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.”

At the Spine Center of Excellence in the Northwest market, team members strive to connect patients to treatment as quickly as possible.

But the Level 5 team struggled when it came to providing timely access to care for Medicaid members.

Before receiving treatment, Medicaid members must undergo a state-mandated pain evaluation administered by the team’s registered nurses. The nurses’ workload, however, meant patients sometimes waited as long as 37 days to be evaluated.

To improve access to care, everyone on the team began screening Medicaid members. In 4 months, they reduced wait times from referral to consultation by 35%.

“When you’re dealing with acute or chronic pain, quicker access to treatment means happier patients,” says Kali Dailey, RN, an OFNHP Local 5017 member and the team’s labor co-lead.

Coordinating spine care

The Spine Center, based at the Sunnybrook Medical Office in Clackamas, Oregon, is part of Kaiser Permanente’s coordinated approach to spine care. Across markets, spine centers help members with neck and back pain find the right treatment programs or surgeries in an expedited way.

In the Northwest, Spine Center staff are represented by the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions. They gather information through questionnaire calls and follow an evidence-based treatment plan for members based on their responses.

Previously, only registered nurses were responsible for completing the questionnaires. They did so during the intake call they conduct with all members to consider which treatments – including injections and surgery – are appropriate.

But the nurses’ workload meant there was a lag time between referral and intake call. Before the team overhauled its evaluation procedures, the wait time averaged more than 37 days.

For members experiencing acute or chronic pain, that’s a long time to wait for a first intervention.

“Some of these patients were feeling like they had been forgotten,” says Jodi Lippmann, the team’s licensed practical nurse and a member of SEIU Local 49.

Fast tracking patients

To connect Medicaid members to care faster, the team obtained permission from Northwest practice leaders to allow its licensed practical nurse and medical assistant to complete the questionnaires.

The team’s new “fast track” system for Medicaid members meant wait times decreased by 35% -- from 37 days to 24 days – from March through June 2021.  This far exceeded the team’s original goal to reduce the wait time to 32 days.

The revamped approach continues to pay dividends – with wait times for all Spine Center referrals continuing to drop. Market leaders have taken notice, too. They recognized the team for improving service access, holding it up as a model for others to follow.  

“Everyone on our team came together on this project,” says Sophia Le, the team’s management co-lead. “The result is better service to our patients.”