Culture

In 1997, the Labor Management Partnership turned strife between Kaiser Permanente and its unions into strength.

That strength is coming to the forefront again today. Decades of working in partnership are helping the organization respond to the COVID-19 pandemic, move forward together and provide a model for the health care industry.

With interest-based problem solving, a Free to Speak culture and performance improvement through unit-based teams, the Partnership has built a foundation that’s given leaders, managers and union members tools and relationships to collaboratively address this crisis.

Acting fast

Some of the response took place at the highest levels. Over a weekend, Kaiser Permanente and union leaders reached an agreement to temporarily enhance benefits for physicians and frontline employees.

“I’ve never negotiated anything as fast,” says Dennis Dabney, senior vice president of National Labor Relations and the Office of Labor Management Partnership.

Throughout the crisis, union leaders joined twice-weekly calls with top Kaiser Permanente leaders and played a central role with command centers and surge planning.

The key to making faster decisions was directly involving labor in operations meetings, says Hal Ruddick, executive director for the Alliance of Health Care Unions.

Having a voice

Partnership laid the groundwork for a nimble response in other ways, too. When COVID-19 hit, most vision appointments were canceled.

In Northern California, IFPTE/ESC Local 20 negotiated with management to have optometrists work in different roles. More than 120 optometrists volunteered to staff the COVID-19 test results call-in line.

“We showed our willingness to do alternative work — work that would be meaningful and keep our union members safe,” says optometrist John Corpus, a member of the local union’s optometry unit board.

Having a voice on the job equipped members to negotiate that deal, which included training, laptops and greater flexibility to work remotely.

“If our teams remain safe, are listened to and feel respected in the changes, they can live with the changes during this time,” Corpus says.

Improving workflows

At Beaverton Medical Office in Oregon, after COVID-19 testing began, managers saw that patients often needed multiple services. A new workflow was required — and the Nurse Treatment Room team’s registered nurses and medical assistants rose to the challenge.

“Everyone began sharing ideas and brainstorming possible solutions,” says nurse manager Cyndy Gillis. “The team formulated a plan that respected scope of practice, safety for the staff and patients, and a streamlined workflow that continues to adjust to new challenges.”

“It was the epitome of collaboration,” says team member Kellie Butchino, a certified medical assistant and SEIU Local 49 member.

Fighting together

One of the most vexing problems during the pandemic has been getting caregivers the personal protective equipment they need to safely care for patients. Working in partnership has helped.

“It’s not perfect,” says UNAC/UHCP member Andrew Calderon, a physician assistant at South Bay Medical Center in Southern California.

“But labor and management were there updating staff regularly and fighting to get us the materials we needed.

“We are able to provide the best care for our members because of partnership.”

Looking forward

Such collaboration across the enterprise will help Kaiser Permanente navigate the future — and inspire others, too.

In May, LMP leaders shared their pandemic experiences during a Labor and Employment Relations Association webinar, drawing praise from members of a 4-year-old labor- management partnership in Massachusetts.

“We are trying to proceed on the premise that there is no business case for adversarial labor relations,” says Bart Metzger, chief human resources officer for UMass Memorial Health Care. Partnership is “the only way we can push organizations such as ours forward.”

Partnership is an effective strategy for labor and management, Ruddick says.

“It’s harder, but it’s worth it because the results that you get are better.”

After government stay-at-home orders derailed their plans for a patient support group, members of Kaiser Permanente’s Marlow Heights Behavioral Health team in Maryland set up a video chat for vulnerable individuals sheltering in place.

“With the COVID-19 pandemic, we had to be open and receptive to connecting with our members in a different way,” says Dawn Anderson, a psychotherapist with UFCW Local 400 and union co-lead for the Level 4 unit-based team. “This way we’re still supporting patients with serious health issues.”

Propelled by the global pandemic, Behavioral Health teams across the Mid-Atlantic States are using partnership principles and tools to transform how and where patients seek care — resulting in changes likely to outlast the crisis.

Connecting with patients

Therapists are working from home and counseling patients via telephone and video. Unit-based team members are meeting virtually, too, using collaborative digital tools to identify challenges and solutions.

They’re also using such tried-and-true performance improvement tools as the Rapid Improvement Model to reveal the best ways to connect with patients by telephone and video.

“Sometimes I will connect with patients on video, then after 5 minutes something will cause a disruption and I’ll have to ask if we can connect via telephone,” says Anderson. “We are still adapting to telehealth technology.”

Adapting quickly

The rapid-fire changes haven’t been easy for team members, who are conducting assessments with patients by phone instead of in person because of social distancing requirements.

“We’ve done things in this pandemic season that we normally would not have done,” says Reuben Steele, Behavioral Health operations manager and management co-lead. “That has caused some initial anxiety but, ultimately, the team has been able to adapt and adjust quickly.”

Being heard

Team members agree having a voice in decisions about ways to deliver care is helping them cope with change. A key feature of the Labor Management Partnership is involving frontline workers and union leaders in decision making.

“The LMP is a great way to think outside of the box and figure out what we can do to meet people’s needs,” says Lindsey McDaniel, a psychotherapist, UFCW Local 400 member and labor co-lead for the Silver Spring Behavioral Health team, a Level 4 UBT in Maryland.

Anderson agrees.

“We’re able to ‘check egos at the door’ and come forth with ideas and suggestions. That’s what I love about the UBT setting,” she says. “Our UBT consultant and manager support us and are open to feedback on team projects and goals. This is the forum where I feel my colleagues and I are being heard.”

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.”