Coalition of Kaiser Permanente Unions Concepts

Our 2012 National Agreement established the conditions for creating the healthiest workforce in the industry.

One of the key innovations in the 2012 National Agreement is the Total Health Incentive Plan, a voluntary program that rewards employees for collective participation in confidential health screenings and improvements. 

The 2010 agreement includes uniform performance goals and metrics for unit-based teams, an enhanced sick leave cash-out option and stable funding for workforce development trust funds.

If you print the PDF out on 8.5" x 11" paper, each sheet will have one two-page spread of the bound contract. 

Northern California: Staff laptops make life easier 

Even in a fast-paced Emergency Department, change doesn’t always come swiftly.

“I’m old school,” says Jacinta Laupua, a clerk and SEIU-UHW member, who was one of the last holdouts when her team decided to try using laptop computers to gather member signatures. 

“I thought of every excuse in the book. But now I love it,” she continues. “If I don’t have a laptop assigned to me, I ask other clerks if they are using theirs, because I want one. In fact, we need more.”

The laptops, provided through a regional initiative, are at the heart of a successful unit-based team project to reduce paper and copying costs in the Emergency Department at the South Sacramento Medical Center. The total savings came to more than $88,000 in 2016. 

The Level 5 UBT’s project got under way in late 2015, when clerks and the team’s co-leads—Bianca Ruff, a clerk and SEIU-UHW member, and managers Susan Velasquez, administrative services manager, and Neeta Kumar, administrative clerical supervisor—brainstormed ways to improve cost savings and efficiency. Their first goal was to save $27,820 over four months. 

Soon team members were trying out the use of laptops with signature capture pads. The technology makes it possible for clerks to register patients at their bedside and record their information and signature electronically. Not only does this eliminate the need for paper registration forms, it also increases the clerks’ mobility and efficiency.

There were many small tests of change needed before everything was working smoothly, but the project has been so successful the department has invested in nine laptops on wheels. And all Emergency Department clerks are trained on
the computers. 

“It’s almost too painful to remember how we used to process forms,” jokes Ruff.

—Tracy Lee Silveria

Northwest: Pharmacy team ‘owns’ its inventory, saves thousands

When team members at the Community Care Pharmacy in the Northwest region did a routine inventory, they were astounded at the value of their expired medications that no longer could be returned. 

“We took a $70,000 loss,” says Rob Yancey, the pharmacy’s manager. The pharmacy serves patients in extended care facilities and often fills prescriptions for costly and uncommon drugs.

Susan Luu, an inventory technician and member of UFCW Local 555, spearheaded a successful project that drew on the free-to-speak culture and collaborative spirit that helps make this a Level 5 team. 

“I knew it was too much to do by myself,” Luu says. “I felt comfortable talking with my manager, and his response was, ‘Let me see how can I can help.’” 

Different staff members “owned” a section of the pharmacy to check for outdated or slow-moving medications. By the time the team did its next inventory, losses had dropped to $7,000.

—Jennifer Gladwell

Mid-Atlantic States: Tackling unwanted side effect of a computer upgrade

When the South Baltimore County Medical Center laboratory in the Mid-Atlantic States region upgraded its computer system in December 2015, it inadvertently increased lab costs. 

The problem? While the new system has many great features, it doesn't have a way to alert staff when providers add a new test to an existing order. In May 2016, the lab missed 32 percent of these “add-ons,” a total of 30 tests, says Samuel Endalew, the lab’s lead technician, a UFCW Local 27 member and the team’s labor co-lead. 

The mistake inconveniences members, who must return to the lab to provide a new specimen. Each missed add-on costs Kaiser Permanente about $35 in extra supplies and employee time. 

The solution: a system to check the lab’s inbox for add-on tests and a team binder to track their progress. By February 2017, the team was missing only 2 percent of add-ons and saving about $1,050 a month.

Leaders from other area labs are considering adopting the process.

—Otesa Miles

When the Ridgeline Behavioral Health team members in Colorado decided to tackle outside medical costs, even they were surprised at how their small touch on a huge issue could result in such significant savings.

Team members identified two ways they thought they could have an impact—including finding out which of their patients were being seen frequently in the Emergency Department—while helping their patients get appropriate care. 

“We know from evidence-based medicine that if patients are seeking care in the Emergency Department for mental health issues, it’s unlikely to provide a long-term improvement in symptoms,” explains Amy Martin, manager of Ridgeline Behavioral Health. 

Team members began the project by researching which outside hospitals Kaiser Permanente prefers to have members and patients use. Armed with the new information, they created a flier explaining the options and shared it with the rest of the staff, who then shared it with patients. This way, when patients did access care, they were more likely to go to a facility that KP has a contract with and thus, cut costs.

The results were remarkable. The team’s patients’ visits to emergency departments decreased by 8.25 percent, which in turn reduced ED costs by 26 percent. The total impact for 2016: $1 million in soft-dollar savings. 

“My union members’ biggest passion is providing good service and high-quality care,” says Nate Bernstein, health care director of UFCW Local 7, which represents about 2,000 of Kaiser Permanente’s Colorado employees. “And we also know the company needs to be sustainable financially.”

But frontline staff can’t do it all on their own. Unit-based teams need leaders who share goals and strategy, helping them connect the dots between quality, service and affordability. 

Knowing the difference such information can make to frontline workers, KP Colorado Health Plan President Roland Lyon provides regular, in-person updates on membership numbers, service scores, financial results and more.

He emphasizes a few key business goals, and he provides a vision: “The best way to deliver affordable care is to deliver high-quality care.” 

Providing that high-quality, affordable care is everyone’s job, at every level. Local, regional and national KP leaders are, for example, revamping purchasing practices and taking advantage of tech innovations to keep a lid on the rising cost of care. In 2016, 4,800 UBT projects reduced expenses by more than $48 million, savings that help keep costs down for members. The sum may seem small in a $65 billion organization, but it speaks to a deeper commitment. 

Leading change

“Workers know where the challenges are,” Bernstein says, “and have led change over the years to improve the patient experience and reduce costs.”

The challenges often directly affect workers. Colorado saw an influx of new members in 2014 and again in 2016. The region still is growing, but a big chunk of the new members left after a year because of changing market dynamics as well as internal service, access and cost issues. 

“The ups and downs of membership growth create strains on our system—and it’s hard on ourteams,” Lyon acknowledges.

Lyon’s updates and other regional communications provide UBTs with information on the types of projects to take on to support Colorado’s strategy. To solve some of the access issues, for example, the region is making greater use of digitally enabled services, some of which were developed by frontline teams and some by leadership.

But success requires the know-how of the teams and, says Lyon, “engaged, enabled and empowered” team members to identify and remove barriers to service, pilot new approaches and help take waste out of the system.

The result is that UBTs in Colorado reduced waste or captured lost revenue to the tune of more than $9 million last year. And they’ve helped the region reduce its expense trend by nearly 1 percent.

But “you can’t cut your way to long-term success,” Lyon tells managers and workers. “You can’t really do more with less. And you can’t do it alone. But we can do more with a little bit more. It’s about providing more access to the best care to more people.” 

Our 2000 National Agreement created the joint LMP Trust Fund. It also created the Performance Sharing Program. It began with these prophetic words:

"This National Agreement was created through an extraordinary collaboration with the input of hundreds of Kaiser Permanente employees at every level. We created this document the way we will work in the future—jointly. The Agreement embodies our collective vision for Kaiser Permanente. The language of this National Agreement cannot begin to fully capture the energy and collective insights of the hundreds of people working long hours to establish this framework. But as work units apply these principles, we trust that their commitment and expertise will make our vision a reality."