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I’ve had the privilege of working for Kaiser Permanente for more than 30 years, and it was clear to me from day one that there is something different about our organization and the people who work here.

We’re big, with more than 175,000 employees and 18,000 physicians who provide coverage and care for more than 10 million members. What makes us unique, though, is our mission—to provide high-quality and affordable health care and to improve the health of our members and the communities we serve—and the actions, behaviors and decisions we take to support our mission. We walk the talk.

Our success these past 70 years has been the result of a lot of tremendous work and effort, individually and collectively, by hundreds of thousands of people. Today, we are fortunate to have great people working in all parts of the organization who are well-informed, highly motivated and focused on fulfilling our mission. We have leaders at every level who are delivering better health for all.

Early in my career at Kaiser Permanente, I gained an appreciation for the important role labor has played throughout our history. In fact, labor plays a broader and very different role at Kaiser Permanente than it does in many companies across America. Part of the reason we have worked well with labor is that even when we’ve had disagreements, unions have demonstrated a lasting interest in the success of Kaiser Permanente and the employees they represent, especially during challenging times.

I also have a personal appreciation for the role of labor in our society. My father belonged to a carpenters union. Unions were a voice advocating for the American dream for my family—saying my father should get work, he should be fairly paid, he should be treated right. My father had the jobs he had and the job protection he had because of the unions stepping up and speaking out.

At Kaiser Permanente, we place a tremendous value on creating and maintaining an environment where people not only feel comfortable speaking out but are encouraged to do so—and the Labor Management Partnership unions are actively supporting this culture. We want everyone in this organization sharing their best thinking every day, so we can create the best experiences for our members and patients, no matter where, when or how they come in contact with Kaiser Permanente—which is the essence of One KP.

As we look to the future, we need to continue to bring our best thinking forward during a time of dramatic change in health care. We need to have the mindset that we are going to embrace this change and lead the industry in charting the course for 21st century health in this country, so we can carry on the legacy of Kaiser Permanente for many years to come.

When I think about the Labor Management Partnership and Kaiser Permanente’s history, I can’t help but believe the creation of the LMP was inevitable—and that it’s been the linchpin to KP’s success after the financial challenges of the 1970s, ’80s and ’90s.

From the very beginning, Kaiser Permanente’s management and its unions shared a philosophy of engagement. This culture never went away entirely, but when the competition from for-profit HMOs mounted in the 1980s, it got pushed to the background. Kaiser Permanente did what many businesses do—it reduced its workforce and made other cost-cutting changes. Union members became frustrated, believing the changes undermined KP’s mission and eroded working conditions.

The unions responded with traditional work actions and strikes.

But I’d say four milestones changed the landscape.

First, in the early 1990s, the Industrial Union Department of the AFL-CIO created the KP Coordinated Bargaining Committee to improve the unions’ bargaining position. That committee, which included most of the major unions at Kaiser Permanente, became the Coalition of Kaiser Permanente Unions. We were charged with coordinating a full-scale “corporate campaign” against KP.

But we realized we might do permanent damage to the company and to our 57,000 coalition union members. So we opted to pursue an alternative strategy. In the mid-’90s, we approached KP with a bold new idea—partnership. Unlike other union-employer “cooperation” arrangements, where management would come to labor for help after decisions had been made, the proposed partnership called for labor’s integration into KP’s management and operations structure.

After almost a year of discussions, Kaiser Permanente agreed, and in 1997, the Labor Management Partnership was formed. The decision demonstrated courage on both sides. It placed a value on the knowledge possessed at every level of the organization, from the boardroom to the front line. Building on that, we broke away from traditional, reactionary problem solving and turned to interest-based problem solving and consensus decision making.

This led to the fourth milestone—the decision to conduct national bargaining using those same problem-solving methods and to include operational leaders and rank-and-file union representatives at the bargaining table.

Other factors have contributed to KP’s financial turnaround, but there can be no denying the impact the partnership made—and continues to make—in ensuring that Kaiser Permanente is the national leader in health care, with a great place to work and industry-leading salaries, wages and benefits. Its position did not come about by accident, but by the courage of leadership and the power of partnership.

Visit Kaiser Permanente's 70th anniversary mini-site.

“Henry J. Kaiser’s Permanente Foundation Hospital in Oakland, built to provide pre-paid medical care for 100,000 shipyard workers, has been opened to the public,” the San Francisco Chronicle announced on July 21, 1945—a momentous shift for a health plan that had been serving only employees and their families.

With World War II coming to an end, the plan’s future had been in doubt. Sidney Garfield, MD, the sole proprietor of the Permanente Foundation Health Plan, argued for its continuance, as did ex-Kaiser workers and their unions in the San Francisco Bay Area. Henry J. Kaiser, always open to bold moves, said: “Well, why shouldn’t we open the plan to the public and see if it works?” While other industrialists had adopted programs to improve their workers’ health, Kaiser was the first to embrace the public.

The plan came under attack—doctors in private practice called it “socialistic.” But support from key labor leaders made the difference that ensured the plan’s success.

Kaiser’s long history of supporting labor—an ethical and business decision he’d come to when handling huge government contract projects—became even stronger in his remaining years. In 1965, the AFL-CIO presented Kaiser with its Murray-Green Award, the first businessman to be so honored by organized labor.

Relations between Kaiser Permanente and labor unions have experienced ups and downs since then. But as the early history of unions at KP and the advent of the Labor Management Partnership in 1997 make clear, there is no health plan in the country with a richer and more positive relationship with working people and the organizations that represent them.

Visit Kaiser Permanente's 70th anniversary mini-site.

For the first five years after the Permanente Foundation Health Plan opened to the public, there were no separate regions. Three hospitals—two in Northern California and one at the Fontana steel mill in Southern California—served the new members.

Northern California

The Oakland hospital opened on Aug. 21, 1942, and the Richmond hospital opened nine days later. Once the plan went public, the International Longshoremen and Warehousemen’s Union and other unions were prominent among the early member groups. Oakland city employees, union typographers, street car drivers and carpenters also embraced the plan. In 1953, state-of-the-art hospitals opened in San Francisco and Walnut Creek, as well as Los Angeles. Today, three union locals in Northern California belong to the Coalition of Kaiser Permanente Unions: SEIU-UHW (28,800 members), OPEIU Local 29 (2,400 members) and IFPTE Local 20 (1,300 members).

Southern California

Harry Bridges, the ILWU president, wanted a hospital in the San Pedro area in 1949, and it was his promise of a large and stable membership that convinced health plan leaders to expand. He proved as good as his word, and KP became the sole supplier of medical care to ILWU’s 6,000 West Coast members. The Southern California Permanente Group was established in 1950. In 1951, the 15,000 members of the Retail Clerks Union Local 770 in Los Angeles, at the time the largest local in the country, joined the plan. Today, there are 13 coalition locals in Southern California: SEIU-UHW (18,000 members); UNAC/UHCP (16,000); United Steelworkers Local 7600 (6,000); OPEIU Local 30 (4,000); UFCW locals 770 (a descendant of the clerks union), 324, 135, 1428, 1442 and 1167 (3,860 total); Teamsters Local 166 (500); KPNAA (350); and SEIU Local 121RN (200).

Northwest

Health plan enrollment opened to the community in 1947 with the opening of an outpatient facility across the Columbia River from the closed Kaiser shipyards. It became a region in 1951 and has been at the forefront of several innovative practices. In 1964, it launched the Center for Health Research to advance evidence-based medicine. In 1974, it became the only KP region to provide prepaid dental services. In 1991, the Northwest started Kaiser-on-the-Job, a workers’ compensation program that has since spread to all regions. Coalition locals in the Northwest are: OFNHP/ONA (3,400), SEIU Local 49 (3,900), UFCW Local 555 (900) and ILWU Local 28 (65).

Hawaii

Hawaii opened in 1958—before the territory became a state—with strong support from the building and construction trades, which benefited strongly from Henry Kaiser’s hotel and housing projects. It was the last region to join the partnership, in 2009. The Hawaii Nurses Association, OPEIU Local 50 (800 members), belongs to the coalition.

Ohio

The Ohio region was the first organizational expansion of the health plan outside the western United States. The Community Health Foundation in Cleveland—which had been established by the Meatcutters and Retail Store Employees Union and had a structure similar to KP’s—merged with Kaiser Permanente in 1969 to form the Kaiser Community Health Foundation. The region left KP in 2013.

Colorado

Colorado also joined Kaiser Permanente in 1969, after requests from a group of labor, medical, university and government leaders. The United Mine Workers had regional headquarters in Denver, and Kaiser Permanente had longstanding relations with UMW through the Kabat Kaiser Institute in Vallejo, later known as the Kaiser Foundation Rehabilitation Center, where injured miners were treated. Today, SEIU Local 105 (3,500 members), UFCW Local 7 (1,800) and IUOE Local 1 (23) belong to the union coalition.

Mid-Atlantic States

In 1980, KP acquired the failing Georgetown Community Health Plan and, through the use of existing community hospitals, began to operate profitably within two years. Kaiser Permanente believed locating in the Washington, D.C., area would provide high visibility regarding health care legislation. The effort was successful: In 1992, Jim Doherty, president of the Group Health Association of America, the professional organization for HMOs, remarked that the move “did more for the HMO movement than any single act since the HMO Act of 1973.” In 1984, the region opened its first pharmacy and changed its name to Kaiser Foundation Health Plan of the Mid-Atlantic States. In 1996, it acquired Humana Group Health Inc., one of the country’s oldest HMOs. OPEIU Local 2 (3,800 members) and UFCW locals 400 and 27 (1,600 total) belong to the coalition.

Georgia

The Georgia region opened in 1985. Its first medical director was Harper Gaston, MD,
a Northern California physician and Georgia native who was proud to return home and serve the initial 265 members. In 1988, the region experienced dramatic growth when the state of Georgia came aboard as a major account and Kaiser Permanente acquired the financially ailing Maxicare Georgia HMO; within a year, the region celebrated its 100,000th member milestone. UFCW Local 1996 (1,800 members) is part of the Coalition of Kaiser Permanente Unions.

Visit Kaiser Permanente's 70th anniversary mini-site.

The dread is familiar: You have a question or a problem, and you need to call a service center to get the matter cleared up. Will the issue be fixed quickly? Or will the call be transferred from one person to the next—to the next—to the next?

As the second open enrollment period under the Affordable Care Act approached, Kaiser Permanente’s Customer & Member Services team knew that it didn’t want the thousands of new members joining KP to have that sort of frustrating experience. Just the year before, C&MS’ Member Service Contact Centers (MSCC) had been swamped by three times as many calls as expected. That had led to many handoffs to Membership Administration, which works with the MSCC customer service representatives to get questions answered. 

And so the first-ever “super unit-based team” sprang into action in September 2014. Its mission: To combat long wait times and better handle the anticipated surge in calls that would come with open enrollment.

What made it “super” was that it transcended locations and time zones, bringing together on a single team representatives from across the country—from the MSCCs in Denver, Colorado; Fulton, Maryland; and Corona, California, and from Membership Administration in Denver and San Diego. In the past, an individual UBT at one of the centers might develop a good practice, but it was left largely to chance that other centers would learn of it and follow suit. But under the umbrella of the Open Enrollment 2015 Readiness Initiative, 29 frontline and managers, supported by regional and national leaders, took a fresh approach to testing initiatives and spreading best practices.

Unifying approach

The combined team helps everyone operate as one team instead of separate entities, says Deashimikia Williams, a customer service representative at MSCC-Fulton and an OPEIU Local 2 member.

The collaborative effort was important because members don’t distinguish between different centers or different divisions. “They see us as One KP,” says Marie Monrad, vice president of strategy and operations for the Office of Labor Management Partnership, “and with this, we are doing performance improvement as One KP.”

The Super UBT’s biggest success so far is known as “one and done”—meaning that the member’s question is taken care of by the representative who picks up the phone. Before, a member’s request to stop an online payment, for example, might have taken up to a half-dozen calls. But with the introduction of the one and done process, the MSCCs were able to reduce the number of handoffs by 60 percent from January 2014 to January 2015.

The secret to success was looking to the customer service representatives for answers, says Jerry Coy, senior vice president of Customer & Member Services. “We asked the people who actually take the calls, ‘What questions are members asking?’ and ‘What would make your job easier?’” he says. “We are the front door to KP. We welcome the members and want them to be a member for life.”

“All of this work is in line with the Labor Management Partnership’s commitment to grow and maintain membership for KP,” notes Janelle Williams, consultant specialist for frontline engagement and growth. 

Answering calls from all over

The call centers that participate in the Super UBT answer the majority of KP member calls from the entire organization, fielding questions on a range of topics from billing to details of the health plan to helping members who haven’t received their membership cards.

Super UBT members received additional education and created a rapid resolution team within Membership Administration. While the representative stays on the phone with the member, he or she can consult with specialists via Lotus Notes SameTime chats or by opening another line. From mid-January through early March, the MSCCS handled nearly 5,400 calls—and more than 5,000 of them were successful rapid resolution calls, with the members helped in a single interaction. In addition, through staffing changes, operational improvements, and the implementation of the rapid resolution team, Membership Administration has reduced mean processing time for member issues from 26 days in January 2014 to three days in January 2015.

While Kaiser Permanente members benefit from the work, the frontline staff members benefit, too.

“We have a better understanding about the changes in different regions,” says Deashimikia Williams, who is the Fulton UBT’s labor co-lead. “Before the Super UBT, it was hard to get everybody engaged. Being engulfed in this work motivated us.”

LaDondra Hancock, senior account administration representative for Membership Administration in San Diego, also says the initiatives started by the Super UBT have improved the way she and her teammates work. “It has lessened the calls we get in from the different Member Services Contact Centers,” says Hancock, who serves as her local team’s labor co-lead and is a member of OPEIU Local 30.

Model practices

The success of this collective effort provides a model for other teams and departments looking to share and spread best practices, and underscores the importance of reaching out to other teams doing the same or similar work.

“Not only is this work of the Super UBT critically important for improving the member experience,” Monrad says, “but it also shows that it is critically important to test, model and explore new ways to bring improvement through our partnership that cuts across not only multiple regions, but multiple unions and multiple functions.”

Although Rahul Nayak, MD, calls himself “fundamentally lazy,” it might be more accurate to call him lazy like a fox. Instead of starting from scratch to create Georgia’s centralized Outpatient Safety Net Program, his team started with a recipe provided by Southern California.

“Someone has already done something that works. Why not start there?” says Dr. Nayak, who was physician program director of patient safety for Georgia when the program launched.

Dr. Nayak’s outlook serves as the guiding force behind spread—the art of adopting a practice, workflow or project from another team, medical center or even an entire region. The benefits? As the Georgia team learned, new initiatives often get off the ground faster if they’re modeled on an already proven concept. The Southern California safety net system had already won a 2012 David M. Lawrence Patient Safety Award for its work.

“The foundation was laid,” says safety net team member Eula Maddox, LPN, a member of UFCW Local 1996. Maddox makes up to 60 calls a day, phoning members who have had abnormal lab results and scheduling follow-up appointments. “These calls reduce stress for patients and costs for Kaiser Permanente,” she says. But, she notes, the team had to adapt the program for it to work well for Georgia members, including changing the hours that calls were made.

For its work, the team won the 2014 David M. Lawrence Patient Safety Award in the transfer category—an award for a region that successfully implements a project from an earlier award winner. The award recognizes the importance of spreading best practices, which ensures that members receive the same high level of care regardless of which medical center they visit. That’s a primary principle of One KP, which sets the goal of providing every health plan member with “the best experience, everywhere, every time.”

“Our members and customers believe—rightfully so—that we know how to operate as one organization,” says Bernard J. Tyson, KP’s chairman and CEO, “and that whatever we learn about the best ways to care for people in one geographic area…is available to all of our 9.6 million members.”

Best practices occur at all levels and in all departments. In Colorado, for example, the Regional Lab unit-based team tackled the issue of standardizing labels. Even a simple mistake—putting a label on crooked—can adversely affect patient care. The team is creating visual aids and tip sheets that will spread to 28 locations by this fall.

“This is a problem people have had to deal with for years and are passionate about fixing,” says Beth Fisher, a medical technologist, member of UFCW Local 7 and sponsor for the regional lab team.

Spreading practices takes effort from both sides. At Virginia’s Burke Medical Center, a project launched by the Primary Care team four years ago has sustained its success in helping patients with hypertension get their blood pressure under control—and the team has helped other facilities in Northern Virginia adopt the practice.

“If it works for us, it will work for other people,” says the Burke team’s lead nurse, Angela N. Williams-Edwards, RN, a UFCW Local 400 member. “Other teams saw it was easy and ran with it.”

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.

When Marianne Henson, RN, left her position as clinical operations manager of the Burke Primary Care team in Virginia, she took something with her—a plan.

In 2011, Henson helped launch a project at the Burke Medical Center that boosted the percentage of patients with their blood pressure under control. Instead of creating a brand-new plan to solve the same problem at her new facility in Falls Church, Virginia, she became a copycat.

“Why reinvent the wheel?” Henson says. “We already knew what worked.”

When Henson was in her role at Burke, other clinical operations managers and physicians from the 10 Northern Virginia medical centers held regular area-wide meetings that allowed teams faced with similar issues to learn from one another. As a result, other facilities began adopting Burke’s practice of having clinical assistants call members with hypertension to ask them to come in for more frequent blood pressure checks. Burke had already discovered that members ignored requests sent via mass mail, so the other centers didn’t waste time or money repeating that experiment.

“We have members waiting only five to 10 minutes,” says Andrea Brown, a clinical assistant at Falls Church and member of OPEIU Local 2. “We let them know over the phone that this will be a quick visit and they will be on their way.”

Brown and the other clinical assistants try to call at least five members each day to see if they can pop in for a check while at the pharmacy or when they have an appointment with a specialist. And each day, depending on the weather, between three and five patients take advantage of the mini-blood pressure appointments. “This brief visit is cost effective, saves time and helps us make sure the member is on the right track,” Brown says.

Brown says members have given her positive feedback because of the convenience.

“It made sense because the whole region was expected to bring hypertension control up to better levels,” Henson says. “We standardized what we do.”

Our Value Compass puts the patient at the center. But—which patient do we mean?

If you are, say, a registered nurse on a telemetry unit, do you mean just your specific patient? Or all the patients in your department? Or at your whole facility? In your region?

What would happen if you took the One KP strategy to heart and considered every patient at every Kaiser Permanente facility your patient?

In this issue of Hank, you’ll find ways to do just that. How? By sharing your own department’s successful practices—and by learning from your colleagues’ triumphs in improving care.

Let’s face it: As at every large organization, there are silos and turf at KP, with attendant rivalries among departments, facilities and regions. That sense of competition on everything from service scores to attendance to membership growth can make it seem like quality is a zero-sum game—that my improvement must come at your expense.

As at other institutions, there’s also a bias against anything “not invented here.” How many times have you heard, “But that won’t work here. We’re—different.” Really? Is the birth of a baby so different in Oakland than in Portland? Is filling a prescription for statins so different in Atlanta than in Denver? Or could the same approaches to improving service and quality work regardless of location?

As an antidote to “not invented here,” try “proudly found elsewhere.” Open your mind, eyes, heart and—yes—ego to improvements from outside your home base. When you view every KP patient as yours, you won’t hesitate to spread what you’ve learned to others and to learn from them in turn.