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.”

Staffing shortages – worsened by pandemic-related burnout and an aging workforce – are among the health care industry's most pressing challenges.

But Kaiser Permanente has an edge over the competition: the Labor Management Partnership, which provides leaders, managers, and union members with the tools, support, and long-lasting relationships to respond to challenges creatively.

The Partnership – an operational strategy shared by Kaiser Permanente and 2 union federations – is helping the organization address staffing challenges on several fronts.

Recent progress includes work with the Coalition of Kaiser Permanente Unions to implement a joint staffing process and accelerate hiring to fill thousands of vacancies through 2024; and a venture with the Alliance of Health Care Unions to design a training program to overcome a shortage of wound-care nurses.

Now, management and labor are boosting another central staffing effort: all-day hiring events that can attract hundreds of job candidates. Often, applicants come away with a job offer in hand.

 "The Partnership is essential to our success," says Abbot Kohler, senior director, Pipeline and Operational Excellence for the Northwest Region, where Partnership union members participate in planning and conducting hiring events. "By bringing labor into the mix, our applicants get a more complete view of the many advantages of working for KP."

'Tailor-made for partnership'

Staffing challenges remain for Kaiser Permanente and the health care industry at large. While KP has taken aggressive action to hire and fill vacancies – and things are starting to improve – staffing continues to be a top priority for management and labor. The hiring events, supported by KP and the Partnership unions, are a step in the right direction.

The events focus on addressing hard-to-fill vacancies for 2 or 3 open positions based on a facility or service area's greatest need. KP works with the Indeed job listings website to advertise events, connect with candidates and schedule interviews.

Enterprisewide, at least 30 hiring events took place in 2023, drawing more than 5,000 applicants and helping KP hire more than 1,200 new employees in 5 regions. Alliance and Coalition union members are actively involved in these hiring efforts. In the Northwest Region, they participated in 9 events that resulted in 149 new hires last year.

"The staffing issue is tailor-made for partnership," says Joshua Holt, RN, a board member with the Oregon Federation of Nurses and Health Professionals. "Involving labor in the hiring process helps to identify new members of the team who will provide the high standard of care that this organization requires."

Event organizers say a central draw for candidates are the unions and their commitment to the Partnership, which empowers frontline workers to collaborate with managers and physicians in decisions to improve care, service, and quality of work life.

"They see it as being able to have a voice and not getting in trouble for speaking your mind," says Olivia Devers, a certified nursing assistant at Kaiser Permanente Sunnyside Medical Center near Portland and a senior labor partner with SEIU Local 49. She served on panels interviewing certified nursing assistant candidates at 2 events last year.

More hiring events in 2024

Partnership union members have been pivotal in driving attendance. A social media campaign led by UNAC/UHCP nurses at South Bay Medical Center in Southern California proved effective in promoting an event last May focused on filling select positions, including tele-health nurses.

Nearly 300 job candidates turned out, with interview panels meeting with applicants late into the day.

"Nurses know other nurses. We've worked together in the past, or we're friends from nursing school," says Cathy Tu, RN, a contract specialist with UNAC/UHCP who promoted the event on Instagram. "When we put out the word, we hit that target audience."

As hiring events continue in 2024, the involvement of frontline union members will remain paramount to their success.

The Coalition, for instance, has committed to taking part in at least 10 hiring events in 6 regions as part of its 2023 national agreement with Kaiser Permanente.

"Anytime you've got a diverse team with different perspectives coming together with a single goal in mind, you come out with a great result," says Shannon Surber, executive director for staffing systems and strategy in the Northwest Region.