Frontline leadership

You say your unit-based team has reached Level 5 on the Path to Performance? Great, everyone take the rest of the week off!

Your UBT is stuck at Level 1 and has been for years? Just hide in a dark corner and hope no one notices.

Not so fast.

Teams soar. Teams stumble. And we need them all to stay in the game.

Unit-based teams are Kaiser Permanente’s platform for improving performance. They’re also the union coalition’s instrument for amplifying workers’ voices in the workplace. All of which has paid off for KP members and patients, through UBTs’ efforts to improve quality, service and affordability. None of which is easy for teams to pull off.

Enter union partnership representatives and UBT consultants. They are recruited from frontline positions in union and management, so they know firsthand what it takes to deliver high-quality health care. They also receive special training that enables them to coach and mentor unit-based teams.

Our leaders knew teams would need such support. But it’s a balancing act. The tightrope for these folks is to gradually build the skills and confidence among team members, then step back at the right time so teams can fly on their own.

Few of us can truly go it alone. We all benefit from coaching—someone to hold up a mirror and offer frank advice (diplomatically delivered!) on how to improve in our jobs. A consultant’s most important skills are listening and observing. Those are skills we’d all do well to improve.

What happens when things change in your job and you have to rethink what’s always worked in the past?

For me, that moment came two years ago when I moved into a management role. I had spent 24 years as a frontline nurse, union steward and labor partner to hospital administration before my job transition.

Frankly, I wasn’t sure what to expect going in, but having been a steward and a labor partner helped me become a better manager. Kaiser Permanente has given me opportunities to grow as a leader that I don’t believe I would have had elsewhere. Along the way I learned six lessons that I think can help others lead in a collaborative team environment:

• Speak well and connect. As a labor partner, I developed my speaking and presentation skills—skills that most don’t learn in nursing school. My confidence grew with each presentation and I now feel a connection with my colleagues that helps us all gain value from our conversations.
• Give and get respect. As a nurse, I was respected at the bedside by physicians, managers and other nurses. I don’t think I would have been as respected as a manager if I hadn’t been respected at the bedside first. My clinical experience helped give me credibility.
• Understand operations. As a labor partner I learned valuable lessons about hospital operations. That allowed me to build on my experience as a caregiver and begin to see the bigger picture—how things are intertwined and why certain decisions are made.
• Listen and hear. You have to be a great listener and actually hear what people are saying. You have to be able to take things in and think about how to respond. As a steward, I always mulled things over before reacting, and I try to do that still.
• Know your contract. Most union leaders know their contract inside out—certainly I did when I was president of the RN bargaining unit. Managers should, too. The National Agreement gives us many tools that can help both sides stay on track.
• Stay flexible, be practical. Nurses are very solution-oriented. The solution to a problem has to make sense. I learned over the years that different people might get to the same outcome, but there are many ways to approach the problem. You need to be willing to try a different route to get to the solution so that everyone feels they have a voice in the process.

As a labor leader, I learned to believe in people and know that there’s always another side to any story. My staff understands they can come to me any time. And our unit-based team helps us draw on everyone’s knowledge and allows everyone to be heard.

In the end, it wasn’t that hard to make the transition from labor leader to manager. In both roles you have to consider diverse points of view, and sometimes you have to step back and ask, “Does it make sense?” You’re not always popular, but I’m OK with that.

We may not always agree. But there is no “we” or “them,” we are all one—because we always put our patients first.

I am one of the chairs the LMP leadership team, along with a union colleague from UFCW and two management leaders. I’m also the co-lead of the Woodland Hills’ union coalition. In addition, I’m a full-time certified registered nurse anesthetist in the operating room. To be an effective labor co-lead takes three things: time, collaboration and planning.

Time

I have been doing partnership work at Woodland Hills for 10 years. People respect the time I’ve invested. You have to be on fire for this because it’s an enormous responsibility. It’s going to cost you time, angst and effort. And you can’t build relationships passing in the hall. You have to make the investment of face time. That means showing up at the LMP council meetings, monthly, from 8:00 a.m. to noon.

Planning Ahead

It is important to bring in and plan for new blood. At Woodland Hills, we rotate the labor co-chair in our leadership team every two years. I believe this allows everyone to have a say. It builds trust and experience. And it ensures buy-in from each union—and each segment of each union. We build-in mentorship. For three months, the new person sits in and the current co-lead shows that person the ropes.

We also did this in the Kaiser Permanente Nurse Anesthetist Association when I was president in 2006. I would go with new facility reps to meetings. 

Collaboration

We really foster union efforts at the medical center level. We’ve got a group of long-term union coalition people and our unions speak with a single, powerful voice. There have been issues between unions, and we had to work things out until cooler heads prevailed. People say ‘I’m sorry’ and move on.

Working with management is both easy and difficult. It’s easy because they are so partnership oriented and respectful of the unions, and they welcome input. They lead by influence—not by authority by virtue of where they are on the food chain—just like we do. It is difficult sometimes because it requires us to work hard as partners. Sometimes it would be easier to just go along with their recommendations, but then we wouldn’t really be doing our jobs as union leaders. At certain points, you have to say, ‘Well, let me think about that,’ and ask your constituents what they think.

Hospitals are traditionally very hierarchical. The partnership is such an opportunity to have a voice.