Winter 2015

Colorado

When the region revamped how it assesses unit-based teams’ Path to Performance rankings in 2014, some teams dropped down on the five-point scale. But the National Agreement and the region’s Performance Sharing Plan motivate teams to reach high performance, and UBTs are rallying around the more objective and accurate evaluation method. The downgrades are proving to be temporary. One Level 5 team is the Cardiology department at the Franklin Medical Office, which improved access by streamlining the referral review process for patients.

Georgia

Musicians aren’t the only ones who go on tour. Loretta Sirmons, a Total Health labor lead, and Tracie Hawkins-Simpson, a contract specialist, who are both members of UFCW Local 1996, hit the road to encourage people to complete the Total Health Assessment. They were joined by their business representative, Louise Dempsey, and Russell Wise, the Coalition of Kaiser Permanente Unions national coordinator for Georgia. “We blitzed the facilities,” Wise says. “For those who hadn’t taken the THA, we explained its importance.” They visited during the work day, dropped in on farmers markets and held cyber cafés. Wise credits the collaboration for increasing regional participation in the THA: In May, it stood at 37 percent. By September, it had increased to 63 percent.

Hawaii

The Hawaii region is partnering with 25 local labor trusts to enhance its members’ benefits and build loyalty to Kaiser Permanente. The new benefit, called Well Rx Hawaii, makes drugs for high blood pressure, high cholesterol and diabetes available free of charge for enrolled members. “Union leaders like it because it shows the value they bring to their members,” says Harris Nakamoto, KP’s director of labor and trust sales for Hawaii. “We like it because it emphasizes the strength of KP's integrated delivery system—and helps members with chronic conditions save money and stay healthier.” KP is funding the program through expected savings in future medical costs and is tracking enrolled members’ compliance with medication, follow-up care and any decrease in emergency room visits or hospital stays.

Mid-Atlantic States

The supply closets for the Physical Therapy department at the Woodlawn Medical Center in Maryland were “in disarray,” admits Dexter Alleyne, materials coordinator and member of OPEIU Local 2. “The overabundance of supplies was money not being used.” Using the 6S method, the inventory operations team took responsibility for the closets—organizing them and setting par levels while preparing to use OneLink for ordering supplies. The team created a spreadsheet for surplus supplies and sent an “up for grabs” email to colleagues at its own medical center and beyond, says Jennifer Hodges, inventory operations supervisor for the Baltimore area. Purging four closets over the summer is yielding savings. The team plans to spread the success throughout Woodlawn and to three nearby medical centers.

Northern California

Concerned by the slow pace of growth in the number of high-performing unit-based teams in the first part of 2014, both the Northern and Southern California regions piloted a SWAT team approach to accelerate the development of Level 4 and 5 teams. The results were impressive. In June, Northern California temporarily reassigned UBT consultants and union partnership representatives from high-performing service areas to assist the consultants and UPRs working in three struggling service areas. As a result, from June to September 2014, the region moved 42 UBTs in the targeted service areas to Levels 4 and 5, out of a total of 90 teams that moved up to high-performing status. During the same period in 2013, 15 UBTs had become Level 4 and 5 teams in those same areas.

Northwest

The Northwest is the only KP region to offer dental services to health plan members—and its dental program is celebrating its 40th anniversary. The idea for the program, which launched in 1974, came from Mitch Greenlick, then director of the Center for Health Research, KP’s medical research unit. Today, Greenlick is a state representative in Oregon—and more than 800 KP dental staff and dentists provide more than 234,000 people with dental care and coverage. The program is home to 19 unit-based teams, almost all of them high performing. Sunset Dental UBT reduced unfilled appointments by creating a wait list and calling patients when a spot opened up. Unfilled appointments improved by 22 percent in 2013, and team members have sustained the result. Get some quick facts and figures on the dental program.

Southern California

Taking a SWAT team approach to boost the number of high-performing unit-based teams, Southern California concentrated resources on several strategically selected facilities. By October, the percentage of UBTs at Levels 4 and 5 was 59 percent, up from 34 percent in January. A key component of the approach was hiring seven new union partnership representatives, including Elsie Balov, an SEIU-UHW member who is aiding teams at the South Bay Medical Center. “It is really important that labor is helping with this work,” Balov says. “We are pulled from the front line to help, so we know the obstacles and the challenges and can work with the UBT consultants on those.

Fists pounding on tables, demands, showdowns, strikes. So went traditional collective bargaining: Each side fighting for a bigger slice of the same pie. Each side gunning for a narrowly drawn agreement on pay and working conditions, leaving mutual concerns about patient care, quality and affordability unaddressed.

But Kaiser Permanente and the Coalition of Kaiser Permanente Unions abandoned the traditional approach in 1997, when they founded the Labor Management Partnership.

Our negotiations feature committees, observers and flip charts of options. Since 2000, KP workers, managers and physicians have worked together to craft four National Agreements and one reopener amid relative labor peace. On March 30, some 150 representatives will begin to negotiate a fifth agreement. Assuming all goes according to schedule, the new contract for the 100,000 workers represented by 28 locals in the coalition will be ready to go into effect when the 2012 National Agreement expires Sept. 30.

In an age of growing health care costs and increased competition, the joint goal is to provide our health plan members and patients with better, faster, less expensive and more personal care and to maintain and improve the best health care jobs in the United States.

“Interest-based bargaining is not a utopia and not always a win-win. It’s taken Kaiser and the unions a lot of hard work to get where they are,” says Linda Gonzales, director of mediation services for the Federal Mediation and Conciliation Service, Southwest Region. “[But] to resolve difficult issues in partnership is a strength.”

Because of interest-based bargaining, Kaiser Permanente and the Coalition of KP Unions have been able to go well beyond wages and benefits—the subjects of traditional bargaining—in  negotiating four program-wide contracts. These National Agreements have developed industry-leading approaches to worker sick leave, safety and training and workforce development. They have created unit-based teams to improve patient care and service, set standards to hold teams and their sponsors accountable, and pioneered programs for the mutual growth of KP and the unions.  

Interest-based bargaining pays off in other ways as well.

“To understand one another’s interests, you have to engage in inquiry and listening, and you have to resist jumping to conclusions about the other party’s intentions,” says Harvard Business School Professor Amy Edmondson. “Doing this develops leaders who better understand how the organization works.”

“People in health care look to Kaiser Permanente as the showcase for working together,” says Gonzales, who helped facilitate bargaining for the first National Agreement in 2000.

The mediation service last year recognized a handful of cases of successful interest-based bargaining. Our Labor Management Partnership was one of them.

Picture a large room with 150 people. Hands are raised. Everyone gets heard. It is pushing midnight and exhaustion is setting in, but everyone maintains a sense of mutual respect and serious purpose.

It’s not the United Nations but the Common Issues Committee (CIC). The CIC is a representative group—made up of Kaiser Permanente workers, managers and physicians as well as delegates from the Coalition of Kaiser Permanente Unions—who take on the responsibility of negotiating a new National Agreement. The program-wide labor contract covers the 28 locals in the union coalition.

This inclusion is part of what makes our negotiations different from other labor contract negotiations—because how we bargain greatly affects what we bargain. By seating RNs and regional health plan presidents with lab techs and program managers during negotiations, interest-based bargaining at KP opens up new issues for discussion and creates deeper support for the final agreement.

“I personally learned a lot from the different perspectives voiced by all of the individuals representing their fields,” says Dr. Varoujan Altebarmakian, a medical group representative on the 2012 CIC. What he learned during bargaining, he says, made him an even more active advocate for partnership at Fresno Medical Center, where he is physician-in-chief.

A new CIC is formed each bargaining year. KP and union leaders select members and assign each to a subgroup to address a topic area. This year, those topics are expected to include Total Health, Work of the Future, and Operational and Service Excellence in Partnership.

Each subgroup is co-led by a management and union representative. Instead of taking hard-line positions, subgroup members stake out their common interests. Over the course of five bargaining sessions, assisted by outside facilitators, they identify interests and develop options.

In 2010, that process led to development of the Path to Performance, which established a uniform way of rating UBTs. “It was a defining moment in partnership,” says LaMont Stone, a labor liaison for Local 29 in Northern California who participated in 2010 and 2012 bargaining. “Before it was case by case, region by region.”

At the final bargaining session, each subgroup brings its proposals to the full CIC for discussion and agreement; the full CIC also negotiates wages and benefits. The finalized contract then goes to KP management for approval and is ratified by the members of each local in the union coalition.

Each day, more than 3,500 unit-based teams use interest-based problem solving and consensus decision making to improve performance and resolve issues throughout Kaiser Permanente. Those same techniques guide negotiations for the National Agreement.

The interest-based process differs from traditional bargaining in several ways. The first major difference can be seen in the room, says Dawn Bading, vice president of human resources for the Georgia region.

“The way we physically sit is different,” she says. “In traditional bargaining, labor sits on one side and management sits on the other. With interest-based bargaining, we sit at a U-shaped table and we are interspersed together. Beside me may be a union rep and on the other side may be someone from management. This physically represents the interweaving of thoughts and ideas.”

This intermingling continues as the negotiations begin, says LaMont Stone, labor liaison for OPEIU Local 29 in Northern California.

“In regular bargaining, you start apart and try to come together,” says Stone, who has participated in bargaining the last two National Agreements. “Here, we start together and try to stay together.”

Part of the power of interest-based bargaining is that in the early stages, the parties aren’t staking out possible solutions.

Walter Allen, executive director and CFO of OPEIU Local 30, says that in traditional bargaining, sides may start off with extreme positions to better their chances of getting what they actually want in the negotiations. “I’ve heard some unbelievable proposals, such as having Groundhog Day off,” Allen says. “Because we don’t do proposals (positions)—we do interests—you don’t get that here. You have to say why this is an interest. How can you argue seriously for Groundhog Day off? No one wants to defend a stupid proposal. Interest-based bargaining eliminates a lot of nonsense.”

This step also helps each side see how much they have in common before moving on to develop options and reach consensus.

“At times it was tedious,” says Angela Young, a unit assistant at Roseville Medical Center. An SEIU-UHW member, Young was a 2010 and 2012 member of the Common Issues Committee and is headed to bargaining again in 2015. “But it keeps the conversation going, and got us where we needed to be. That’s a good thing.”

When I was asked to serve on the national bargaining team in 2012, I was a newbie. I had never done bargaining before and didn’t know what interest-based bargaining was. I quickly learned it is a skill that would serve me well, both in the bargaining sessions and in my career beyond that event.

Bargaining began with a significant investment from the company providing both labor and management representatives with education sessions to understand interest-based bargaining. Part of this education was to understand the landscape of Kaiser Permanente and how we were doing in the industry. It also included a look at the future, as well as the history of KP and the value of the partnership. Bernard Tyson (KP’s chairman and CEO) made it clear that partnership is an asset to KP and it wasn’t going away.

I worked on the Growth team, which was to find ways to help grow KP and union membership. We practiced together with scenarios, using the interest-based problem solving tools—a great way for the team members to start to trust each other.

As we went through the process, there were times we disagreed, and we worked through that. Getting through those tough conversations really showed that although we might be coming from a different place, we had the same commitment and common interests.

One of the interesting aspects of working with a national team was meeting folks from across the KP program. Although I am from Colorado, it was interesting to see that the concerns we had from our region were similar to those of Mid-Atlantic States.

I was a little concerned going into the process that we’d get stuck on some of the local issues. When specific regional issues came forward, we were able to quickly work through them and refocus. I was impressed with my labor partners, who really helped us move from the local issues to the strategic.

Honestly, there were times when I wondered if we were going to be able to get through it. The process was a reaffirmation that we are all on the same page. Other companies haven’t been able to do what we do. We stumble and fall back on traditional methods at times, but there is power in the KP model of how we do things.

When I was asked to represent The Permanente Medical Group at 2012 bargaining, I leapt at the opportunity. My own experience with partnership at Fresno Medical Center showed me what great things could be accomplished with collective problem solving.

I sat on the subgroup that looked at how to improve partnership to enhance performance and Kaiser Permanente’s operational agility. I was amazed at seeing so many people with different backgrounds sharing their thoughts and shaping the outcomes. From the highest levels of Kaiser Permanente and union leadership to the front line, everybody was around the table, and they were all equal in this venue. Everyone was heard and engaged.

I personally learned a lot from the different perspectives voiced by all of the individuals representing their fields. I strongly believe that collective wisdom is better than individual wisdom, and that with collective wisdom you can achieve anything in life. Interest-based bargaining, which assembles voices from all levels and reaches of Kaiser Permanente, is a great example of collective wisdom.

Another thing that struck me—how much folks craved the physician perspective. When I spoke, all 25 to 30 people in that subgroup really listened. And there were issues where a physician perspective was critical. That was a strong message I brought back to physicians. In most unit-based teams at Fresno, there is physician involvement. The intention is to bring those perspectives together to enhance the care for our members and patients. But does that mean if I walk into a UBT meeting I’ll see a doctor? Maybe yes, maybe no.

I’ve worked at Kaiser Permanente for 34 years, and I saw the pre-partnership years. They were contentious ones. We’ve had relative peace with coalition unions since partnership. That’s not to say that working in partnership is perfect in every way. It can’t be done without trusting each other. And how do you develop trust? Through transparency. The whole bargaining process was about transparency; essentially, everybody could share everything. That doesn’t mean people didn’t disagree.

The interest-based, collective approach takes into account everyone’s perspectives to reach a better outcome, which is ultimately a common goal—superior care for our members and patients.

I just used interest-based problem solving (IBPS) while I was at a union convention in Philadelphia. We got five people to rent a car together and go sightseeing on our one day off. So we had to decide what to do in Philadelphia for 24 hours. We brainstormed, then identified the ideas we all supported. We went to Valley Forge, Amish country and the boardwalk in Atlantic City. It worked great.

My husband and I used interest-based problem solving to make a decision about a major purchase recently. I used IBPS to get to “yes.” IBPS is the easiest way to organize your mind. My mind automatically goes to it and that whole process. If a conversation gets confusing, you can go back to the structure provided by it.

Being at a round table with interest-based problem solving is the best way to move health care forward. What we do at the bargaining table with IBPS is great, but we need to do a better job bringing that back to the workplace. We can make it better by having more frontline managers at the bargaining table.

Frontline managers, especially the newer ones, need a sense of the history and commitment of our National Agreement. And frontline managers need more support. There are still problems with backfill, with allowing employees to be involved in LMP activities.

The way we do business at Kaiser Permanente is the Labor Management Partnership, so we need to have those interest-based discussions. I’ve been involved in 2000, 2005, 2010 and 2012 bargaining. I am in awe of the great work labor and management representatives do—and how we can come up with common goals in a nonadversarial manner. I hope we all see it as a value.