negotiated with -- well, a few of these people we had negotiated with before -- but they had new lead negotiators, and we didn't know what to expect. Were there particular things that started to change your mind or build trust? Was it a lot of little things? Was it one big thing that created trust? How did your change of mind happen?

Well, I think as I saw them starting to . . . maybe not totally agree with what we were saying, but at least be open to our ideas, and what we brought forth to the table. At the beginning, I don't think they knew what to do, so I don't think they were eager to play into it, but as time went on, and as we worked with them and built relationships with them, it got much better, they were trying, or at least most of them were trying, to try to come to an agreement that we could all agree to.

KD: This was a bigger group that we've ever negotiated with, on both sides, than we've ever had before. I mean, part of the difference to me felt like there was a big big cast of characters, and lots of cats to herd, in any conversation we had, and that things started to get a little bit smoother when we started breaking down into some of the Side Tables and Follow Up Groups. Which of those did you participate on?

Teams and Culture, Leaves of Absence, Documenting Department Policies, and Absenteeism . . . quite a realm of different topics.

KD: One of the things that was really good about having lots of little teams was that we got a lot done quickly. I mean, it felt like a lot of work for each little individual team, and when you added it all together, we did a lot of work in a little bit of time. At least, that's how it felt to me, and I was not even on as many groups as you. Was there a group that worked better for you, in a way that would be worth telling people about?

Well I think my smallest group was on Absenteeism, and I think because we all agreed that it was a problem that everyone needed to deal with, and we looked at in a realistic way, we came to a conclusion much faster and easier because it was pretty much laid out straight forward. You know, everybody can't be absent from work and have the work get done. You know, so, that one there was probably the easiest. It was a pretty cut and dried topic.

The Teams & Culture Side Table involves a lot a lot of things, and a lot a lot of people, so that one there took more time, more effort, but it seemed to work out well in the end as well. It was just a lot different from a simple topic group.

KD: So that's the group that was trying to figure out how to make UBT's [Unit-Based Teams] work? We've talked about that on the blog before, and we can point folks toward that.

The thing that's interesting to me, and I heard my co-worker Will saying this too, that he found himself surprised when we came to times when management was advocating for positions that are traditionally union-type arguments, and the union was advocating for things that were more management-type positions.

And you're saying that in your smallest group, you just all kind of were on the same side. You know, there needs to be a certain level of staffing, and we need to have it so people can be out when people can be out, and have the staff to run the place here. But I'm wondering, what surprised you about management's approach to teams? Were they more receptive to the idea of teams? Did they have a different idea of teams?

DC: I think first of all it's a very new topic to everybody, so nobody knows exactly what this is going to entail, but everybody in my group was very enthusiastic.  So, they're all wanting to do it, wanting to do a good job, trying to figure out where they can start it, what projects are going to be achievable so we don't have any failures at the beginning. So I think it's a happy topic, whereas absenteeism . . . not so much. It's encouraging, if it works, which we're going to make sure that it does. It's something that people can look forward to, and look forward to getting involved in. It's not a tedious kind of punishment group like some of the others were. Where, you know, you're doing something bad, what's going to happen to you? This is all good. Doing something good. Trying to make things better.

KD: Can you imagine that kind of topic being discussed in any of our previous negotiations? We've not had a topic that happy in past negotiations, I don't think. How much of that is dependent on the people who are negotiating?

DC: For SHARE’s part, this work just kind of keeps going. For a while, we focused a lot on Patient-Experience Projects. We did a great job. In the end, everyone had good intentions, but it just petered-out, you know? You go along go along go along . . . then okay, where is it? It’s gone. Everyone had great intentions, but there was no means to finish the project off and actually come up with results. So people are skeptical that anything can ever really happen, and truly be good.

KD: I’m really interested in that thing that you said, about in the past things just petered out, even SHARE’s best-intended projects. We had some success, and then other priorities took over. Those improvement projects didn’t have -- I forgot your exact words -- but they didn’t have what it takes to see it through to the end, not in a way that improved the hospital as a whole. You still sound, in spite of that, optimistic, that this round negotiations is turning out some different kind of outcome, that isn’t going to fizzle. You sound optimistic in spite of your experience. Obviously we don’t know yet. What makes you feel like this could actually bring more more effective outcomes than we’ve had before?

DC: Because this time around I have, and I’m depending on this, the words of people like Bart Metzger and Eric Dickson, that we have their full support to make sure that these things happen. They are committed to doing it. Committed to helping us. They’re committed to being a part. If we have questions, and we need to talk to them, speak to them, they’re committed to helping us make this be a success, so it’s the best support we’ve ever had. We’re not out there on our own, we have the words of these people, of the higher-ups at UMass, that they’re there to support us.

KD: That commitment is built into our contract now. And we’ve negotiated a lot of structural things this time. There’s one difference that we knew going in, that there’s a philosophical agreement at the top,  that frontline employees should be involved in decision-making, and it’s in the hospitals initiatives. We shall see.

Let me ask, this is our twenty-year anniversary -- come September, SHARE will be twenty years old. You’ve been here for some of that. How do think that SHARE has made an effect on the hospital in those twenty years?

DC: Well, I was speaking with SHARE before there was a union here. They were calling me at home, I was speaking with all of the organizers. I’ve always been a big pro-union person, and I believe one-hundred percent that SHARE has helped with every aspect of UMass’ people who are involved in the SHARE union. Without them, I mean, we’d be in dire straits. Before SHARE, and I was here for many years before SHARE also. I’ve been 30 years at UMass. We were at the mercy of the State of Massachusetts. So we got whacked quite a few times, and there was no one to turn to, it’s just the way that it was. You just had to accept it, or go work somewhere else. You know, so SHARE has been great as far as I’m concerned. I don’t have a bad thing to say about our union at all.

KD: We’re looking forward to another twenty years more, at least. What’s the best thing that you’d like to see happen, what’s something you’d like to see SHARE do in that 20 years. What would you like to be able to say, “Boy, SHARE really knocked it out of the park by doing . . . x?"

DC: Well I think along with our contract that we just negotiated, keeping our pay competitive, so people can afford to live, so they’re not impoverished. That’s very important to me. Our health benefits, keeping them affordable -- which SHARE always has done -- is very, very important. So, I think those are the two main things. You have to come to work, and you have to be able to do a day’s work for a day’s pay, and make it the best we can. SHARE has helped, and that’s what we’re aiming for with this contract. And having a decent wage, and decent benefits, which we’ve always had . . . you couldn’t ask for more. That’s what you need to work for. You have to have it to be able to survive.

KD: We have held on to really good benefits and had consistent raises for twenty years, and the challenges to those things aren’t going away. If anything, they’re getting harder. So, that makes sense to me that should still be our focus. I just want to say thanks very much. We’ll see you again at negotiations next time . . .  and of course, sooner.

DC: Thank you very much!

Introducing the First Unit-Based Teams

Michelle Drew and Mary Misiaszek
from Tri-River Family Health in Uxbridge

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 Teams. The 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

Field Report from the 2016 Institute for Healthcare Improvement Conference

Right now, I’m on a plane home from this year’s IHI conference, and want to get some things down while they’re fresh. It was a fantastic trip. I’ll be coming back to our hospital with new ideas, new connections, new tools, and a number of insights into what’s happening out there in the broader world of health care, and SHARE’s role in that.

This is my first-ever trip to the annual event. I had already learned some important things from IHI, through SHARE reports from past conferences, and from the IHI’s online resources. But I still found myself surprised as I became more aware of just how much the organization does to change lives in meaningful ways.

If you're going to make successful improvements, you
need to make it as easy as possible, and that involves
 SHARE members defining the work that doesn't need
to be done at all. 

I went there excited to talk with folks from other hospitals about SHARE’s new contract agreement. Members of the Kaiser Permanente Labor Management Partnership, including dozens of front-line union members, come out to the east coast for the event, presenting the latest on their own work with Unit-Based Teams. I was eager to compare notes. Beyond that, however, I learned about many more hospitals using teams, in ways similar to those we're introducing in the new SHARE contract. Unsurprisingly, involving front-line employees in decision-making has been the key factor in the success of those teams.

On top of all of the inspiring and practical learning I brought home with me, the conference was in Orlando, very near in Florida to the home where I grew up. Even though this trip was limited pretty much to inside of the conference hotel, I definitely felt the tug that comes along with any homecoming. So good to see the old palmetto-scrub landscape out the window.

Which, unfortunately, brings me to the toughest keynote of the whole event: a presentation by six employees of Orlando Regional Medical Center, caregivers whose lives were changed by their work in their hospital on June 12, 2016, when the Pulse nightclub, which was two blocks from their hospital, became the site of the worst mass shooting event in American history.

The ORMC team explained for us their triage decisions that night. They described wounds like none that their Level I Trauma Center had before encountered, those from weapons of war. The team depicted for us the patients and families who came into their lives that night, and how they and the whole community have worked to take care of each other and make sense of that senselessness.

Every patient who was brought into their Operating Room that night survives to this day. The presenters attribute that to thoughtful planning and thorough practice, and encouraged all of the hospital employees in the audience to keep at their efforts, to be prepared for the worst.

The conference was sobering, inspiring, and highly educational. I’m looking forward to writing and talking about those meaningful, learning moments I experienced. More on all of that soon.

I expect more materials directly from the conference will be posted online soon, and we'll link to them here. In the meanwhile, if you'd like to listen to one of the speakers firsthand, here's Abraham Verghese -- best-selling author, physician, and one of this year’s keynotes. He described the ritual of the relationship between caregivers and patients, and how caregivers need to have the time to give good attention to those patients who sit right in front of them. At the conference, he expanded on many of the ideas from his popular TED talk, which you can watch through the link below:

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.

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...