Frontline Workers

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.

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.

Inspired by the goals of the worldwide “Baby-Friendly Hospital” initiative, the Health Education UBT at the Manteca Medical Center in Northern California set out in early 2012 to increase the percentage of new mothers who exclusively breastfeed. At the time, the number stood at 70 percent.

Steps emphasized by the initiative, sponsored by UNICEF and the World Health Organization (WHO), include training health care staff to inform every pregnant woman of the benefits of breastfeeding and to help mothers begin breastfeeding within one hour of giving birth.

Closing care gaps

The challenge was that while Manteca health educators provided prenatal services to expectant mothers, the moms went to Modesto to deliver their babies. The Manteca employees didn’t always learn whether their patients ended up breastfeeding. In order to make sure their patients were getting full support for breastfeeding as they made the transition from prenatal care to labor and delivery and beyond, the members of the Manteca UBT reached out to their hospital colleagues.

“As a Health Education department, we provide breastfeeding education during their prenatal care, but we were not reaching 100 percent of…moms after they switched to hospital services,” says Maria Prieto de Milian, a health educator, lactation consultant and active SEIU-UHW representative on the Manteca UBT. “There was not a consistent breastfeeding message.

“Our moms were in need of a continuum of care for breastfeeding.”

Researching best practices

The Manteca team, which meets monthly, is linked to a larger Health Education UBT at Modesto. The larger team meets quarterly and includes Modesto employees as well as the employees from the smaller teams at Manteca, Tracy and Stockton.

After researching best practices in breastfeeding support and exploring what other Kaiser Permanente locations were doing, the Manteca team introduced two small tests of change:

• Working with the larger Modesto UBT and with full support from the Women’s Health department, the Manteca team set in motion a collaborative approach to breastfeeding support involving health educators, lactation consultants, physicians, pediatricians, medical assistants and nurses. This includes hospital employees encouraging observance of the “golden hour” immediately after birth, when a newborn is placed skin to skin on the mother’s chest to promote bonding and breastfeeding.
• The team worked with other employees to make sure mothers-to-be were asked about breastfeeding at the regular 28-week prenatal visit, and that their questions or concerns were directed to lactation educators for follow-up.

The results were dramatic. By the end of 2012, 92 percent of Manteca prenatal care patients who delivered at the Modesto hospital were exclusively breastfeeding.

The umbrella UBT decided to spread Manteca’s idea.

“We turned it into a service-area initiative. It started as a pilot just for Manteca, and then the group decided it was so beneficial we’d roll it out to the whole Central Valley,” says Jose Salcedo, the management co-lead for the larger UBT. “The results were really conducive to parents and moms having a great experience. It’s a whole pathway from the early stages of pregnancy to the delivery and then to the pediatricians.”

“The breastfeeding initiative is now regular workflow throughout the Central Valley,” Salcedo said.

Good results sustained

At the time the Manteca UBT started its effort to improve breastfeeding rates, the Modesto hospital was working to achieve the Baby Friendly designation from the UNICEF-WHO program. After making significant progress toward that goal, it switched its focus to implementing the Northern California region’s Breastfeeding Toolkit, a new program that encompasses the same goals.

It's now been almost two years since the small tests of change, and Prieto de Milian says the Manteca UBT no longer is tracking the rate for its moms, viewing the project as a continued success.

New ideas are continually being added to strengthen the process. These include the advice call center providing 24/7 breastfeeding support while also scheduling follow-ups to the calls with lactation educators. In addition, lactation consultants are available to assist pediatricians by phone or by email on KP HealthConnect® during patient appointments.

With everyone’s minds and hearts on one goal, Salcedo and Prieto de Milian say, teamwork was seamless.

“What I like about the UBT is it’s a joint effort,” Salcedo says. “We have really good lactation educators who think outside the box, search for best practices and apply them. They went ahead and ran with it and made the recommendations. Management supported them all the way.”

Standing on a stage in front of hundreds of his fellow health care workers at the largest Ebola educational session on the West Coast to date, registered nurse Peter Sidhu demonstrated how to use personal protective gear in the way that keeps both patients and workers safe.

Sidhu inspected his equipment first—two pairs of gloves, a gown, mask and face shield. Then Arjun Srinivasan, MD, the associate director for health care-associated infection prevention programs at the federal Centers for Disease Control and Prevention, gave him detailed, step-by-step instructions in putting them on.  

The Nov. 7 educational session in Los Angeles was hosted by Kaiser Permanente, the Coalition of Kaiser Permanente Unions and other organizations that are coming together to help frontline caregivers learn about the newest CDC protocols and guidelines for handling Ebola patients. Hundreds attended in person, while thousands more nationwide watched a live telecast of the event.