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Creating a better workplace turns cynics into champions of unit-based teams. UBTs give workers represented by a union in the Coalition of Kaiser Permanente Unions a way to lead change. They help workers, managers and physicians better serve Kaiser Permanente members and patients. Yet too many people don’t know they are part of a UBT. Truth is, everyone in the unit is a UBT member. And, as you’ll see in this issue, engaging with your team can change lives—including your own. Read on and see how.

Big picture comes into focus

Kimberly Carolina, clinical assistant, OPEIU Local 2, Neurology (South Baltimore Medical Center, Mid-Atlantic States)

"When we first learned about working in partnership, I thought it would be difficult. I was a little skeptical and reluctant. It was hard to work with management because they’re actually your boss. I was part of a hiring team and felt uncomfortable speaking up to say why I thought certain candidates wouldn’t work.

Working as a team was very new to everyone. I wondered if there would be backlash or repercussions. Some employees didn’t feel secure about their jobs and didn’t feel like they even had a voice. One day, I realized they were the same as I was. I had a fear of speaking up and so did the managers. After I realized that, we were able to move forward. Employees, providers and everyone needed to have a voice. We needed to not only talk, but to make things happen. It’s been a lot of learning, a lot of great experience and growth.

When I first started out I didn’t see how you needed each person and each piece to make the company grow. The puzzle came together for me.

Now the communications piece is there. We work to be effective, efficient and see the broad picture. It’s amazing to see everyone come together with one common goal to fix things, such as patient wait times.

I enjoy it better now. I’m learning more. I like the results I have seen. Partnership is like you had a child two decades ago and they’ve grown up to be a successful person."

Henrietta is on vacation. This guest column is by Michael Aidan, who represents clinical lab scientists and others in Northern California. He chaired the Coalition of Kaiser Permanente Unions executive board in 2014–2015.

Workers—and the unions that represent them—care about performance. Kaiser Permanente employees come to work to ensure patients and members deliver the highest quality of care and service. Everything they do, almost without exception, is focused on this. 

So I was dismayed when I recently attended KP’s Associate Improvement Advisor training, meant specifically for frontline workers, and saw very few union faces at the table. I know that many would want that training. And I believe employers should recognize the benefits—and justice—of having frontline workers with an equal voice in performance improvement.

Our National Agreement provides a vehicle for union workers to be actively engaged in performance
 improvement. Unit-based teams, co-led by union members, are embedded in KP operations. Yet union members run into roadblocks when seeking training or a seat at the strategic planning table. That lessens the contributions all workers could be making—and discourages many from fully engaging with their teams.

Our coalition is stepping up efforts with KP to expand opportunities for workers in performance improvement efforts, enable workers and unions to help shape needed innovations, and build union capacity to give workers the tools and support they need.

This will remove barriers we face that have outlived their time, and enhance patient care and service.

Holly Craft Moreno was a medical assistant in a geriatrics department. But she’d occasionally put in a few overtime hours at the infusion clinic at her hospital. One day, a young woman—a woman who was her father’s only daughter, who had not yet had children herself—came to the clinic for an infusion. Her prognosis was grim. As Moreno checked the patient in, she thought to herself, “This might have been prevented by a Pap smear.”

And when her shift ended, Moreno says, “I walked down the hall and scheduled an appointment with my ob/gyn.”

That day six years ago was the start of Moreno’s journey as a wellness champion at the Panorama City Medical Center in Southern California. A member of SEIU UHW, she’s been active in rallying her colleagues toward better health. One of her first projects was putting together a “Passport to Thrive,” a brightly colored checklist for recording the dates of preventive screenings and key health measures such as blood pressure and cholesterol.

This fall, efforts like hers are taking a giant leap—or perhaps Zumba shimmy—forward with Kaiser Permanente and the Coalition of Kaiser Permanente Unions announcing the details of a new Total Health Incentive Plan, the broad outlines of which were negotiated as part of the 2012 National Agreement. (Non-represented employees and most managers also will be included in the program.)

The plan is a bold, unprecendented step that acknowledges that ill health is not solely the result of individual choices and that chronic illnesses, which drive much of the high cost of health care, must be addressed collectively. It recognizes an employer can do a lot to support employees in creating better health habits.

“We’ve created a groundbreaking program around the health of our workforce, and it will have a legacy for decades to come,” says Kathy Gerwig, KP’s vice president of Employee Safety, Health and Wellness. “By building a community of support throughout the organization, we’re hoping it will be easier for healthy individuals to stay healthy—and that it will be easier for those with health risks and conditions to get the resources needed to improve.”

The program will track the overall progress of those covered by the incentive plan, region by region, on four key indicators of health—body mass index (BMI), smoking status, blood pressure and cholesterol. There will be a payout of $150 if 85 percent of managers and employees in a region have up-to-date health screenings by year-end 2014 and another $150 if 75 percent also take the total health assessment (THA). If both those goals are met, there’s another $200 if the region sees at least a 1.7 percent improvement in the at-risk population and there is no decline in any of the four areas being measured. 

Taking the THA—a confidential, online questionnaire that helps a person take stock of a wide range of issues affecting his or her health and offers personalized advice—can be a first step toward the improvements the plan aims for.

“You probably know if you aren’t eating enough vegetables or if you’re drinking too much—but the THA helps you become more immersed in creating an environment and awareness of healthy living,” says Cynthia Beaulieu, the union coalition’s Total Health labor lead in the Northwest region. As a result, she says, “you’re more likely to participate in it.”

The incentive program has been derided in some quarters, but most are applauding the effort to confront the prevailing belief that an individual’s choices on matters of health are independent of the culture and environment that person lives in.

“The forces are too strong for any one person or organization to do it alone,” says Roger Benton, the Healthy Workforce practice leader for the Southern California region. “There are unhealthy negative influences that we all get caught up in—stress, sedentary lifestyle, food choices—all of which lead to chronic illnesses.”

Shared interests

Like many other aspects of the Labor Management Partnership, the creation of the Total Health program came about because of a shared interest between management and labor: Improving the health of the workforce is a priority.

As SEIU UHW President Dave Regan points out, “If current trends continue, by the year 2021, 15 percent of Americans will have diabetes; one-third of our population will be pre-diabetic.”

The human and financial costs would be catastrophic—but can be avoided if a joint campaign to improve the health of workers succeeds. So in part, Total Health is a response to the high cost of health care.

“The employer told us the cost for health care for union members is too high,” says Walter Allen, the executive director of OPEIU Local 30 who is serving as interim director of the coalition. “The choices are A) shift more of the cost to workers or B) bring down the cost. We will take plan B. The main way to keep costs down is for people to be healthier and require less care. An incentive is a way to start people off—above and beyond the reward of being healthier.”

By lowering costs, the organization’s financial picture improves, which helps ensure KP’s success and longevity. Improving the health of our large employee population group also would demonstrate to other employers the value of this approach.

In exchange, KP “will leave cost sharing as it is,” says Allen, noting that at a time when many unions reluctantly were accepting concessions in their contracts, health insurance benefits for union coalition members remained unchanged in 2012 bargaining.

“We made a commitment, and now we have to come through,” Allen says.  

Leading by example

But Total Health is more than the sum of economic interests. It’s about how KP and the coalition are leading the way to shift the culture of workplaces toward wellness. Frontline caregivers know they need only look in the mirror to see they suffer from many of the same ills as their patients. It’s time to lead by example.

“Healthy health care workers make for healthy communities,” says Stacey Anderson, an imaging assistant and UFCW labor partner at Sunnyside Medical Center in the Northwest. “I believe we can set the standard for others to follow.”  

At KP, the growing emphasis on employee wellness is a natural complement to the preventive care model.

“We’ve got to create a culture where doing the right thing is the easier thing to do,” says Sylvia Swilley, MD, the physician Healthy Workforce champion at Downey Medical Center in Southern California, where Pop Chips (120 calories per bag) recently replaced Fritos (160 calories per bag) in the vending machines. “We can’t serve stuff in our cafeterias that we tell members in their health education class not to eat. We have to be the face of how to do it right.”

While many workforce wellness programs reward—and punish—individuals for their success or lack thereof, the KP plan will calculate results at the regional level.

“Some people will see it as unfair,” says Elba Araujo, a pharmacy assistant at Los Angeles Medical Center and UFCW Local 770 member. After all, the person who keeps smoking and gains weight might end up with the same bonus as the person who quits smoking and lowers her cholesterol. “But if people see results,” she says, “they will want to get involved.”

By offering programs such as KP Walk!, Mix It Up and the total health assessment, Kaiser Permanente is doing its part, says union leader Allen. In return, he says, the unions are saying, “We will do our part; we will educate our members.”

And they’ll help change habits, too—Local 30 no longer serves junk food at monthly steward meetings, for example.

“We are in health care. We have to take care of ourselves,” says Judy Coffey, a senior vice president and area manager of the Marin-Sonoma Service Area in Northern California, who helped negotiate the plan. “Wouldn’t it be great to be able to say our employees have lowered their cholesterol, their blood pressure, their BMI?”  

It’s true that the Total Health Incentive Plan—and a healthier workforce—will benefit Kaiser Permanente, says pharmacy assistant Araujo.

“But it will help the individual more,” she says. “It helps the patient, the company and yourself.”

At 8 a.m. every workday, an alarm sounds at the Member Services Call Center in Denver. Instantly, Olivia Johnson and her entire unit-based team of customer service representatives to leap out of their seats.

And dance.

The dance break tradition started when one of Johnson’s co-workers set a regular medication alarm that plays music.

“He started dancing when his alarm went off, then another person started dancing with him. Now it’s all of us dancing every morning,” says Johnson, a member of SEIU Local 105. “Afterwards we clap and tell each other it’s going to be a good day.”

Shaking their groove thing, having regular potlucks and sharing information that might make work easier for others are ways Johnson’s team combats potential stress at work. Constant stress can result in faster breathing and an increased heart rate, which the American Heart Association says can lead to physical pain, depression and unhealthy behaviors to compensate.

The members of Johnson’s UBT also alternate work assignments, so that representatives aren’t doing the same thing every week. One week, half of the team fields the calls from Kaiser Permanente members, while the other half answers questions from all of Colorado’s customer service representatives via SameTime chat. The next week, they switch. The variety helps keep the demands of the job manageable.

Stress comes with the job

Terrence J. Cooper, who manages the Maple Lawn Call Center in Fulton, Maryland, says one reason working in a call center can be stressful is, simply, the nature of the work.

“We take complaints here,” says Cooper, who has been at Kaiser Permanente since 2006. “Complaints alone can be stressful.”

Cooper, who manages 20 people, tries to keep his team upbeat by injecting humor into his UBT’s daily huddles and team meetings. The team also host potlucks and does team-building activities outside of work, such as bowling.

“This allows us to catch up as a team,” Cooper says. “We talk about the weekend or the kids. It gives everyone an opportunity to take their minds off that last call.”

Cooper also serves as the local co-lead for the Kaiser Permanente wellness program “Live Well, Be Well” and tries to promote a healthy work environment to reduce stress. Frequently, fitness video games, board games or music are available in the break room to help folks “de-stress,” he says. “We try to lighten the mood.”

There’s a serious side to adding fun and festivities to the job: A study in the 2006 Ivey Business Journal Online found that workers who feel empowered and engaged—one of the outcomes of the light-hearted endeavors—are more productive and have fewer safety incidents.

Giving people a say

Another key element to reducing stress is giving people the ability to make more decisions at work, says Deashimikia Williams, a customer service representative in Maryland and member of OPEIU Local 2. Williams also serves as her UBT’s union co-lead and is a member of the national call center “Super UBT,” whose membership crosses regional boundaries.

Williams says empowering workers and improving their work processes can have a positive impact on stress at work. Making customer service representatives, CSRs, aware of what they can do to resolve a member’s issue also reduces frustration, says Williams, whose role on the Super UBT includes exploring different improvements.

“We look at the issues CSRs and managers experience on the floor. If we streamline a process, it may not be as stressful,” Williams says. “If we can let them know what can be done by each department and who can help resolve a member’s problem, it reduces frustration.” 

Many of the several hundred health care workers who gathered at the Manhattan Beach Marriott on May 10 are used to working through the night—it goes with their jobs. But they aren’t used to waiting. By midnight, some were napping on the couches in the lobby. Others milled about in small groups, talking quietly. And some retired to their rooms and asked friends to call them if and when anything happened.

Finally, around 2 a.m., the news came: A subgroup had ironed out the final details. By 3 a.m., the hotel’s central ballroom was filled with cheering, hugging workers—and supervisors, middle managers and senior vice presidents. The 140 management and union negotiators who formed the Common Issues Committee (CIC) gave their unanimous thumbs-up to a new National Agreement that will guide the work of some 130,000 workers, managers and physicians in the nation’s largest private health system.

“It was like we had just won the World Series,” says Alan Kroll, director of the Clinical Contact Center in Colorado and a first-time member of the CIC. “We’d had our ups and downs as a team, but in the end, we all came through as a team. The energy and camaraderie was tremendous.”

R-E-S-P-E-C-T

“The energy of the room was not because we liked each other. It was because of the respect that partnership had brought,” says Ashwin Deo, an orthopedic technician in Sacramento and SEIU UHW member who served on the CIC.

The agreement, reached in the course of five three-day sessions from March to May, is the largest private-sector labor agreement negotiated in the United States this year. Like previous National Agreements, it covers not only wages and benefits but also goals related to service, quality, affordability, workforce and community health, and more. 

Yet how the CIC reached the agreement is even more remarkable than the agreement itself. Rather than engage in a power struggle, the negotiators used interest-based bargaining to solve problems. That process allowed it to focus on solutions to the biggest issue facing health care today—that it costs too much, and too few Americans can afford it—while maintaining Kaiser Permanente’s industry-leading wages and benefits.

Rather than chopping care or benefits to control costs, says John August, executive director of the Coalition of Kaiser Permanente Unions, the agreement “provides union members with the tools to tackle cost by improving care and efficiency. Improved care and efficiency, delivered by workers at the front line, are the key to extending quality care to every person in our country.”

“Our national bargaining is unique,” says Dennis Dabney, the senior vice president of National Labor Relations and the lead management negotiator. “There is not only a group of labor negotiators at the table, but a broad cross-section of our employees providing recommendations on how to better deliver high-quality, affordable care and ensure Kaiser Permanente is a great place to work well into the future.”

Moreover, the outcome is a testament to the interest-based approach to partnership, not just interest-based bargaining.

“As our facilitators told us, economic issues are tough to resolve in interest-based bargaining,” says Adam Nemer, care delivery finance officer in the Northwest and a member of the bargaining subgroup that focused on benefits. “In the end, we met both management and labor's key interests. But I suspect that was not just because of what happened at the benefits table. It was also the result of an open and honest dialogue on benefits between senior labor and management leaders over the past few years. It was about trust and transparency. In my view, we didn’t reach a solution just because of interest-based bargaining—but we couldn’t have gotten there without it.”

Revolutionary healthy workforce plan

As part of the solution to controlling costs, the agreement includes a revolutionary plan to create the healthiest workforce in the health care industry. Beginning in 2013, the agreement will reward the collective workforce achievement of reduced health risk factors, measured by body mass index (BMI), cholesterol levels, blood pressure levels, smoking rates and workplace injury rates.

“Unions and management agreed that health improvement is an essential strategy for reducing chronic conditions—one of the leading drivers of rising, unsustainable cost,” says SEIU UHW President Dave Regan. “This is a high-road, long-term strategy for the common good.”

Those involved in the process say it’s unlikely that the high road would have been taken had these been traditional, adversarial negotiations. As Joan Mah, an optometrist at San Rafael Medical Center in Northern California and a first-time observer representing her ESC-IFPTE Local 20 colleagues, put it: “Traditional bargaining is really about what I want and not about what is right….When you take the time to allow management and labor to surface their interests, it’s really looking for a global solution.”

“At times it was frustrating, but it was also interesting to see how the interest-based process led us to options we could work with,” says Jean Melnikoff, a senior director of human resources for Southern California, one of the management co-chairs of the workforce of the future subgroup.

Opening doors—and minds

Her sentiment was echoed by members of every subgroup. But that is not to say the process is easy.

“When things get difficult, you need to regroup and work your way through it,” says Arlene Peasnall, senior vice president of human resources in Southern California. “But you end up with better results and stronger relationships.”

“The people who’d done it before said, ‘It’s OK, it can be done,’” says orthopedic technician Deo. “Don’t be afraid of the tension in the room. Don’t be afraid of emotions, because that’s what gets creativity out….When labor and management are at the table, talking to each other as equals, and the ideas are valued equally—I think that opened a lot of doors. And minds, too.”

It's a simple set of five letters, but it can pay big dividends when you're interacting with patients.

Let's spell it out and communicate our best.

Acknowledge—The first letter of the AIDET acronym reminds each staff member or care provider along the patient’s path to acknowledge his or her presence. Making eye contact with a patient or giving the member a smile is all that’s needed.

Introduce—When you identify yourself by name, you change the patient’s visit from an anonymous interaction into a personalized experience.

Duration—A little information goes a long way. Letting patients know how long a visit is expected to take lets them know their time is valued. If a doctor is running late or the lab is behind, letting patients know about the delay and keeping them updated shows respect.

Explanation—Whose body is it? No one likes it when a caregiver starts doing something without telling a patient what they’re doing and why.

Thank you—The last step wraps up the visit by thanking the patient for coming in or for providing the information needed to provide them with excellent care.

For the second year in a row, the Northwest region experienced the fewest workplace injuries of any hospital-based region in Kaiser Permanente. The Northwest ended the 2011 reporting year with a 15 percent improvement over injury rates in 2010. (The two California regions, Hawaii and the Northwest operate hospitals, while Colorado, Georgia, the Mid-Atlantic States and Ohio do not.)

Workplace Safety Committee co-leads Marilyn Terhaar and Susan McGovern Kinard attribute the region’s success to several factors:

• Real-time information. Terhaar sends safety alert emails to managers, stewards, UBT co-leads and safety champions. The alerts list the injuries for the prior week and offer safety tips and resources.
• Goals at the frontline. Keeping injury rates low is a regional goal and a PSP goal. Unit-based teams are encouraged to work on these workplace safety issues prior to tackling other goals.
• Culture change. Safety conversations have become part of the workplace culture. If an employee sees someone not working safely or a hazard in the work area, she or he speaks up, knowing the problem will be addressed.
• Investigation. The approach to safety is proactive. The Employee Health and Safety department investigates the root cause of an accident and tries to make sure the accident does not happen again.

High cost to both employees and KP

Employee injuries are significant in several ways. An injured employee may lose pay and time at work, and a department may have to work short, which may impact patient care. And there’s a financial impact on the organization—which eventually could affect member premiums.

 “The cost to open a workers’ compensation claim is about $1,200 on average,” says Terhaar. “Once you start adding in medical and surgical costs, the expenses can soar.”

Indemnity claims—those claims that cover employees with more serious injuries that require a longer time off—average $21,000.

 “That’s one of the reasons we have such a laser focus on safe patient handling. The risk to the employee for injury is so great,” explains McGovern Kinard.

Prevention

The Northwest region employs a well-constructed safe patient handling program. New employees are trained on safe patient handling, and more than 1,000 employees were retrained in 2011. Hospital and clinic policies require staff to move patients using safe handling techniques and equipment.

 “We have mobile lifts and overhead lifts at Kaiser Sunnyside Medical Center and will have the same equipment at our new hospital opening next year,” says Paulette Hawkins, RN, a workplace safety consultant. “In addition, all medical and dental clinics have mobile lifts and receive annual hands-on refresher training on request.”

Members of the workplace safety committee aren’t resting on their laurels. This year, they plan to bring the focus of safety to the UBT level.

“Most teams can solve their own issues,” say McGovern Kinard. “There’s been an increase in awareness that’s been growing steadily over the last five years. Our numbers say it all.”

For nearly a year now, the Neonatal Intensive Care unit at the Fontana Medical Center has welcomed parents 24 hours a day, thanks to a unit-based team that put the patients’ needs first.

Since April 5, 2011, parents have been able to stay on the unit with the newest member of the family regardless of the hour and even during shift changes and rounding.

“The belief in family-centered care is put into action here,” says management co-lead Annette Adams, RN. “Nothing should come between parents and babies.”

Team members put themselves in the shoes of the parents whose children are treated on the unit: The distress of having a newborn baby staying anywhere other than right by your side, of having to leave your baby in the hands of strangers, and being told when you could come and see your own child.

Making it better for parents

Keeping the service point on the Value Compass in mind, the team looked inward to tackle the problem of concerned parents lacking 24-hour access to the unit.

The UBT began by researching what it takes to have successful open visitation in the NICU and what the benefits are for members and patients. The team found that many NICUs were not truly open to parents 24 hours a day, as parents were asked to leave during change-of-shift reports and physician rounds.

The UBT concentrated on how to make sure parents could remain, despite the concerns.

Shift reports are done at the bedside. But the NICU is one big room where anyone can hear anything. Team members researched how to solve this problem by asking how other Los Angeles-area NICUs, such as Cedars-Sinai Medical Center, handle shift reports without compromising privacy.

Involved in shift hand-offs

Not only do parents now get to see their babies whenever they desire, they are also asked to participate when the physicians round and during the change of shift hand-off, which gives them the opportunity to meet the nurse assuming care of their baby.

“The belief that family-centered care is an essential part of each family’s experience was the driving philosophy behind the progressive move in visiting policy,” says Sheila Casteel, RN, the NICU team’s labor co-lead and UNAC/UHCP member.  

The representative team members enlisted help from the rest of the unit by introducing the concept through the monthly staff newsletter and giving presentations at staff meetings.

Unit staff members were asked for their ideas about how to overcome barriers—real and perceived. Some of the practices adopted included:

• moving the staff hand-off huddle outside the unit to the conference room
• making the relief and admitting nurse available to answer parent questions during hand-offs

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!