Frontline Managers

Ten weeks of national bargaining between Kaiser Permanente and the Coalition of Kaiser Permanente Unions concluded Saturday, June 6, when 150 union and management representatives approved a tentative 2015 National Agreement. The agreement now goes to the 28 union locals that compose the coalition for ratification and to Kaiser Permanente senior leaders for approval.

The three-year tentative agreement is designed to help unionized workers and managers achieve quality, affordability and safety of care; prepare for jobs of the future; and develop innovative solutions to health care challenges. The agreement also will enable our 3,500 unit-based teams to better deliver award-winning care and service to Kaiser Permanente’s more than 10 million members and patients.

“This is an outstanding agreement that deepens our ability to provide affordable, high-quality care to our members and patients,” says Dennis Dabney, the senior vice president of National Labor Relations and Office of the Labor Management Partnership. “Kaiser Permanente leads the industry because it is a great place to work and a great place to receive care—and the two are inseparable.”

“We’re on year 18 of a remarkably successful strategy,” says Hal Ruddick, executive director of union coalition. “Our contract is better than ever, Kaiser Permanente’s quality and service scores are higher than ever, and the organization and unions are both healthy and growing. Partnership pays off for workers, consumers and mission-driven organizations like Kaiser Permanente.”

Agreement highlights

The agreement includes wage increases in each year of the agreement (see specifics below), provides operational flexibility and bolsters joint problem-solving capabilities. It builds on the successful 2012 National Agreement, strengthening provisions for workplace health and safety, providing additional funds for workforce training and development and ensuring the consistent application of partnership principles.

The new three-year tentative agreement includes:

• Across-the-board wage increases in each year of the agreement: All employees in Northern and Southern California represented by a coalition union receive 3 percent increases in the first two years and 4 percent in the third year. Employees in the regions outside of California represented by a coalition union will receive a 2 percent increase each year of the three-year agreement. In addition, they will receive a 1 percent increase at the end of the third year.
• Enhancements to benefits such as dental coverage, life insurance and tuition reimbursement. The tuition reimbursement was increased to $3,000 per employee per year. For the first time, tuition, dental coverage and life insurance are standardized for coalition union members across all regions.
• A long-term solution that protects retiree medical benefits for current and future retirees, with no net increase to retirees’ out-of-pocket expenses, while reducing liabilities associated with those benefits.
• Increased funding to the Ben Hudnall Memorial Trust and the SEIU UHW-West and Joint Employer Education Fund to ensure career development for Kaiser Permanente’s diverse workforce.
• Improved methods for assessing unit-based team performance and for spreading and adopting successful practices.
• Updates to our groundbreaking Kaiser Permanente Total Health Incentive Plan,  which rewards employees for healthy behavior and provides incentives for collective improvement.
• Joint participation on community health projects by the coalition unions in KP’s local and regional Community Benefit programs.

Next steps

Our agreement is the largest private-sector contract in the United States this year. Once it is approved by Kaiser Permanente senior leaders and ratified by union members this summer, it will take effect Oct. 1, 2015, and be in effect through Sept. 30, 2018.

The impact of the agreement “goes beyond the words on paper,” says Jerry Vincent, the Northern California region’s director of Labor Relations. “It lays the foundation for us to continue to provide quality, affordable care for many years.”

“There were some tough moments,” Denise Duncan, RN, the executive vice president of UNAC/UHCP, says of the negotiations. “But people came back together. It was a reminder that our national agreement—and our partnership—is very strong, and we keep making it better. There’s nothing like it anywhere else.”

For more information, see www.bargaining2015.org.

Improving performance and strengthening partnership is the work of the Operational and Service Excellence in Partnership subgroup—one of three subgroups in national bargaining.

At the third session of national bargaining, members of the subgroup made recommendations on topics including improving learning, accountability, problem solving, consistency, flexibility and support for unit-based teams.

The many perspectives represented at the table—with all regions and a wide range of job types in the mix—enriched the group’s discussions.

“We are really making progress. We’re having good discussions that can help people back at work overcome barriers in their day-to-day UBT work and make their lives easier and better,” says Holly Davenport, a union representative for UFCW Local 770 in Southern California. The group is investigating ways to improve the spread of practices from one team to another and to ensure that UBT assessments accurately reflect performance.

One LMP

The subgroup is also looking at ways to improve partnership at all levels of Kaiser Permanente and at the elements—from tools to training—that affect its success.

“Our group is trying to establish the principles of partnership and ensure they’re applied consistently across regions,” says Rita Essaian, an executive administrator with Southern California Permanente Medical Group.

“No matter what region you’re in, the partnership should be the same,” says Ruby Robley, a respiratory therapist at Antioch Medical Center in Northern California and an SEIU-UHW member. “We need One LMP, just like One KP.”

First-timers excel

Many of this year’s negotiators are new to bargaining in partnership, including manager Casper Yu, the director of Dental Sales and Marketing in the Northwest. “I love how this process works,” he says. “We negotiate and still come out with great personal and working relationships. I tell people, ‘This is what it truly means to be in partnership. I get it now.’”

Operational and Service Excellence in Partnership is one of three subgroups tasked with crafting the next National Agreement. The other two are Total Health and Workplace Safety and Work of the Future.

Visit bargaining2015.org for more information, videos and slideshows and to sign up for bargaining updates.

Elizabeth Rollice, RN, always knew that the Intensive Care Unit at the Woodland Hills Medical Center in Southern California was a great place to work.

As a staff nurse there, she and her co-workers enjoy good teamwork and excellent communication, and they deliver high-quality care to the sickest patients.

Now they have proof of their success.

This spring, the unit received the Gold Beacon Award for Excellence from the American Association of Critical-Care Nurses, the world’s largest specialty nursing organization. The award recognizes hospital units that demonstrate exceptional care through improved outcomes and greater overall patient satisfaction.

The team will be honored at the National Teaching Institute & Critical Care Exposition in San Diego, May 18-21.

“I knew that we did a good job and that everyone worked well together,” says Rollice, a member of UNAC/UHCP and a representative on the department’s unit-based team. “This award validates the quality of our work and tells us, ‘Yes, we are doing a pretty good job.’ ”

What’s best for the patient

Superb communication and a culture of collaboration among all members of the care team are key to the team’s success, enabling the consistent practice of evidenced-based medicine that has improved the quality of care.

Daily multidisciplinary rounds, for example, involve everyone on the care team who touches the patient.

“It’s about working in partnership with physicians, nurses and other staff to deliver high-quality care based on the newest evidence,” said Lynne Scott, RN, a clinical nurse specialist for the Critical Care and the Definitive Observation Unit. “We’re constantly moving forward.”

Nurses say team rounding gives them an opportunity to speak up and influence care decisions that affect their patients.

“We’re able to talk together about what’s best for the patient,” said Erica Bruce, RN, a UNAC/UHCP member who is the team's union co-lead. “If I feel that something is inappropriate, then I get a chance to ask the doctor. Family members get to ask questions about their concerns, too.”

Multidisciplinary rounding has produced an unintended benefit—higher member satisfaction. “I started in the ICU in 2002. We didn’t have a big rounding team at the time. Families sometimes felt unsupported,” recalls Paramjeet Dhanoa, RN, a staff nurse and UNAC/UHCP member. “Now that we have a big team, our families are more satisfied, because they feel they are not alone in making decisions. They are more comfortable.”

Open communication

Communication is vital in a department where staff members work around the clock in rotating shifts. To ensure information is consistently shared from shift to shift, the team:

• practices Nurse Knowledge Exchange Plus (NKE Plus)
• holds monthly UBT meetings, with members of the representative team responsible for sharing information with individual staff members
• holds quarterly staff meetings; those who miss the meeting must review the staff meeting binder and sign a form indicating they’ve read it
• uses a bulletin board to post important news and activities

The bulletin board, sandwiched between the nurses’ station and the staff restroom, attracts passersby with colorful fliers and posters.

“Your eyes are drawn to that communication board,” Rollice says. “You pass by a wall full of fliers, notes and postings, you can’t help but stop and look. It’s in a prime location.”

Conducted at the patient’s bedside, NKE Plus provides nurses with a template for patient safety and communication.

“It helps promote open communication and it helps us understand what’s going on with the patient,” says Judy Stone, RN, a staff nurse and UNAC/UHCP member, of the structured, in-depth, face-to-face handoff between the outgoing and the incoming nurse.

Stone says an additional itemized checklist “forces us, as nurses, to have all the pieces of the puzzle ready in the morning for multidisciplinary rounding. It really focuses us on everything that is going on with the patient so that we can deliver the best care that we possibly can.”

Clinical successes

Building the culture of collaboration and openness has had a big payoff:

• No ICU patient has contracted VAP since the first quarter of 2011.
• There have been no central line-associated bloodstream infections since the fourth quarter of 2011.
• The unit achieved the 86th percentile on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient satisfaction survey from January 2013 through August 2014.

“To consistently deliver the best patient outcomes, you must have the processes and structures in place,” says Kareem Younes, RN, nursing project coordinator for Woodland Hills. “It’s about doing the right thing at the right time, every time.”

Finding ways to help Kaiser Permanente employees enjoy long, healthy, productive lives is the mission of the Total Health and Workplace Safety subgroup.

The subgroup, one of three in national bargaining this year, will expand upon the achievements of the 2012 National Agreement. It will also address how Kaiser Permanente and the Coalition of Kaiser Permanente Unions can partner to improve the total health of the communities we serve.

Delivering exceptional care and service and supporting a healthier, injury-free workforce go hand in hand. “We can’t provide quality, affordable care to our members and communities unless we first provide a safe and respectful environment that promotes the collective health of our workforce,” says Kathy Gerwig, Kaiser Permanente’s vice president of employee safety, health and wellness and the management co-lead for the subgroup.

Personal and collective health

In 2012, negotiators established the groundbreaking Total Health Incentive Plan. The wellness program encourages employees to assess their own health and aim for collective improvement in measures like cholesterol and body mass index. In addition, healthy employees can serve as role models for Kaiser Permanente patients.

This year, the parties will suggest ways to create a healthier, safer work environment by improving employee access to services such as wellness coaching and better understanding trends in workplace violence and prevention. Another goal is to encourage employees to eat healthily, exercise at breaks and prevent workplace violence and intimidation.  

Expanding wellness to communities

In a first for national bargaining, the subgroup will also suggest ways to bring a holistic approach to wellness into communities Kaiser Permanente serves, especially those with limited access to healthy food, affordable health services and places to exercise.

“Our union members tend to live in communities that have high needs around health or issues around violence,” says Meg Niemi, the president of SEIU Local 49 and also a union co-lead for the subgroup. “So our members have an interest in their communities being healthier and safer further upstream, before they need critical care.”

The other two subgroups tasked with crafting recommendations are Work of the Future and Operational and Service Excellence in Partnership. (For more on Work of the Future, watch this slideshow and read this article.) Negotiators are developing a tentative agreement that will become the National Agreement after it is approved by Kaiser Permanente leadership and ratified by union locals this summer.

Visit bargaining2015.org for more information, videos and slideshows, and to sign up for bargaining updates.

Equipping frontline workers with the skills and knowledge for tomorrow’s jobs—an essential element in preserving Kaiser Permanente’s competitive edge—is the focus of the Work of the Future subgroup at National Bargaining.

The negotiations this year focus on three topics, in addition to wages and benefits:

• Workforce planning
• Training and development
• Innovation and technology

“Health care is changing,” says Hal Ruddick, the executive director of the Coalition of Kaiser Permanente Unions. “We have a huge new influx of members because of the Affordable Care Act. We have to meet their needs differently—and we can do that through the solutions we create bargaining in partnership.”

Planning for change

Flexibility, foresight and planning are essential to developing a workforce that is ready for coming changes in the health care industry, said Zeth Ajemian, the director of Workforce Planning and Development for Southern California and Hawaii.

“To prepare our workforce for the future, we need to align staffing with current care delivery transformation, innovation and new technologies that meet the evolving needs of our members,” he says. “We're entering a tremendous era of change. A portion or all of an employee's work will change and their skills, training and experience will need to change to fit that job.”

Creating career pathways that allow current KP employees to move into new roles is essential, says Brian Lockhart, security lead at Sunnyside Medical Center in the Northwest and a member of ILWU Local 28.

“We want some flexibility around the experience component,” says Lockhart, who explained that employees who have trained for new roles are sometimes unable to move into them because they don’t have the necessary work experience.

Role of technology

Leveraging technology to meet the emerging needs of our patients will be another key issue for the bargaining team, says Dennis Dabney, senior vice president of Labor Relations and the Labor Management Partnership.

“We need to decide how we bring that new technology into our work environment,” he says. “We need to react more to what our patients want, rather than what we want to give them.”

Whatever innovations are designed and implemented in the future, frontline workers need to be engaged from the start, say union partners.

“Kaiser Permanente is on that bullet train toward the future and if the labor movement is not on that train, we are going to be left behind,” says Janis Thorn, interim president of United Steelworkers Local 7600.

Work of the Future is one of three subgroups tasked with crafting the next National Agreement. The other two are Total Health and Workplace Safety, and Operational and Service Excellence in Partnership.

Visit bargaining2015.org for more information, videos and slideshows, and to sign up for bargaining updates.

After their letters to members went unanswered, the members of the Burke Primary Care team changed their approach.

Instead, clinical assistants called patients with the message, “Your doctor is concerned that your blood pressure is not being controlled,” says Angela N. Williams-Edwards, RN, a member of UFCW Local 400, the team’s lead nurse and former labor co-lead. “It worked better because it was more personal.”

This was in 2011, when the team had challenged itself to get more patients’ blood pressure under control and reduce their risk of a wide range of diseases. They succeeded—and their success mushroomed, with the other centers in Northern Virginia adopting it. All Primary Care teams share the goal of having more patients with blood pressure in a healthy range, and there was no reason for the other teams to start at square one since Burke had demonstrated its way worked—and worked well.

Four years ago, to entice members to come in more frequently to better manage their hypertension, the Burke team also made changes to make the visits for blood pressure checks as appealing as possible:

• Patients could pop in almost any time for the mini-checks, so they could stop when they were at the medical center for other reasons. There was no copay for the quickie visits.
• The members don’t have to wait long. “If they wait too long,” Williams-Edwards says, “their blood pressure will go up.”
• If a member’s blood pressure reading was too high, the doctor came in during that same visit to discuss options—possibly making medication changes—and to urge the member to return for a follow-up within 10 to 14 days.

All of these factors helped the Burke unit-based team increase the percentage of patients whose blood pressure is under control from 75 percent in January of 2011 to 85 percent by August of 2011. Today, the team has not only maintained that improvement but surpassed it. As of November 2014, the team boasts that 90 percent of its patients with hypertension have their blood pressure under control.

“Burke worked so hard to have the results sustained,” says Eileen Chiama, who has been the team’s management co-lead and clinical operations manager for about three years. “We achieved these gains through the huddling process and by keeping focused on it. It became part of our normal workflow.”

Moreover, Chiama says, “The workflow process was shared with other medical centers. The way you spread is to find a champion—someone on the team who is so passionate about the goal.” She says Edwards-Williams is that champion at Burke. “Never underestimate the power of one to generate enthusiasm in the rest of the team.”

Marianne Henson, RN, who was the team’s manager when the project first started, says she met regularly with the area’s other internal medicine clinical operations managers. “We share best practices that way,” she says. Now, several Northern Virginia teams—including Henson’s current teams at Falls Church and Tysons Corner—have improved their rate of blood pressure control, too.