title: A Quasi-experimental Evaluation of Performance Improvement Teams in the Safety-Net: A Labor-Management Partnership Model for Engaging Frontline Staff.
abstract: Unit-based teams (UBTs), initially developed by Kaiser Permanente and affiliated unions, are natural work groups of clinicians, managers, and frontline staff who work collaboratively to identify areas for improvement and implement solutions.
  
  
  
  We evaluated the UBT model implemented by the Los Angeles County Department of Health Services in partnership with its union to engage frontline staff in improving patient care.
  
  
  
  We conducted a quasi-experimental study, comparing surveys at baseline and 6 months, among personnel in 10 clinics who received UBT training to personnel in 5 control clinics. We also interviewed staff from 5 clinics that received UBT training and 3 control clinics.
  
  
  
  We conducted 330 surveys and 38 individual, semi-structured interviews with staff at an outpatient facility in South Los Angeles.
  
  
  
  Each UBT leader received an 8-hour training in basic performance improvement methods, and each UBT was assigned a team "coach."
  
  
  
  Our outcome measure was 6-month change in the "adaptive reserve" score, the units' self-reported ability to make and sustain change. We analyzed transcripts of the interviews to find common themes regarding the UBT intervention.
  
  
  
  The survey response rate was 63% (158/252) at baseline and 75% (172/231) at 6 months. There was a significant difference-in-change in adaptive reserve between UBTs and non-UBTs at 6 months (+0.11 vs -0.13; P = .02). Nine of the 10 UBTs reported increases in adaptive reserve and 8 UBTs reported decreased no-show rates or patient length of stay in clinic. Staff overwhelmingly felt the UBTs were a positive intervention because it allowed all levels of staff to have a voice in improvement.
  
  
  
  Our results indicate that partnership between management and unions to engage frontline staff in teams may be a useful tool to improve delivery of health care in a safety-net setting.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of North Carolina at Chapel Hill (Drs Laing, Dixit, Steers, and Brook); Departments of Medicine (Drs Dixit, Steers, and Brook) and Family Medicine (Dr Laing), David Geffen School of Medicine at UCLA, Los Angeles, California; and RAND Corporation, Santa Monica, California (Ms Berry and Dr Brook); Los Angeles County Department of Health Services, Los Angeles, California (Dr Laing); and Department of Health Policy and Management at the UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, California (Dr Brook).
authors.forename: Brian Yoshio
authors.initials: BY
authors.lastname: Laing
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Dixit
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Berry
authors.forename: W Neil
authors.initials: WN
authors.lastname: Steers
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003299:Cooperative Behavior; D006801:Humans; D007324:Institutional Management Teams / Q000639:trends*; D007750:Labor Unions / Q000639:trends*; D015141:Los Angeles; D009936:Organizational Innovation; D010348:Patient Care Team / Q000639:trends*; D015397:Program Evaluation / Q000379:methods; D036301:Qualitative Research; D058996:Quality Improvement; D064876:Safety-net Providers / Q000458:organization & administration; D057566:Self Report; D011795:Surveys and Questionnaires; D000066477:Work Performance / Q000592:standards* / Q000706:statistics & numerical data