The Pediatric Clinic Unit Based Team (UBT) is a group of enthusiastic, thoughtful staff with a good sense of humor. In the discussions we’ve had on various topics, it’s clear that they care about their patients and their families . . . which, of course, leads to thinking about patient satisfaction as a high priority. The UBT has done valuable work over these past 3-4 years in taking on projects that improve work processes that benefit the patients, the staff, and the hospital. Some of these have involved streamlining processes like ordering a urine sample, paperwork needed, and communication within teams. All of this work helps to save wasted time, increase efficiency, and leads to more satisfied patients and staff. One particular project that helps the hospital was improving the wrap-up process in order to collect hundreds of thousands of dollars more in payments in a timely fashion.
I have very much enjoyed coaching this UBT, and - since they are so enthusiastic (read, “passionately talk a lot”) — I’ve had to use my coach’s time-out signal more frequently with them than with some other UBTs. While all members are enthusiastic, they each understand and appreciate the need to listen closely to one another which has built strong, respectful relationships. Their “enthusiasm” is a visible indicator of their commitment to their work, the patients, and each other.
—Marie Manna, UBT Coach
Jen McRell and Maureen Guzzi: Pedi Clinic UBT Co-Leads
Interview by Anna Weick, 2/23/21
J: In the Beginning, we didn’t know what to make of the Unit Based Team. But within a few weeks, people started feeling comfortable enough to come to us with ideas and things we could work on in the meetings. It did take a few weeks to get it up and running and get people on board with it.
M: So, Jen and I have been together on this since the get-go. The UBT project was presented to the managers and we sent it out for volunteers. We tried to gauge interest and see who wanted to join. I had a core number -- not a huge number -- of people interested. Jen was one of the people who came to me and said she was interested, and she became my co-chair. The people who are currently on it have pretty much the people who have been on it since the get-go. We have had some people leave, and we’ve brought a few new people in. But for the most part, it has been led by the same people and same team who were interested in the beginning. While we might get more interest now, we encourage people to speak if they want to join, or to give us suggestions. Like Jen said, we originally met about almost 3 years ago. We met, we defined, with our coach Marie, who comes to all our meetings -- who guided us to where we wanted to go.
The staff went back out to talk to the other staff. Within a couple of weeks we had about 20 ideas when we first started this. We all met together and put the ideas in order of priority, and then we started to tackle them. We recorded it, took minutes, posted it on our UBT board in our lunch room area. We went through about 12 of those 20 things in the first year, putting them in order, starting one and seeing it through. Some of the stuff over the course of the year, it self-corrected. So the next year we talked about the next big three projects we wanted to take on. We tackled those three projects -- we probably weren’t as ambitious as when we originally started because we had a lot of small projects to go through.
This last year we just met again, we looked again at the True North metrics for the organization, and we tailored what we want to accomplish around those.
J: And then Covid happened . . . everyone got deployed for a while.
M: Coming back we learned that -- reuniting back together was really challenging for us, so we had to spend some of our time on rebuilding the team. It was hard during deployment.
J: And then going into new roles, with coming back -- now there are telehealth visits, and things not in person. It’s a whole new work environment that a lot of us weren’t used to. So, getting together and coming up with rules for that too.
M: Normally they knew what they did every day. They did the same things pretty much every day. While you say you want to implement something new, we found the challenge is, well, you can’t just say ‘go do the telehealth,’ because no one knew how to do a telehealth. And then, when we thought we knew how to do the telehealth, the people doing the telehealth realized that there were inconsistencies in information that families and patients were getting.
J: So we came up with a script for that to walk people through it.
M: That’s the kind of thing we talk about in our UBT meetings. When we started, we met every single week, up until about 6 months ago. Now we meet every other week. For the first two years we met every week for a hour. We always made it an important meeting, we only cancelled one or two meetings in the past 2 1/2 years. We try to say this is important and let’s at least connect. In the last couple months we are trying to keep the meeting to a half an hour -- we’re struggling a bit but it’s in appreciation of other employees’ schedules being disrupted by people being gone for a full hour.
Workflow things -- our clinic is huge, we started some of the efforts on the biggest thing that we all voted on -- something on Jen’s side, where at the end of the night, whoever was the last employee, they were getting stuck with a lot of responsibilities like 20 urine samples sitting, not having orders, and more. That was one of the first things we did.
J: For us on my side where I came from it was big. There was a lot of running around and chasing doctors for orders. So we came out with a strict list of what we do. So at the end of the day someone isn’t left wondering what to do.
M: We tag into the True North metrics and we also continue to do stuff we started last year. The metrics are increasing number of patients. We started with a really low number and we have brought it back to the staff and identified 5 people who wanted to own the process themselves. We asked for volunteers and we were able to make those 5 people “super users” What could they do to support me to support the organization? We did that around MyChart. For telehealth, everyone is doing it, but people were struggling, so we made a little cheat sheet around workflow to make it easier for people.
J: We broke people off into teams and took sections of the doctors -- it was a domino effect, it made everything much easier. It made it a much smoother process after coming back from deployment, in this new transition that nobody really knows well.
M: Jen’s more of the clinical nursing part, but we also have two ASRs who are on our UBT committee. They come to every single meeting and they are helping us with our efforts to collect co-pays. Pre-Covid we were pretty good about collecting copays, but then Covid hit and no one wanted to handle money or credit cards. We fell off and were collecting very little. Many in-persons were telehealth, you can’t make someone pay when they’re at home. So we used their input a lot to brainstorm how we could get better around our co-pays. We made efforts based on what the front desk staff thought and we implemented changes there.
We started this journey about 6 months into the UBT realizing that -- we are attached to the hospital, so not only do we bill for provider visits but we bill for a facility charge. That’s attesting that they use space and rooms and nursing services here. I kept getting a report that we were missing the facility charges. I put a lot of efforts into it initially on my own before the UBT. How can I make sure people see that they didn’t do it? It’s a really busy clinic, these staff were seeing 325 patients a day. They’re busy and they forgot to go back and do it. So I started keeping my eyes on it and we ended up adding a column in our online system so we coil see. Still, things were getting missed. I caught a lot but I was still missing some. So I hired a clinical coordinator with her eyes on it. We were seeing about 50 still missing each month - it was a lot of money. Marie was really excited to know the UBT could be part of a financial gain, so we brought it to UBT. The people at UBT thought, hey, I can own a piece of this, we can have three people also on the floors who are looking at it. So Jen asked who wanted to do it. We were doing better, then COVID hit. And we came back from COVID and a lot of stuff people just forgot what to do. My eyes ended up going back on it. So we started knowing again that a lot is being missed. Recently we just brought it back to UBT, and we came up with a process trying to regain back where we were.
J: When we did it like that, it went from 50 a month then a couple weeks ago it was 0-5 a month. With all of us looking at it.
M: We get like 170$ for that facility fee - it’s graded by level. It’s a lot of money. Two months ago we had zero in the month, first time in ten years. We learned something: of those five, sometimes they were booked as a physical so we did not do them, because we don’t do a facility charge for physicals, or the provider was late or unable to do the physical, or just did a follow-up. But the follow-up DOES need a facility charge -- we didn’t do it because something was scheduled wrong. Working together, we have a really great partnership. Not just with Jen and me, but with everyone on our team. People have been great to go out and share what we are doing with our UBT. Unfortunately, sometimes managers take the brunt of resistance to making change, without the buy-in. But I have my people also speaking to the changes. That's one of the biggest things for me as a manager. Buy-in from the people who are doing it -- people also feel open to saying what isn’t working, or what we need to change.
J: There’s a good open line of communication, it makes it easy to get stuff done and come to people with our problems and concerns, and feel confident that it will at least get addressed. Even if it’s not perfect there will be an effort made.
M: We have a really great UBT team because of the relationships. We’ve been through it from the get-go. We know what works and what doesn’t. We know how we each work. The biggest thing for me as a manager is that I want the change to happen I can try to justify my way, but I am not the solution. So really, the best thing for me is to have this core group of my team communicating workflow issues or changes. It’s great for the team to see that the changes aren’t always easy to roll out, we have to work at it, and sometimes go back to the drawing board.
J: The UBT gives us a better perspective of her responsibilities.
M: They're going to go and work on the details. Just keep it open, they come and say anything to me. IT gets us to where we want to be in the end. Sometimes it’s like, “Holy moly, another thing!” But at the end of the day, our interests are in the staff and the clinic. This is the first time we were a Tier 1 project.
J: An open line of communication is the most important thing for the UBT. The manager being open and receptive to your ideas. Everybody here as the same goal in mind. We work really well together.
M: With that, we have our frustrations. Nothing is perfect here. We just started talking last UBT meeting about trying to understand everyone’s role -- and what people are doing every day. There are some hurt feelings if it seems like someone is working harder than others. So we made a mandatory meeting to discuss and understand better everyone’s roles and how we can all help each other on the team, and how to improve everyone’s workflow. The MNA has joined in our UBT -- we want everyone’s input. Sometimes we are in a meeting and think we have an agenda, but then someone brings up frustration from the floor. We haven’t been getting as many ideas right now, but even to have meetings to have conversations about what is going on in the floor.
J: These are concerns from a week ago and we already have a meeting planned about it.
M: The minutes are always typed up and posted so everyone can read it. There is a good line of communication. After the meetings I always email everyone about the direction we want to move in. The staff can start the conversation -- this is what we are trying to do. You HAVE to get the buy-in, you can't just have one or two people there.
J: It has to be a group effort. The more people that were involved, the easier the solution was to come to.
M: For the wrap up, for me, when you put a dollar amount to it -- the staff all want the organization to be successful. It’s more than just, “you missed something.” Instead it’s, “Oh! We could have gotten an extra 10k this week if we had caught that” I think it led to an instant buy-in. Even from the get-go for us, we had all of those ideas come in, and then in the meeting we typed up all the ideas and asked the staff to pick the top three to work on. That’s how we sorted it. That took 2-3 weeks figuring it out.
J: We kind of went with issues that they already knew were going on. And they saw the issues right in front of their face, that helped.
M: We included everyone in the process. We’d say “we’re doing this because of this, but do you have a better idea?” We’d help teammates figure out the language to explain the changes to the other staff members.
I’m not perfect, I go to the floor and try to help them when they say they’re drowning. I have been in their shoes. I think that is really helpful. I appreciate how hard it is.
J: She doesn’t reprimand. She brings stuff up that gets everyone on board and wants to be proactive about it. You aren’t feeling like you are being singled out or reprimanded. She has a different way of saying hey, we need something else.
M: We are successful because of our partnership amongst ourselves. I’ve told people, well, I remember when I first started UBT, I did feel like “OMG, this is another thing, it’ll be a lot of work” . . . and honestly, it probably was. The first six months to a year, it was a lot — the minutes, communications, updating everyone. Yes, it took effort. But we are in such a better place. The solution isn’t with the manager, it’s with the team. If I didn’t have my team, I’m not successful. I’m only successful because of them -- and having the appreciation that you need buy-in. At the end of the day, it’s them doing most of the work, telling you what is not right out there. I can only assume everything is perfect and then it’s not. If they don’t tell me what isn’t going well, I’m looking pretty foolish if I think I have a wonderfully running clinic. You have to rely on your people. People can join any time they want. We want people to tell us what’s going on, in the meetings or with suggestion notes.
J: Everything was hairy when we came back from deployment. Working with new rules for months and then coming back to a new environment — it was really hard. Even though we are back, it’s completely different.
M: Some people were upset with others. I think when you are away for four months, you do forget some of the stuff. People forgot to do steps in their processes.
We used to have 300+ patients in-house; now it’s 150 in-house and 150 telehealth, so the workflow has still totally changed since Covid.
J: Our workflow is much better now and smoother because everyone knows their roles.
M: We did a video before COVID hit, for the staff. We have done some dancing and singing videos. We have a new one coming out, we are looking to a mask-free summer. We are trying to show the hope we have through our new video that will be coming out. It’ll be out on the UMass page.
J: We do really like each other and we have fun. There has to be a balance. Plus we are with kids, so it’s a different environment. For the patients’ sake, they are coming in scared. When you’re a bit of a goof, it makes them a bit more comfortable.
