Kaiser Permanente and the Alliance of Health Care Unions

New (and Better) Workflow Improves Blood Pressure Control

Workflow Helps Patients Control Blood Pressure

Team co-leads with a staff member

Cindy O'Brien, the team's labor co-lead; Cynthia Field, its management co-lead; and Angela Washington, a clinical assistant II and OPEIU Local 2. 

Team went "all-hands" to keep hypertension in check

The Largo Medical facility had 11,400 members with uncontrolled blood pressure, which represented the highest percentage in the Mid-Atlantic States region.

Largo’s Adult Primary Care department, with its diverse team of nurses, physicians, certified nursing assistants, nurse practitioners, pharmacists and receptionists, wanted to see who was slipping through the cracks in terms of blood-pressure management—and why.

And for good reason.

National studies show that for every 36 patients with hypertension whose blood pressure is brought under control, one life is saved from a heart attack or stroke.

The team decided to take action against the care gaps by following up machine blood pressure readings with manual readings. They sent the patients with repeat high blood pressure readings to a nurse practitioner or pharmacist for further treatment or counseling.

For the CNAs, they provided tips on better techniques for taking blood pressure to get accurate readings. To reach more patients with chronic hypertension, the team increased outreach calls for each receptionist to an average of 20 names each week.

But they also added reward to the work and posted weekly certificates acknowledging staff members who were the highest performing or most improved in number of outreach calls and number of blood pressure checks.

“Our approach is to address every elevated blood pressure at the point of contact in all clinical areas,” says management co-lead Cynthia K. Fields, RN, clinical operations manager. “The all-hands-on-deck approach is the key to our success.”

In four months, the team exceeded its goal with 73.6 percent of hypertensive patients with blood pressure under control.

“The providers and staff know that they work hard every day,” says Cynthia O’Brien, nurse practitioner, labor co-lead and union shop steward. “But transparent data showing improvements week by week allowed them to see the fruits of their labor.”

The team also began spreading successful practices to the specialty departments within the Largo Medical Offices so when patients have appointments there, they will get their blood pressure checked and managed.

As part of their efforts, the team ensured no patient with a repeat high-blood pressure reading left the facility without a plan of care based upon individual needs. The improved workflow also improved communications and morale. 

For more about this team's work to share with your team and spark performance improvement ideas, download a PowerPoint.


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