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.”

When it comes to addressing health care disparities, medical office assistant Anna Jenkins thinks her unit-based team is up to the challenge. 

“I can go to my UBT members and say, ‘This is a care gap. Give me your feedback. Give me your ideas,’” says Jenkins, an OPEIU Local 30 member and labor co-lead for the Rancho San Diego Primary Care team. “Our administration listens to us. They’re very open to letting us try it our own way.” 

The Level 5 team is leveraging Labor Management Partnership principles and tools to communicate, coordinate and customize care for Latino patients with diabetes. The approach has led to better health outcomes and improved service for a group disproportionately impacted by diabetes. 

The unit-based team has increased the number of Latino patients ages 65 to 75 whose blood sugar levels are under control, according to recent clinical quality measures. 

“That partnership between management and labor is important,” says Silvia Hernandez, RN, medical office administrator and the team’s management sponsor. “This teamwork helps us to improve patient care and quality with excellent member satisfaction.” 

Adapting approaches 

Key to the team’s success is partnering with Complete Care Management, a specialized strike force that monitors the health of patients who struggle to control chronic conditions, such as diabetes and high blood pressure. 

To better support her Latino patients, care manager Lily Thamiz, RN, has adapted her approach. She books longer appointments for Spanish-speaking patients who need interpreters, refers others to bilingual diabetes education classes, and relies on phone calls to connect with those short on time. 

“The only time we can talk is when they’re driving,” says Thamiz, a member of Specialty Care Nurses of Southern California, an affiliate of UNAC/UHCP. “These are solutions I’d never considered before.” 

UBT members tailor treatment in other ways, too. To ensure continuity of care for Latino patients in their 60s and 70s, they standardized the steps needed to download and share data from glucose monitors. Providers use the devices to track patients’ blood sugar levels and adjust their medications. By consistently managing and sharing data, staff members guarantee they do not miss crucial patient information when communicating with one another. 

“They make you feel like you really matter,” says Mary Hart, 71, a Latina patient who has diabetes. “They really show their concern for your health.”