By Anthony J. Coronado
Pictured are (top row from left to right) Michael Harlani, Mauricio Suastegui, Anthony J Coronado, Yusuf Wasi, Alain Luque, (bottom row from left to right) Raul Lopez, Jeff Hernandez, James Cho, Milton Cortez, Po Chung, Lee Dean, Brandon Bittle and Garry Bezart.
For the past 20 years, the HTM community has been dedicated in supporting the conversion of patient health information into electronic health information. The interconnection between medical devices and electronic health records helped health care organizations improve patient care by connecting different medical device modalities to diagnose patients faster, share medical history between caregivers and develop health trends that can be populated into a patient portal. In order to have a successful and compliant clinical engineering department, technical integration activities would have to be a high priority for patient flow within a health care facility today. There is also another form of integration that is just as important: organic integration. Kaiser Permanente has perfected this form of organic integration that results in a healthy network of team members with a shared vision of success.
The integration of personnel, teams and departments can be just as complicated as designing a technical integration plan. The relationship between management and labor staff can be the difference between a high- and low-performing department. Also, the management of skill sets between team members is essential to develop an effective service delivery plan for a clinical engineering department within a medical center. Kaiser Permanente has established tools that help with this type of integration by establishing unit-based teams (UBTs) to provide direction, a structured framework and motivational approach to allow departments to be efficient and effective.
In all labor orientated organizations, effectively managing individuals to result in positive outcomes is always a huge challenge. Kaiser Permanente recognized this and established the innovative approach of the UBT in 2005 and it was written into Kaiser Permanente’s National Agreement with the partnering labor unions. The objective was to change the roles of union members and managers to create an environment that thinks critically about surfacing issues. This strategy allowed local departments to become more cohesive and work with other departments within a whole medical center on issues that have a wide range affect. The medical center can then share their experiences with other medical centers within their Region to standardize their practices and solve common issues. This allows their Region to share their successes within the complete Kaiser Permanente system and establish “Best Practice” approaches to their national patient care delivery plan. In essence, an innovative integration plan.
Like Middleware components in a technical integration plan, a UBT serves as that purpose and it can then be integrated with other unit-based teams developed by other departments within a health care organization. Kaiser Permanente has over 3,500 unit-based teams that are improving health care and promoting their vision. All unit-based team members are oriented to the partnership within the first 120 days of hire. They are provided with continuous education in business literacy, metrics and measurements, and improvement methodology. The training provides each team member with an understanding of the strategy within their own department’s unit-based team and within the whole organization’s mission for patient care. This form of personnel organization is just as innovative as any technical integration plan.
Unit-based teams are structured with a Charter that is approved by all team members. The Charter defines the member roles/assignments, project formation tools/trackers, and other written techniques to help team members integrate within their departments. There are two co-leads for each UBT, and they are represented by one management and one labor team member. Unit-based teams meet monthly, follow a comprehensive detailed agenda, and communicate meeting minutes with all team members. Projects are formulated during these meetings to improve performance and solve issues within a department. UBTs can also be combined with other UBTs from other departments to solve issues that might have an impact on multiple departments. All decisions made within the teams must have the required consensus indicated in the Charter and one of the focal points is encouraging each team member to contribute to the team.
The Clinical Technology Example
An example of a project established in a Clinical Technology UBT is limiting the amount of Unable to Locate (UTL) equipment during preventive maintenance cycles. At Kaiser Permanente we know that this is not just a clinical engineering issue, but rather a multidisciplinary issue that includes each department that owns the medical devices. A goal is established for only 1 percent of the units due for preventive maintenance be put into UTL managed status. Unit-based team representatives for each corresponding department will meet during a combined meeting to obtain clear directions and provide input to reach the goal. Progress trends will be observed in a Project Tracker and the integration of departments will be established. Once the UBT Project Plan was initiated at several Kaiser Permanente Medical Centers, there was an immediate impact on the lowering of ULT percentage. Some examples of other Clinical Engineering projects that can be used in this format include reducing cost on consumables, extending useful life of medical devices, and cybersecurity initiatives. The overall goal is what Kaiser Permanente calls “One KP.”
The Big Picture
Kaiser Permanente’s “One KP” initiative provides the next step in this form of organic integration. One KP was established with the patient or member’s interest in mind by improving the patient care experience. One KP also evolved into an employee satisfaction initiative by allowing Kaiser Permanente employees to have a voice within the organization, a way to recognize their achievements, and provide the tools to help them in their daily activities. Managers are required to perform “Direct Rounding” with their employees on a monthly basis, which consists of one-on-one meetings that focus employee’s outlook on department improvement. This promotes the interaction of departments and aligning each team member with the overall mission and vision of Kaiser. This big picture can be viewed as the portal for UBTs that connects each department to form a multidisciplinary mindset.
When it comes to technical integration for a clinical engineering department, the activities necessary to help an organization operate effectively include the utilization and connection of different types of medical devices. In order to accomplish this, technical plans and diverse forms of engineering must be integrated to formulate a secure efficient network. Organic integration assures that various personnel modalities or departments throughout the medical center are also integrated to ensure the organization operates effectively. Using framework established in a unit-based team and with the mindset of “One KP”, a healthy network of team members can be established.
The combination of technical and organic integration plans can allow hospitals and clinical technology departments to flourish in all aspects. Performance improvement, compliance, team building and other department attributes will have a structured plan that involves all members’ input. Technology is great and constantly evolving, but the integration of the personnel behind the technology places health care organizations in a position to thrive. An effective team can be compared to an effective IT network. The integration of multiple systems, communication between different departments and the integrity of information shared is key for a healthy network. Kaiser Permanente believes that both forms of integration are essential to our mission of excellence and every plan requires individuals that are integrated in the network of care.
– Anthony J Coronado, MBA, is Area Clinical Technology Manager, Kaiser Permanente, Baldwin Park and West Los Angeles Medical Centers.
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