The San Diego UBT fair: Sharing successful practices
LMPtalk is the place to come online to engage in dialogue about Kaiser Permanente’s
Labor Management Partnership.
June 20th, 2011
by Dan Ryan and Paul Staley

Receptionist Andrew Aranda tells Medical Group Administrator Jim Malone about the
concierge program at the Clairemont Mesa MOB.

Some of the brightest stars in the UBT constellation are at the San Diego Medical Center
and its many satellite facilities. At a recent San Diego UBT fair, co-leads from departments
throughout the medical center proudly displayed storyboards explaining their teams’ goals
and their most up-to-date results on performance improvement. UBT fairs have truly
become a best practice for sharing of ideas and allowing the people who do the work to
explore with their fellow workers what’s working and what’s not. More than 535 employees
stopped by and chatted with team leaders in San Diego and hopefully, picked up a few
new ideas that could be incorporated into their teams.

The majority of co-leads represented Level 4 or 5 teams, although there were a couple of
Level 3 teams that snuck in due to their outstanding performance. At a recognition
ceremony, each set of co-leads was greeted with certificates as well as a gift for the team
from Mary Ann Barnes, senior vice president and executive director of the San Diego
Service Area, Jim Malone, medical group administrator, Dr. Paul Bernstein, area medical
director, Walter Allen, executive director and CFO of OPEIU, Local 30, and Barb Grimm,
senior vice president of the OLMP.

It wasn’t always this way

A few years ago things were quite different in San Diego. Very few teams were in place
and among those, very few were hitting anything close to what could be labeled as
“performance improvement.” Thanks to a fantastic resource team, things have changed
dramatically. Jenny Button, Amy Steiner, Katie Doyle and Sylvia Wallace and their hands-
on sponsors, Marianne Giordano and Ray Hahn have all contributed to transforming the
medical center into a forum for continuous learning through unit based teams. This is a
key ingredient in the success of the service area, which is the third largest in Kaiser
Permanente with a membership of more than 500,000. Currently there are more than
6,300 employees and 830 physicians in the area, which stretches from the border with
Mexico north to La Mesa and hundreds of miles to the east. Throughout this huge
territory, the resource team has managed to engage the staff in the important work of
improving the quality of life for every Kaiser member.

San Diego is the latest in a growing number of areas hosting UBT fairs. Hawaii held one
last month and Orange County plans to hold its second UBT fair in November. Its first fair
was held late last year. We’ve said this before but it bears repeating: The pride the co-
leads show in exhibiting the work of these high performing teams in these fairs is
immediately apparent. The excitement and energy generated is amazing and a real
pleasure to observe We encourage every facility or service area to continue to hold UBT
fairs and proudly display the great work going on daily at Kaiser Permanente. And don’t
forget to invite us so we can experience the great work you do every day!
Thank Heaven for
Insurance Companies blog
KP On Call

Kaiser department rankings

Cancer score card

Cardiology score card
US Health Insurance
Kaiser Permanente executives

Retaliation by Kaiser
Missing Medical Records
Warnings deleted from
abnormal test results
Kaiser conflicts of interest
San Diego
Education Report
Kaiser fails to diagnose
Kaiser employees
consent form
Kaiser Permanente

Urology score card: x-rays on
thermal paper, missing x-rays
Comparison San Diego  hospitals

Kaiser: missing x-rays, x-rays
stored only on thermal paper
Kaiser arbitration

Kaiser peer review
Paul Bernstein and Kaiser
Healthcare reform
Remediating failure to diagnose
Nathaniel L. Oubré, Jr.

Mary Ann Barnes
Kaiser executives
George Halvorson, Kaiser
Permanente CEO
Profits grow as Kaiser cuts
patient care costs
Blog: Kaiser Permanente
Dr. Eugene Rhee, chief of
urology San Diego
Lynette Seid, CFO San Diego
X-rays (VUCG)
Struggle: It’s not a dirty word
August 30th, 2011
by John August
LMPtalk is the place to come online to engage in dialogue about Kaiser Permanente’s
Labor Management Partnership.

Call centers are a hard place to work

Over the past couple of months, I have visited with frontline teams in Colorado, Virginia,
Maryland, Washington, D.C., Honolulu, Los Angeles and Oakland. Without exception, I
observed a broad cross-section of our unionized workers and their partners struggling for
positive outcomes.

“Struggle” describes what is involved in unit-by-unit improvement work. Struggle can be
positive. It’s necessary for people to transform, and not just make a few cosmetic or
ephemeral changes.
Call centers: One of the toughest workplaces

One example that comes to mind is a discussion I observed among UBT co-leads in a
large call center. The team leaders focused on a more than yearlong battle to improve
attendance. Call centers are tough places to work day in and day out. The calls never
stop. The work is sedentary. As one worker told me, “When you are at work all day on the
phones talking with and advising Kaiser Permanente members, you have very little, if any,
interaction with your co-workers.”

This team didn’t give up. They recognized they needed to create more camaraderie in the
call center. They implemented several tests of change:

The team has figured out how to meet regularly, despite the challenging logistics.
When leaders suggest changes in call center operations, the representational team
surveys members of the unit before making them.

They created a set of message boards in break rooms. On these bulletin boards,
employees were encouraged to post news about family, friends and community. The
boards are wildly successful and seem to be bringing people together.

This team was feeling lots of pressure to improve. The managers were feeling the heat,
yet they did not collapse under the pressure. Rather, they stuck to the principles they had
been taught about how to bring about frontline improvement.
There is no easy way out

Struggle is positive and necessary. It takes a toll but is also exhilarating. Employees and
managers at the front line feel pressure to make their teams high performing. This is
understandable, since the 2010 National Agreement sets forth aggressive goals around
expanding the number of high-performing teams. But frontline teams cannot do it alone.
They need the support of the whole organization.  

Our colleagues from Rutgers University, in conjunction with Johns Hopkins University and
Kaiser Permanente’s Division of Organizational Research, have identified five essential
systems of support and encouragement for frontline teams:

Line of sight
Team cohesion
Processes and methods
Infrastructure and support
California Physician Group Organization Welcomes Ten
New Board Members
Business Wire 2009

The California Association of Physician Groups (CAPG) is pleased to announce that ten new members
were recently elected to serve on their Board of Directors. CAPG represents medical groups that employ
or contract with nearly 60,000 California doctors and provide care to 15 million Californians.
The CAPG board is responsible for monitoring the needs of the organization's membership, particularly
in light of changes and demands in the healthcare marketplace. Part of their accountabilities also
include enhancing the delivery of coordinated healthcare, working with health plans to improve benefit
designs and healthcare delivery, and identifying and developing strategies to help strengthen their
medical group practices.

Joining the CAPG Board are the following:

Beaver Medical Group, LLP, Redlands, CA
John D. Goodman, CPA
John Goodman serves as President and Chief Executive Officer of EPIC Management LP, a
management and consulting services firm dedicated to Southern California multi-specialty physician
groups and independent practice associations. EPIC's first and largest client,
Beaver Medical Group, is
a highly respected, large multi-specialty group providing a broad range of services to patients living in
San Bernardino and Riverside Counties. Beaver's long track record of clinical and financial success
reflects not only the hard work of its highly qualified physician staff, but also the systems, policies and
processes developed by EPIC Management. Mr. Goodman received his Bachelor of Science degree in
Accounting from California State Polytechnic University and is a Certified Public Accountant.

Dennis P. Flynn, MD, MBA
Dr. Flynn, a family medicine physician, joined
Beaver Medical Group in 1989. Dr. Flynn is Chairman of
Beaver Medical Group's Credentialing Committee and Chairman of NORCAL's Medical Review &
Advisory Committee. His past appointments include serving as the Chief of Staff at San Bernardino
Community Hospital and President of San Bernardino County Medical Society. Dr. Flynn has also served
as Vice President of Medical Affairs at EPIC Management since 1997. In his current role at EPIC, he is
responsible for overseeing credentialing, quality management and utilization management activities,
and process improvement initiatives such as same day access. Prior to his medical management
position at EPIC, Dr. Flynn practiced family medicine for 25 years. Dr. Flynn received his MD in 1972 from
McGill University and completed his internship and residency at McMaster University in Canada.

Lakeside Medical Group, Inc., Glendale, CA
Francesco Federico, MD
Dr. Federico is President and Chief Executive Officer of
Lakeside Community Healthcare as well as
President and CEO of Lakeside Systems, Inc. (LSI), the parent company for Lakeside Community
Healthcare. Dr. Federico serves on the board of LSI. He was one of the founders of Lakeside Health
Services and has served as Chairman of the board, Chief Executive Officer and President since its
inception in 1991. Dr. Federico is also the founder and President of Lakeside Medical Group. Dr.
Federico was a practicing physician specializing in oncology/hematology for 30 years. In 2007, he left
his practice to oversee Lakeside Community Healthcare's operations on a full-time basis. Dr. Federico
graduated from Harvard College in 1972 and received his medical degree from Harvard School of
Medicine in 1976. His post-graduate training includes an internship and residency at UCLA San
Fernando Valley Medical Program.

Kerry Weiner, MD
Dr. Weiner is the President of
Lakeside Community Healthcare Medical Group. Dr. Weiner has served
as an Executive Vice President of Lakeside Healthcare and a board member since its inception in 1991.
Dr. Weiner was one of the founders of Lakeside Health Services. In addition to his duties overseeing the
medical group, Dr. Weiner has been practicing gastroenterology and internal medicine since 1983. Dr.
Weiner received his medical degree from UCLA School of Medicine in 1978 and his masters in public
health in 1978. His post-graduate training includes a residency at UCLA San Fernando Valley Medical

Riverside Physicians Network, Riverside, CA
Howard Saner, MBA
Howard Saner is the Chief Executive Officer for
Riverside Physician Network, a physician organization
that is a contracted network of independent primary care and specialty physicians which has served the
greater Riverside area since 1984. Mr. Saner also serves as the co-Chair for the Inland Empire Region
of the California Association of Physician Groups. Mr. Saner celebrated his 20th anniversary with the
healthcare industry, starting as a member service representative for FHP Healthcare. While at FHP
Healthcare, he worked his way through the company's operations taking on various positions ranging
from medical group operations, contract negotiations, community relations, and strategic development.
After FHP Healthcare sold to PacifiCare, he followed the physicians to Talbert Medical Group where he
served as Vice President of Managed Care and, eventually, as the Senior Vice President of Business
Development and Marketing. Having served in various positions, he was enthusiastic to come back to
Riverside and work with local physicians who have established roots in the community. Saner
graduated from Long Beach City College, California State University at Long Beach, and received an
MBA from the University of Phoenix.

Timothy Mackey, MD
Timothy Mackey is a pediatrician and the President of
Riverside Physician Network. He is the
past-Chairman of the Department of Pediatrics at Riverside Community Hospital. He has served as a
board member of the Riverside Physician Network for the past 15 years and was a teacher of pediatric
advanced life support at Riverside Community Hospital for the past 18 years. Dr. Mackey received his
MD at the University of Texas.

SynerMed, Inc., Monterey Park, CA
James Mason, MBA
James Mason was appointed to the role of SynerMed president and Chief Operating Officer in January
2002. With more than 15 years of broad health care experience, Mason is responsible for the
management and strategic direction of the company. During his tenure, SynerMed has grown from one
client and a few hundred members to more than 450,000 members through its customer base. Prior to
SynerMed, Mason served as Vice President of Operations for Comprehensive Healthcare Management
which became SynerMed after a successful turnaround and reorganization. Mason has and continues to
be involved with the development of Medicare and Medicaid managed care initiatives including
Multi-purpose Senior Services Programs (MSSP), Program of All-inclusive Care for the Elderly (PACE),
Social HMO (SHMO) and various Medicaid managed care programs in California including County
Operated Health Systems (COHS) in Orange County, Geographic Managed Care in San Diego and
Sacramento and the Two Plan model in Los Angeles County, Fresno and the Inland Empire. Mason
received his bachelor's degree from the University of Redlands and a master's of business
administration (MBA) from Pepperdine University.

Southern California Permanente Medical Group, San Diego, CA
James G. Malone
Jim Malone is the Medical Group Administrator for Southern California Permanente
Medical Group (SCPMG) in San Diego. SCPMG is San Diego County's largest medical
group, with 830 physicians serving nearly 500,000 Kaiser Permanente Health Plan
members from 15 locations throughout the county. In his role as Medical Group
Administrator, Jim oversees all of SCPMG's operations in San Diego County.  Prior to
joining SCPMG, Jim was the Executive Director of Ambulatory Services for Kaiser
Permanente in Ventura County. Before joining Kaiser Permanente in 2007, Jim served as
Chief Executive Officer of the Buenaventura Medical Group, Inc. for more than 8 years.
Previously he held executive positions with several prominent medical and pharmaceutical
organizations, as well as Senior Consulting Manager with Arthur Andersen & Co.

Mark Bird MD, MBA, MSW
Dr. Bird has been an Anesthesiologist with the Southern California Permanente Medical Group
(SCPMG) since 1992. He was elected to the Board of Directors of SCPMG (1997-2008) and during that
time served on the SCPMG Budget Advisory, Investment, Retirement, Revenue, Information Technology
and Administrative Stipend committees. As part of his responsibilities on the board he led negotiations
for physician compensation for several years. During this time he was elected as a Delegate to the
California Medical Association for Very Large Group Practice where he continues to serve. Dr. Bird also
represents SCPMG in Political Action and the Executive Marketing activities. In addition to his medical
training Dr. Bird holds degrees in Business (MBA) from UC Irvine and Social Work (MSW) from USC.

John Muir Health, Walnut Creek/Concord, CA
Mike Kern, MD
Dr. Kern is a family physician, who currently manages quality for John Muir Health, a regional health
system in the San Francisco Bay Area. After a two-year stint as an emergency physician for Kaiser
Permanente, he had a private practice in Lafayette, California, for 17 years. During this time Dr. Kern
became involved in various aspects of care management, eventually being named Senior Vice
President & Medical Director at John Muir. Dr. Kern has been involved in many quality activities across
the state of California, such as the CCHRI efforts to improve chronic care, and the Integrated Healthcare
Association's Pay for Performance initiative. Dr. Kern is a member of the Steering Committee for Pay for
Performance. He also has been an advisor to CHART, the California Hospital Assessment and
Reporting Taskforce. Under his leadership, John Muir was one of the top performing groups in clinical
quality in the initiative's first four years. Dr. Kern more recently has focused on improving care for
patients with chronic illness, and children with obesity. His Transforming Chronic Care (TCC) initiative
supports frail elderly patients, and serves both Network and traditional Medicare patients of John Muir.
He received his bachelor's degree at Marquette University, his MD at the University of Nebraska, and
completed his residency training at the University of Wisconsin, Department of Family Medicine.

About CAPG

CAPG is committed to improving health care for Californians and supports a progressive and organized
system of health care delivery which focuses on coordinated treatment plans and comprehensive
coverage, including the most current preventive services and exams. This allows physicians to focus on
illness prevention and proactive management of patients in order to maintain their optimum level of
Southern California Permanente Medical Group, Inc.
Company Profile
Southern California Permanente Medical Group (SCPMG) is a for-profit organization of
doctors who serve the 3.3 million members of Kaiser Permanente's Southern California
region health care network. The Southern California Kaiser Permanente regional
organization is made up of a
not-for-profit company [Kaiser Foundation Health Plan
and Hospitals] that administers the company's health plan,
a group of about a dozen
community hospitals, and the for-profit SCPMG. The physician group practice organization
provides general practice and specialist care services. Its Southern California service
territory encompasses Metropolitan Los Angeles, San Diego County, the Inland Empire,
Orange County, and western Ventura County.           

393 E. Walnut St.
Pasadena, CA 91188
James G. Malone
Medical Group Administrator James G. Malone provides
executive leadership to the Southern California
Permanente Medical Group here in San Diego...

[I think that means he's the Chief Executive Officer,
succeeding Oubre as CEO in San Diego.
Kaiser is a non-profit, and pays no taxes.
Permanente Medical Group (SCPMG) is  for--profit.
And the partnership is very, very lucrative for both.
SCPMG in San Diego
In 1996, the Permanente
Medical Groups created
The Permanente
, a separate
entity, which focuses on
standardizing patient care
and performance under one
name and system of policies.

Around the same time,
was also
chartered as a vehicle to
provide investment
opportunities for the
for-profit Permanente
Medical Groups.

One of the ventures of the
Permanente Company is
Kaiser Permanente
, a venture
capital firm that invests in
emerging medical