Best Health Care Solutions Come from Nurses, Others Doing the Work

by Mike Hall, Apr 25, 2008

George Halverson, CEO of Kaiser Foundation Health Plan and Hospitals, says worker input boosts care quality.

When front-line workers are part of the team developing new strategies and techniques to improve health care quality and reduce costs, the results are effective and often innovative—from the easily implemented, like a reflective vest, to a top-to-bottom revamping of operating room procedures.

John August, executive director of the Coalition of Kaiser Permanente Unions, told a health care forum yesterday:

“You create the best quality care by having the front-line workers mobilized to find the innovations to do that.”

August, along with several other Kaiser Permanente labor and management representatives, union leaders, health care experts, lawmakers and others took part in the First Annual Health Care Forum presented by the Kaiser Permanente Health Care Institute at the National Labor College (NLC) in Silver Spring, Md.

Preserving and improving quality care was a major focus, but the forum also touched on a wide range of topics including the vital components of health care reform, the political outlook for reform and bargaining and protecting union health benefits.

AFL-CIO President John Sweeney told the 300 participants that “high-valued and patient-centered” is a “non-negotiable issue” in the health care reform debate.

Our goal is not just to create universal health coverage, but high-quality, affordable universal health coverage.…In our national political arena’s debate over the shape and substance of health care reform, for us the words affordable, high-quality health care for all are inseparable.…We will not bargain for nor will we accept a second-class health plan.

At Kaiser Permanente—where about two-thirds of its 150,000 employees who provide care for Kaiser’s 8 million members are unionized—workers have a significant voice in maintaining and improving patient quality care. George Halverson, chairman and CEO of Kaiser Foundation Health Plan and Hospitals, said “the fundamental focus of our national health care system should be to ensure quality care.”

We are using front-line, unit-based teams to improve care quality and value in our worksites.

Hospital medical errors, especially medication errors in which patients receive the wrong dosage or medication, cause some 180,000 hospital deaths a year, Sweeney said. A group of Southern California front-line workers developed a system to prevent deadly errors, one that centers on a highway worker’s reflective vest and masking tape.

A unit-based team at the West Los Angeles Medical Center came up with a plan in which the shift nurse dispensing the medications wore a reflective vest to remind workers and supervisors: “Don’t Interrupt.” A masking tape border was placed around the medication station that told nurses and other workers not to bother those filling each patient’s medications. Allen says that simple technique reduced medication errors and now is being promoted as a best practice to other Kaiser facilities.

The reflective vest was a success, said Walter Allen Jr., executive director of Office and Professional Workers (OPEIU) Local 30, because distraction is a major reason behind medication errors. Allen, the Southern California labor lead of the Kaiser Permanente Labor Management Partnership, said nurses and other workers preparing and dispensing medications often are interrupted or sent to other duties. While the solution seemed simple, it was “brought forward by people who do the work every single day, not by managers in a building somewhere across town,” Allen noted.

It didn’t come from somebody who went to a seminar and said, “Here’s a thought.” Quality is not more expensive; in fact, quality is less expensive. Doing it right the first time is always better for the patient, better for the outcome and less expensive.

Allen also told of a team of surgical workers—surgeons, nurses, technicians and workers who cleaned the operating room and took away the hazardous materials—who came up with a plan to reduce times between surgeries in an operating room and ensure that operations aren’t canceled because of delays.

Paul Kumar, United Health Care West (UHW) policy director, said the improved quality and reduced costs go hand in hand.

You empower the front-line staff around mission-driven work to improve quality and contain costs. Containing costs is not just a simple matter of add and subject, but providing people the best patient-centered care….That paves the way for what’s necessary in national health care reform redesign….Without real improvement in delivery of services, without great quality outcomes and efficiencies to contain wasted costs, we will not achieve that.

If health care reform is not achieved soon, said Sen. Sheldon Whitehouse (D-R.I.):

There will be a tsunami of health care costs coming at us…and if we don’t get ahead of it, I think we in Congress are going to be presented with horrible choices to make for our economy in terms of enormous additional taxation…or heartless cuts to health care. 

Kaiser Permanente has had a unique labor-management partnership for more than 10 years that involves more than 160,000 union, management and physician employees. In 2007, Kaiser and the Coalition of Kaiser Permanente Unions donated $450,000 to the National Labor College to fund the Kaiser Permanente Healthcare Institute, a program at the college dedicated to educating labor leaders and union members on health care issues. As part of the grant, the NLC is sponsoring an annual health care forum for leaders of unions and allied organizations.

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