Challenge/Strength - Color

As we move toward the “next normal,” the Labor Management Partnership has played a key part in supporting COVID-19 vaccinations.

Frontline workers, doctors and managers have come together to get shots in arms. These fruitful collaborations point the way forward as Kaiser Permanente and the Partnership unions work to transform fear into confidence, confusion into clarity, and hesitancy into bold action.

Look at the data

A joint effort between SEIU-UHW and physicians pushed vaccination rates of the union’s members from less than 50% all the way up to 64% within 3 months. It began when union leaders crunched the numbers — and didn’t like what they saw.

At the beginning of February, less than half of SEIU-UHW members at Kaiser Permanente were vaccinated against COVID-19. For instance, only 40% of union employees were vaccinated in the Emergency Department at Downey Medical Center in Southern California, where Gabriel Montoya works as an emergency medical technician.

Montoya and his fellow union members — working with physicians and managers — wanted to raise those rates, so they pulled together labor-doctor huddles. Union members were scared, confused and hesitant.

Building trust

At first, they considered joint physician-labor rounding. But they realized being in patient areas wouldn’t support those conversations, so they pivoted to huddles — short, informal team meetings.

Carol Ishimatsu, MD, a pediatrician with the Southern California Permanente Medical Group, was one of the first doctors to join a huddle in Downey.

“Vaccines are our most important intervention,” says Dr. Ishimatsu, who participated in the clinical trials for the shots when they were being tested.

To build trust, Dr. Ishimatsu emphasized her shared experience with SEIU-UHW members as warriors on the front line. “I told the employees: I do the same thing you do after work,” she says, describing her ritual of removing her clothes in the garage and putting them directly in the washing machine before entering the house. “We are in different professions, doing the same thing.”

Joel Valenciano, an Environmental Services manager at Downey, helped organize huddles at outlying clinics.

“I encouraged the staff to be honest, relate their fears and doubts, anything holding them back,” he says. “And they really opened up.”

“We did it in partnership,” says Montoya, the emergency medical technician. “The labor partners led the huddles and introduced the doctors.

I can’t imagine that happening in a nonunion hospital, or even a non-Partnership hospital.”

Union leaders crunched the numbers, and they didn’t like what they saw.

At the beginning of February, less than 50% of SEIU-UHW members at Kaiser Permanente were vaccinated against COVID-19. It was even worse for employees in the Emergency Department at Downey Medical Center in Southern California, where Gabriel Montoya works as an emergency medical technician. There, only 40% of his fellow union members got the shot.

Montoya and his fellow union members — working with physicians and managers — wanted to raise those rates, so they pulled together labor-doctor huddles. And by mid-April, 64% were vaccinated. 

“We did it in partnership,” says Montoya. “The labor partners led the huddles and introduced the doctors. I can’t imagine that happening in a nonunion hospital or even a non-Partnership hospital.”

Going live

SEIU-UHW members set up a phone bank to call — in Spanish and English — members who worked in housekeeping, food service and central supply departments, where vaccination rates were lowest. The union also hosted a Facebook live event where Black and Latino KP doctors answered questions.

Those proved so popular that they wondered, why not do this live at the facilities?

Angela Glasper loved the idea. The chief shop steward at Antioch Medical Center in Northern California got frustrated when she talked to fellow union members who were conflicted about getting vaccinated.

“I listened, but I couldn’t address their concerns,” says Glasper, who works in optical sales and needed someone with the clinical expertise to answer their questions. “Wouldn’t you rather hear it from a doctor than me?” she asks, with a hearty guffaw. “People would say to the doctors, ‘Labor has been telling us about it, but you answered our questions.’”

One of the most popular doctors at the huddles in Antioch was Jeffrey Ghassemi, MD, an anesthesiologist. He shared his harrowing stories about working on the COVID units and was, in Glasper’s words, “patient and gentle.” With a newfound confidence, employees signed up for vaccine appointments during huddles.

Building trust

Pediatrician Carol Ishimatsu, MD, who volunteered to talk at a huddle in Downey, has given children shots to prevent measles, mumps and chickenpox for more than 2 decades.

“Vaccines are our most important intervention,” says Dr. Ishimatsu.

To build trust, Dr. Ishimatsu emphasized her shared experience with SEIU-UHW members as warriors on the front line.

“I told the employees: I do the same thing you do after work,” she says, describing her ritual of removing her clothes in the garage and putting them directly in the washing machine before entering the house. “We are in different professions, doing the same thing.”

Joel Valenciano, an Environmental Services manager at Downey, helped organize huddles at outlying clinics.

“I encouraged the staff to be honest, relate their fears and doubts, anything holding them back,” he says. “And they really opened up.”

The trust and open communication cultivated by working in partnership were key to building vaccine confidence.

“Working in partnership has intensified during the pandemic,” says Valenciano, “because people realize we need to work together.”

Dr. Ishimatsu agrees. She was involved with the Labor Management Partnership when it started more than 20 years ago. “At the time, I wasn’t sure it would evolve,” she recalls. “It treats us like one big family, instead of segments. The thing that keeps one person safe, keeps everyone safe.”

Joy in work might seem like an idea that’s superficial or unattainable — especially in a pandemic. But in times like these, it’s more important than ever.

Joy in work is about being connected with what you do and why you do it. It’s the feeling of success and fulfillment that comes from doing work that matters. It connects us with colleagues and patients through a sense of shared purpose.

Joy in work is practical and science-based, according to the Institute for Healthcare Improvement, which has taken the lead in researching the subject. Joy in work produces tangible results: Studies link it to reduced turnover, higher productivity, and improved patient experience, outcomes and safety.

It doesn’t turn every workday into a breeze. There still will be fatigue, long hours and tough days.

But cultivating joy in work creates the deep engagement that helps keep stress from turning into burnout — which was a serious issue in U.S. health care even before COVID-19 arrived on the scene.

For everyone’s benefit, let’s nurture it at Kaiser Permanente.

What brings you joy in work? Use the stories, tips and tools on these pages to explore that question — on your own and with your team. Work together to create joy in work.

COVID-19 is testing partnership as never before.

Management and labor have had to work together quickly to retool the delivery system to support rapidly changing needs. Employees’ and physicians’ skills and talents are needed in new ways and in new places — so leaders from Kaiser Permanente and unions created labor pools to get KP employees to where they were needed.  

It’s one of dozens of innovations made to provide top-quality care at a time when every day is bringing new challenges. The swift work was possible in part because of the foundation provided by the relationships and values of the Labor Management Partnership.

In Southern California's Riverside service area, “It’s all-hands on deck,” says Jiji Abraham, area chief financial officer. “Even physicians are in the labor pool.”

As physician assistant Larry Rick, PA-C, made his rounds of the South Bay Medical Center one recent morning, staff stood at the hospital’s main entrance and screened members, patients, and employees for signs of cold- and flu-like symptoms. Like Kaiser Permanente facilities enterprise-wide, the Southern California hospital adopted the new procedure to protect patients and staff from COVID-19, the respiratory illness caused by the novel coronavirus.

A well-established approach is also helping: Frontline workers here say years of working collaboratively with managers as part of the Labor Management Partnership has better prepared them to fight the pandemic. The Partnership has saved money, improved care, and led to better service – and now will literally be saving more lives because frontline workers, managers, and physicians are working together.

An opportunity to speak up

“Partnership is a fantastic tool,” says Rick, a member of UNAC/UHCP, who has 34 years of experience fighting infectious diseases including H1N1, HIV, and sexually transmitted diseases to prevent the spread of HIV. “Every Kaiser Permanente senior leader has been responsive to our requests and has heard us. We’re working together and everybody is leaning in” to treat more patients now, while preparing for an expected surge. In response to unit-based team members’ concerns, for example, tape was placed in 6-foot intervals on pharmacy floors to help members and patients maintain social distancing while standing in line.

“We’re able to speak up as labor and help figure out the solution,” says Alejandra Navarro, a registered nurse in Maternal Child Health and a member of UNAC/UHCP.

Working in partnership together has also built trust between management and labor. That’s been key to maintaining open lines of communication now and helping counter misconceptions spread by social media, say frontline workers.

Education and support

“They’re educating us and giving us a lot of support,” said Lizz Burnett, a licensed vocational nurse in Geriatrics and a member of SEIU-UHW. “If I can help educate someone and they can tell their family, then maybe we can stop this.”

Tynikko Snyder, a registered nurse in Family Medicine at the Gardena Medical Offices, has 2 children with asthma and her mother suffers from chronic obstructive pulmonary disease. She is worried about the impact of her work on her family. “I am afraid, but I know that I need to step up to the plate and do what needs to be done,” says Snyder, who is a member of UNAC/UHCP. Rick says that can-do spirit is needed to combat the spread of the disease: “If we all do our jobs, we will save lives.”

All improvement requires making change — and change can be difficult. These practices are culled from Kaiser Permanente’s Organizational Effectiveness consultants and from unit-based teams that have moved through change successfully, developing new processes, transitioning to new leadership, etc. These tips are meant to support UBT co-leads and team members as they manage change — and the resistance that often comes with it.

For unit-based team co-leads and sponsors: Identify and manage resistance

• Clearly communicate reasons for the change.
• Make it safe to voice concerns throughout the change process.
• Identify team members mostly likely to resist the change and give them key roles.
• Involve naysayers as early and as often as possible to minimize grumbling.

For all UBT members: Assess the effects of the change and enlist support

• Develop a common understanding of the change, getting everyone’s point of view:  Ask, "What’s being done now and what will be done differently?"
• Engage everyone affected, including physicians, members of other departments and your team sponsor.
• Identify specific enablers and barriers to implementation — areas that will require greater attention.
• Allow team members to identify solutions and make decisions that affect them most.

Celebrate short-term successes — and acknowledge failures

• After each test of change, recognize and reward contributing team members at huddles and meetings. Use these small wins to increase credibility and keep the momentum going.
• Accept failures — and talk about what can be learned from them.

Course description

The training provides an overview of why the Labor Management Partnership is important to Kaiser Permanente and the Coalition of Kaiser Permanente Unions and how unit-based teams are transforming Kaiser Permanente. Topics covered are types of unit-based teams, roles and responsibilities of employees on unit-based teams and consensus decision making basics.

Path to Performance

Level 1

Duration

• 4 hours (classroom)
• 45 minutes (online)

Who should attend

Employees within their first 120 days of employment at Kaiser Permanente should attend this course. Job categories who can take this class are labor, management and physician members of unit-based teams.

Course requirements

This is an introductory course. There are no prerequisites.

When Terri Imbach, Family Practice manager at Mt. Scott Medical Office in the Northwest region, and labor co-lead Christina English, a licensed practical nurse and a member of SEIU Local 49, began to work together as UBT co-leads several years ago, they knew they needed to shake things up with the department’s unit-based team. 

The staff worked hard to meet the demanding needs of the fast-paced medical office, but morale wasn’t great—and team members weren’t taking ownership of improvement work. UBT meetings were poorly attended and often turned into complaining sessions.  

The co-leads’ first move was to go to UBT training classes together. That experience gave them an idea for their next move—which was to shake things up between the two of them by stepping away from work and getting to know each other outside the office. 

“Getting out of the work environment is a good way to get away from the stress of the department,” explains English. This mindset set the tone for how they would operate together and helped them sustain a good relationship over time.

The co-leads also adopted “fun” as part of their regular UBT agenda, and meetings now are attended by nearly 100 percent of the staff.  

“We think of fun ways to get to know each other in and out of the office, and we work to include fun elements in all of our meetings,” Imbach says. During the holidays, team members played relay games at their UBT meeting, and they participated in a fundraiser for a local youth organization that included playing basketball on donkeys. 

The creative energy of the co-leads has helped engage all 40 members of the Level 5 team, who are juggling more than a dozen quality projects. 

“Team members step up to take on projects now,” English says, “and there are friendly competitions to meet our goals.”

Our bodies metabolize the excessive sugar in processed foods just as it processes alcohol and other toxins, causing damage to our liver and other organs.

Sugar makes us more likely to develop a variety of risk factors that lead to serious illness, while making us crave sweet even more.

In fact, sugar causes a cycle of addiction in the brain in much the same way as drugs and alcohol—and cigarettes. When it comes to addictiveness, nicotine takes the, um, cake.

Physicians at the University of California at San Francisco (UCSF), led by outspoken pediatric endocrinologist Robert Lustig, MD, published a paper in February in the journal Nature showing that like alcohol and tobacco, sugar is a toxic, addictive substance. They argue that it should, therefore, be closely regulated, with taxes, laws on where and to whom it can be advertised and age-restricted sales. The researchers said that increased global consumption of sugar is primarily responsible for a whole range of chronic diseases that are reaching epidemic levels around the world.

Is sugar—so pervasive in processed foods, soda and junk food in general—the new tobacco? Let’s see.                                    

It can kill you.

If Lustig and his colleagues—and many other independent researchers—are even half right, sugar and junk food have been responsible for millions of preventable deaths. According to journalist Eric Schlosser, author of “Fast Food Nation” and the children’s book “Chew on This,” poor diet and lack of exercise may soon surpass smoking as the No. 1 cause of preventable death.

People make huge amounts of money by selling it.

Remember how long the tobacco industry denied the link between tobacco, advertising, and lung cancer and heart disease? We are hearing the same protestations from the processed food industry today. Don’t buy it!

Schlosser, a keynote speaker at the 2012 Union Delegates Conference, recounts how McDonald’s was built. Founder Ray Kroc discovered that profits were higher when kids ate out with their parents. So he lured children in with lollipops. Later, he added a clown. Today, fast food chains hire child psychologists, hold focus groups for toddlers and put 5-year-olds in MRI machines to see which part of their brain is responsible for brand loyalty.

“Think about the profit margin in a soda,” Schlosser says. The raw materials are water, food coloring, sugar and a paper cup. Nutritional value: less than zero. Cost to produce: pennies. Now there’s a profit margin!

An imaginary friend of mine smokes, is decidedly chunky, and has high blood pressure and high cholesterol. His kids nag him about the cigarettes and weight; his wife worries more about the hidden conditions.

This fellow could be any one of many of us, and if he wanted to track his efforts to improve his health, he could use the “cloverleaf” graphic introduced in this issue of Hank—a visual summary of the four measures of health at the heart of the new Total Health Incentive Plan.

The cloverleaf has a lot in common with the Value Compass, which illustrates the interconnectedness of service, quality, affordability and the workplace environment. The Value Compass reminds us that improving in one area at the expense of another isn’t progress—and that improving in one area frequently leads to improvements in other areas.

So it is with health. If I take up smoking and have a cigarette each time I’m tempted to eat something sweet, I may improve my Body Mass Index, or BMI—but I won’t have improved my health. If my imaginary friend starts to make better food choices and ups his exercise, however, he’s likely to see improvement across the spectrum of health issues he’s facing. By measuring improvement in several areas, the new incentive plan puts the emphasis on bringing the whole person into better balance.

And by putting the focus on collective improvement, the plan recognizes that all of us are making decisions as individuals in a social system—a system that can make it harder, or easier, to make better choices. Losing the dougnuts at a breakfast meeting may seem like a small gesture, but many such gestures add up to powerful change.