Cancer is a scary diagnosis. Patients who receive this devastating news find support and hope from the Central Interstate Oncology and Infusion team.

The Portland-based team manages an infusion clinic where an average of 70 patients receive chemotherapy daily.

Thanks to a UBT project launched in 2023, the team is helping patients better manage chemotherapy side effects. Results have led to a steep drop in the number of patients sent to the hospital because of severe reactions.

The results illustrate the power of the Labor Management Partnership. The project brought together physicians, managers, and frontline staff to find ways to lower hospitalizations and ease the burden on patients.

“This is just one highlight of how amazingly well our cancer team works as a whole,” says Christine Barnett, MD, chief of Oncology at Central Interstate.

Rising hospitalizations

The oncology and infusion unit-based team set out to reduce the number of patients hospitalized for severe chemotherapy reactions.

They began by closely reviewing an unexplained rise in patients receiving infusion treatment in the hospital.

The team found that about half of these patients could have continued with outpatient infusion treatment, which typically lasts 2 to 3 hours. Hospital infusions can take up to 11 hours and involve patient monitoring and additional medication measures.

“It really spoke to the need for providing more thorough onboarding and training and review for existing staff,” says Monica Hahn, manager of Central Interstate’s Cancer Service Line and Medical Oncology back office.

Significant turnover on the team during the COVID-19 pandemic led to gaps in understanding of the different treatment options available to patients, says Hahn, the team’s management co-lead.

The team’s journey pointed to a larger issue as well. During the pandemic, many teams paused important UBT work to meet increased demand for patient care.

The Central Interstate team was no exception. By early 2023, the team had dropped from Level 5 to Level 1 on the Path to Performance as completed UBT projects fell off. The Path to Performance is a five-stage “growth chart” teams use to measure success.

The care experience project marked one step in the team’s renewed focus on UBT work. They returned to Level 5 in just 10 months.

Refreshing skills

To reduce unneeded hospital visits, the team developed a skills refresher for everyone.

Pharmacy staff conducted in-service training to help employees understand the range of medications available to ease difficult side effects.

Unit-based team leaders also received training. They reviewed ways to assess chemotherapy reactions and determine which patients required hospitalization.

The training was led by Dr. Barnett, Chyna Turnbull, a nurse practitioner, and Jennie Burns, a registered nurse, both members of OFNHP Local 5017.

This educational push led team leaders to develop a 2-page handout of clinical practices. Staff members review the information with patients to help them understand expected side effects.

After taking these steps, the team saw hospitalizations for chemotherapy drop by more than 90% over 2 months in 2023. The team continues to maintain the lower level of hospitalizations.

This is good news for patients, who often must pay high deductibles for hospital admissions. And it’s good news for Kaiser Permanente, which is saving an estimated $198,000 annually due to reduced hospitalizations.

Patients also have a better care experience. They develop trusting relationships with infusion team members and maximize recuperation time at home.

“They come in for their treatment and they’re home in time for dinner,” says Burns, the team’s lead registered nurse.

“The patients see that we are all together in this,” says Rebel Herbert, the team’s labor co-lead, who is a medical assistant and member of SEIU Local 49. “We’re always just a phone call or an email message away.”

If one word inspires dread in the Optical Lab Surface department, it is “swirl.”

The Northwest team helps make eyeglasses for Kaiser Permanente members. Their work is sometimes complicated by swirls – circular scratches on the lenses that can occur during the production process.

In 2022, the team - based at Kaiser Permanente Sunnyside Medical Center outside Portland - grappled with a mysterious increase of swirls.

“Normally, we will get about one swirl per day that we can’t polish out,” says Rodney Edwards, department supervisor and the team’s management co-lead. “But suddenly we were seeing 12 or 13 per day. We knew we were dealing with something very strange.”

When extra polishing can't remove a swirl, the team must fashion a new set of lenses. This raises costs and slows production, delaying delivery of eyeglasses to KP members.

By conducting a painstaking review of its processes, the team uncovered the cause of the swirl surge and improved care and service.  

When everyone participates in performance improvement, the better the results and the stronger the work environment. Collaborating on performance improvement also advances a culture at KP in which continuous learning and improvement come naturally.

From technicians to sleuths

Finding the source of the swirls was not easy. The Level 4 team prepares about 700 eyeglass lenses each day.

“It’s tough for us to troubleshoot these things," says Dustin Rushing, an optical lab technician and OFNHP Local 5017 member, who is the team's labor co-lead. "We’re operating at such a high volume we can’t really stop the presses."

To identify the problem, the team performed multiple tests of change.

Team members analyzed vats of liquid lens polish. They improvised new polish filtration devices. They scrutinized surfacing procedures and the calibrations of each piece of machinery. The tests and tweaks occurred while the team tried to keep up with high demand for eyeglasses.

Weeks of testing uncovered the problem: wear and tear on machinery was leaving metal shavings in liquid used to polish new lenses. The solution? Modifying worker procedures and intensifying maintenance and replacement of machine parts.

As a result, the team saw a 94% reduction in swirls during the first 4 months of 2023. That success continues. The team reduced monthly costs to replace damaged lenses, from $525 to $31, for a projected annual savings of $6,000.

While the cost savings may seem small, it illustrates the impact of unit-based teams. Enterprisewide, more than 3,600 teams contribute to KP’s national leadership in measures of affordability, quality, service, and care.

The project earned the optical lab team a UBT Excellence Award from regional leaders.

“The biggest reason for this project’s success was the openness and communication between us all,” Edwards says. “That really opened up some doors for us as a team.”

Jenna Li and Autum Tomlin serve in different specialties at opposite ends of the country. Yet each plays a central part in efforts to harness patient data to improve care and eliminate health disparities at Kaiser Permanente.

Li is a chemical dependency counselor with the Mid-Valley Addiction Medicine team in Salem, Oregon. Members of her unit-based team, represented by Alliance-affiliated unions, make standard practice of asking patients about their sexual orientation, gender identity and preferred pronouns.

Tomlin is an urgent care technician at Reston Medical Center in Virginia. She and her team – represented by Alliance- and Coalition-affiliated unions – collect information about patients’ race, ethnicity, and preferred language. She has seen, first-hand, the power of speaking to patients in words they can understand.

“Usually, you can see the patient is at ease and feels a sense of relief that they are able to communicate in their preferred language,” says Tomlin, the team’s labor co-lead and a member of OPEIU Local 2, part of the Coalition of Kaiser Permanente Unions.

Like others across the organization, the Level 5 unit-based teams are seeking to address disparities in health and access to quality care that persist across a range of dimensions – including race, language, gender, and sexual orientation. By asking patients about their backgrounds in a safe, respectful, and compassionate way, the teams are changing how they deliver care and service to members – and relate to one another.

“The effort is minimal, and the effectiveness can be really high when we help a patient feel seen and understood,” says Li, labor co-lead for the Mid-Valley team and a member of OFNHP Local 5017, part of the Alliance of Health Care Unions.

Making members feel welcome

To better understand patients’ health risks and needs, the Mid-Valley team began asking members about their sexual orientation and gender information. They asked the questions during the intake assessment and entered patients’ responses into their electronic health records, making important background information available to all KP providers.

The practice is already changing how the Northwest team delivers care to LGBTQ+ patients.

For instance, Mid-Valley is referring more members to a weekly group therapy session for LGBTQ+ patients to discuss their unique challenges. Misunderstandings about sexual orientation or gender identity are among the obstacles such patients face in accessing effective care. They also are at elevated risk from health threats including alcohol and substance abuse.

Recently, the team hustled to track down a teen-ager in crisis who had fled their clinic’s waiting room. Knowing the teen identified as nonbinary, staff members convinced them to return after expressing sensitivity to their fears and addressing them with their preferred pronouns.

Gestures to support these patients are especially important because they come to treatment reeling from the “double whammy” of stigmatization for their addiction struggles and LGTBQ+ identity.

“We can do a lot to make a member feel welcome by using language they are open to hearing,” says Carri McCrary, Mid-Valley clinical services manager and the team’s management co-lead.