peer advice

Bernie Nadel is director of customer service and call center operations at Patient Financial Services in Southern California. He co-chairs the Regional Operations LMP Council, bringing together 27 business units, including the regional laboratory, central refill pharmacy and optical services.   

None of us was born into a unit-based team. Partnership is learned. Teams and their leaders need guidance and a playbook.

I tell other managers partnership makes my job easier. I have 10 other people helping to come up with solutions. I know some managers are uncomfortable with that approach. They act as though they can opt out of the Labor Management Partnership. It’s as if they said, “I know we have KP HealthConnect™, but I want to use this other computer program.” I say, if you don’t want the LMP, don’t work at Kaiser Permanente. You don’t get to opt out of the company’s policy.

Owning the work

Recently, our UBT went through a list of issues to work on. Call volume is up 30 percent, and we’re figuring out how to deal with that. We are going to do several tests of change. UBT members are gung ho about it. If I were to try to make those changes myself, I’d miss things. I would not get the insights of the people who interact with our members every day. And the people doing the work wouldn’t have the ownership and energy that comes with having a voice. Employees know I believe in partnership—and I give them the time to do it. That is a challenge. But you can’t solve the problems if you don’t invest.  

Not that long ago this call center was a toxic environment. There was low trust and low morale. All that has switched 180 degrees. A big step was my predecessor attending a sponsorship training class, which led her to involving UBTs more in day-to-day operations. I wanted to build on that.  

Taking the first step

LMP is a dance between labor and management, and management has to take the first step. When labor sees that management is serious, that’s when it changes. We’ve shown that you can change the culture.

Recently, we had a meeting with top executives about improving the consumer financial experience. Our UBT representative group prepared a report, and it gave our executives insights they couldn’t get any other way. It was not slick, it was real. I’m grateful to the group for the experience, commitment and knowledge they bring to this work every day.

I am one of the chairs the LMP leadership team, along with a union colleague from UFCW and two management leaders. I’m also the co-lead of the Woodland Hills’ union coalition. In addition, I’m a full-time certified registered nurse anesthetist in the operating room. To be an effective labor co-lead takes three things: time, collaboration and planning.

Time

I have been doing partnership work at Woodland Hills for 10 years. People respect the time I’ve invested. You have to be on fire for this because it’s an enormous responsibility. It’s going to cost you time, angst and effort. And you can’t build relationships passing in the hall. You have to make the investment of face time. That means showing up at the LMP council meetings, monthly, from 8:00 a.m. to noon.

Planning Ahead

It is important to bring in and plan for new blood. At Woodland Hills, we rotate the labor co-chair in our leadership team every two years. I believe this allows everyone to have a say. It builds trust and experience. And it ensures buy-in from each union—and each segment of each union. We build-in mentorship. For three months, the new person sits in and the current co-lead shows that person the ropes.

We also did this in the Kaiser Permanente Nurse Anesthetist Association when I was president in 2006. I would go with new facility reps to meetings. 

Collaboration

We really foster union efforts at the medical center level. We’ve got a group of long-term union coalition people and our unions speak with a single, powerful voice. There have been issues between unions, and we had to work things out until cooler heads prevailed. People say ‘I’m sorry’ and move on.

Working with management is both easy and difficult. It’s easy because they are so partnership oriented and respectful of the unions, and they welcome input. They lead by influence—not by authority by virtue of where they are on the food chain—just like we do. It is difficult sometimes because it requires us to work hard as partners. Sometimes it would be easier to just go along with their recommendations, but then we wouldn’t really be doing our jobs as union leaders. At certain points, you have to say, ‘Well, let me think about that,’ and ask your constituents what they think.

Hospitals are traditionally very hierarchical. The partnership is such an opportunity to have a voice.

I have worked at Kaiser Permanente for 33 years, starting as a distribution worker in materials management. Being on the front lines helped me better understand the challenges staff face—and helped me, in my current role, see what it takes to spread and sustain change in a complex organization.

When we launched our first unit-based teams in 2007, I knew they could give our managers and teams a powerful tool for change. But to achieve their full potential, UBTs need the support of leaders at every level. In working with UBTs every day, I have found five practices that can help teams achieve their goals, and have helped me be a more effective leader.

Have patience

I’m not a patient person by nature, and it took a visit to the world-class health care system in Jonkoping, Sweden, for me to see that it takes patience to sustain meaningful change. When you’re solving problems in a team-based workplace, real systemic change takes time. But it also takes hold deeper into the organization.

Really see the work

Spend time with a UBT, or hear teams present their test of change, to understand what they’re working on and how you can support them. There’s no way you can feel the excitement and energy from the team members and not feel proud and motivated by their work.

Spread good work

In Orange County—which has two large hospitals, in Irvine and Anaheim—we expect all teams to continually test and then spread their ideas and successful practices. We call it “One OC” and we talk about it all the time. You’re never going to achieve greatness globally if you don’t spread good work locally.

Provide tools

Early on we formed an Integrated Leaders group of senior labor and management leaders who meet monthly to monitor and assist our 107 UBTs. If a team is struggling, the IL group doesn’t descend on them and try to fix the problem. We provide tools and resources that help the team work through a problem and get results. For instance, we put together a UBT Start-up Toolkit with information on everything from setting up teams to finding training. We’re also looking at toolkits on fishbone diagramming, conducting small tests of change and providing rewards and recognition. And we’re asking how to make it easier for teams to access resources quickly—for instance by identifying go-to people for questions on budgeting, patient satisfaction metrics and so on.

Then, get out of the way

 I have a saying: “Hire great people, give them the coaching and mentoring they need, then get the heck out of their way and let them do what they were hired to do.” I think that works at all levels of the organization, whether or not people are your direct hires. You don’t tell people to make a change or streamline a process without any encouragement or support, but you don’t need to micromanage them either. Delivering great health care is not just a job. It is a calling. Whether you’re a housekeeper preventing infection or a surgeon treating cancer, people’s lives are in our hands. That shared mission drives us to be the best.