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For everyone at Kaiser Permanente—union members, managers, care providers—speaking up is a right and a responsibility. Being #FreeToSpeak is part of working in partnership. It keeps our patients safe and makes KP a better place to work. It’s not always easy, but your voice makes a difference. The short stories above make that clear.

The photos and quotes above launched a new LMPartnership.org feature, Humans of Partnership. Visit the entire collection.  

Management and union representatives in Southern California were at odds when they gathered in March 2015 to settle a UNAC/UHCP grievance over the working conditions of registered nurses in Home Health, Hospice and Palliative Care. 

Because of the dispute’s complexity and scope, involving nurses regionwide, it was moved from the grievance process into issue resolution.

“When they started, it was the Mason-Dixon Line. It was management on one side and labor on the other side,” recalls Marcia Meredith, who works as a neutral facilitator in Southern California. She gets called on when “sticky and contentious” issues come up involving the Labor Management Partnership, which is celebrating its 20th anniversary this year. “It was pretty tense.”

Months later, managers and union representatives were working side by side, forging consensus on key issues. 

Key to their success was the issue resolution (IR) process spelled out as part of the partnership between the Coalition of Kaiser Permanente Unions and Kaiser Permanente. It incorporates interest-based problem solving (IBPS) and consensus decision making (CDM) to provide a framework for settling disagreements collaboratively—providing a modern-day take on Henry J. Kaiser's line, “Problems are only opportunities in work clothes.” 

Bringing order to chaos

They also benefited from the fact that Southern California—after watching people struggle for months and sometimes years without resolving their problems—recently had clarified how the process was to be used and had added a clear path for escalating issues.  

“Issue resolution helps you focus on what the problem is and the possible solutions,” says Meredith.

The nurses and managers eventually agreed to make changes to assignment workflows, improve communication and enhance training opportunities for frontline workers. “They came up with good things that they’re still using,” says Meredith. 

Crafting Southern California's appeals process took months of hard work. Key stakeholders included regional LMP Council members, coalition union leaders and Human Resources administrators.

Before escalation changes took effect on Jan. 1, 2015, the issue resolution process had tended to spin out of control. 

‘It was like the Wild West’

“It was like the Wild West. Everybody did their own thing,” recalls Ilda Luna, an SEIU-UHW service representative for Glendale Medical Offices in Southern California. 

Alex Espinoza, the Coalition of Kaiser Permanente Union’s national coordinator for Southern California, agrees.

“People would email whomever they thought would resolve the issue,” he says, citing examples of individuals who leapfrogged layers of union and management intervention to appeal directly to leaders at the national level.

During national bargaining in 2015, Southern California representatives shared the region’s appeals process, and the subgroup working on the issue recommended a similar process be created in every region.

The approach calls for resolving issues at the lowest possible level. For stubborn disagreements, there is now a standardized process for escalation the aggrieved parties can turn to, with 30-day deadlines for resolution at every step of the way.

In Southern California, for issues that can’t be resolved at the facility level, a nine-member regional SWAT team made up of management and union representatives serves as a court of last resort before the matter heads to national leaders. 

But since the process was adopted two years ago and local LMP Councils and union leaders were educated about how to use it, no issue has been referred to the regional team. 

That’s good news, says Maryanne Malzone Miller, senior director of Human Resources in Southern California and a SWAT team member. 

“I like to believe we’re pushing it to the level where it should be resolved,” Miller says. 

“It’s a success,” agrees Espinoza, also a SWAT team member. “Folks are engaged and are talking to each other.”

Patient transportation workers at Sunnyside Medical Center in Portland were in a tough spot: No matter how hard they scrambled, they were constantly running late to pick up patients. 

Some of the challenges were clear. The transport workers, members of SEIU Local 49, are qualified to backfill certified nursing assistant positions—and short-staffed nursing units were calling on them to do just that. 

In addition, a new computer-based dispatch system had automated patient transfer requests but required fewer dispatchers. The resulting staff upheaval, along with rumors about changes to their certification requirements, threw the unit-based team into turmoil. 

Delays and frustration

Amid frustration and mounting delays—the team was only infrequently meeting its goal of getting to the patient within 15 minutes—improvement advisor Lolita Burnette worked with the team to resolve its issues. To better understand its challenges, she created a process map of the team’s workflow. That turned up a variety of obstacles that were thwarting efforts to improve times. 

“Shadowing the team was an eye-opener. We discovered issues that were immediately actionable,” says Burnette. Because of the complexity of the situation, team members called for an issue resolution to identify solutions.

“My staff are really concerned about their patients. They had valid concerns about what was hindering our on-time performance,” says Marta Witsoe, the team’s management co-lead.

The issue resolution took place from July to September last year and helped further identify issues that were impacting on-time performance, as well as showing how delays affected imaging appointments and patient satisfaction.

As it tracked the source of delays, the team discovered that often, the patient was not ready to be moved when transporters arrived. The patient might need a different gown for imaging, or needed to take medications before being moved. Making matters worse, nurses and other staff members had gotten accustomed to transport arriving late and often put in orders ahead of time. But if the transport person arrived on time, the resulting delay had a domino effect, making it more difficult to be on time for subsequent transport requests.

New equipment, new hires

As a result of the issue resolution, the team is partnering with other units to become more efficient. Several improvements are being worked on simultaneously to increase productivity and overall satisfaction—and the team is confident the changes will lead to improved metrics. 

In perhaps the most significant change, hospital leadership agreed to hire additional transport staff. The new positions are dedicated to support the Emergency Department, a frequent source of patient transfer requests.

“With time and commitment,” says Esther Logan, the team’s union co-lead, “we agreed upon issues that needed to be addressed within the department.”

Olivia Devers, a labor partner with SEIU Local 49, added, “This IR process was the most positive that I have witnessed in many years—the team and management worked in true partnership from start to finish.”

Henry J. Kaiser, Kaiser Permanente’s co-founder, famously told fellow industrialist Warren Bechtel, “Problems are only opportunities in work clothes.”

If you work with unit-based teams—as a co-lead, consultant or sponsor—you might be rolling your eyes right now and thinking, “Well, if that’s true, I sure have a lot of ‘opportunities.’ Grrr!” 

When a team has problems, it’s difficult—if not impossible—to boldly improve service and quality for our health plan members. Especially if problems linger and fester, eroding trust and goodwill. These can depress morale and even endanger patients. 

Lucky for us, the leaders of Kaiser Permanente and the Coalition of Kaiser Permanente Unions had the moral imagination more than two decades ago to envision a better way to solve problems. Together, they formed what would become our Labor Management Partnership.

As we celebrate our partnership’s 20th anniversary this year, we can look back and see how we have built the tools, structures and culture that support this alternative vision of how workers and employers can interact.

One of those tools is issue resolution. As you will see in the stories that follow, this process bypasses more traditional forms of problem solving in favor of going deeper to really uncover the source of the difficulty. By doing that, union members, managers and physicians not only can preserve their working relationships, but also make them stronger. This, in turn, fosters innovation and improvement. 

Now that sounds like a great opportunity.

Kaiser Permanente and the Coalition of Kaiser Permanente Unions resolve most differences involving our Labor Management Partnership through interest-based problem solving or interest-based bargaining. 

But when the process bogs down, the 2015 National Agreement provides a way for managers, physicians, union leaders and frontline workers represented by a coalition union to move it forward: issue resolution. 

Section 1 of the National Agreement covers a number of topics: how the partnership operates, unit-based teams, and such programs as Total Health and Workplace Safety. The most common disputes encountered are covered by this section. A new issue resolution process, one of three related provisions in the agreement, covers such disputes.

The process starts at the level at which an issue arises; so, for example: 

• When disagreements arise at the facility level, the parties directly involved meet and use interest-based problem solving to try to resolve the issue themselves.
• If they cannot do that within 30 days, the issue may be referred to the local LMP Council.
• If there’s still no resolution, the next step is the Regional Council, and then national LMP leadership. Each body has 30 days to resolve the issue, using interest-based problem solving.
• If no solution can be reached, the question may be decided by a joint panel that includes a neutral designee.

This process is an alternative to, but does not replace, existing grievance procedures. It offers another approach to problem solving. 

“It’s easy for people to get dug into their own place on an issue,” says Denise Duncan, president of UNAC/UHCP. “Partnership and the National Agreement commit us to spending the time to figure out jointly how to resolve problems and do the work.”

Wondering how to keep your meetings short and to the point? Stop by Gilroy Medical Offices in Northern California and watch a unit-based team power through its five-minute daily huddle.

On a Tuesday in October, the Family Medicine UBT for Station 1 gathers around a magnetic marker board filled with visual reminders and messages. Medical assistant and SEIU-UHW member Nabi Lopez takes her turn leading team members through the day’s staffing and scheduling assignments, a discussion of where they stand on key clinical goals and upcoming department events.

Exactly five minutes after they gather, a buzzer sounds, and the 10 nurses, physicians, clerks, pharmacists, EVS staff and others head off to start their day.

A new routine

Crisp meetings and high team engagement were not always the norm for the department.

“Prior to using visual boards, our meetings were few and far between,” says SEIU-UHW member Dawn Reyes-Takaki, a medical assistant and member of the original project team. “They were chaotic, filled with complaints and negativity. Staff felt that changes were forced on them with no input.”

Three years ago, a San Jose-based team studied performance improvement techniques in other organizations. One of the ideas that stood out was the use of visual boards. A larger group of managers, workers and improvement advisors agreed on necessary adjustments and a standard format for the boards, and selected Gilroy Medical Offices to test their use.

Last year, the outpatient procedure unit-based team at Capitol Hill Medical Center rewrote the instructions it sends to patients scheduled
for a colonoscopy. A patient who found the earlier directions confusing played a leading role in the process.

The new instructions helped reduce by 20 percent the number of colonoscopies that needed to be repeated. Involving the patient was “a transformational experience
for the team,” says Jennifer Walker, RN, lead UBT consultant and improvement advisor in the Mid-Atlantic States region.

It also showed the power of a new provision of the 2015 National Agreement.