Interest-Based Problem Solving

What does it mean to work in partnership?

It’s a joint commitment to collaborate, enshrined in the Labor Management Partnership’s national agreements.

It’s employees, managers, physicians and dentists building on common interests to make decisions and solve problems.

It’s Kaiser Permanente and the Partnership unions finding creative, mutually beneficial solutions that result in improved care, service and affordability.

There's never been a better time than right now to shine a fresh spotlight on the basics — the team-tested tools and practices fundamental to a strong partnership, such as the Rapid Improvement Model, consensus decision making and interest-based problem solving.

Whether you’re new to partnership or well-versed in its ways, use these performance improvement tools to identify issues, test changes, solve problems, make decisions, deliver better care and service, and enhance your work life.

LMP tools are designed to help you work together when things are going well — and bridge differences when the going gets tough. This approach addresses the needs of union members and helps the organization improve performance — which ultimately benefits Kaiser Permanente’s patients, members and communities.

Course description

Issue resolution/corrective action is one of the foundation blocks for success of the partnership. The course explores how issues are discovered and together labor and management determine root cause, working with the employee. Also covered is how creative problem solving is used in the workplace to resolve team issues to individual performance in a non-punitive manner.

Path to Performance

Level 1

Duration

8 hours

Who should attend

Job categories include stewards, union representatives, managers and human resources consultants

Course requirements

Belong to a union in the Alliance of Health Care Unions or the Coalition of Kaiser Permanente Unions, or work with an Alliance- or Coalition-represented employee

Course description

Interest-Based Problem Solving offers labor management partners a method to solve problems using a non-adversarial process. This training program provides guidance in the four-step interest-based problem-solving process, along with a simulation exercise that gives participants an opportunity to practice the process.

Path to Performance

Levels 1, 2 

Duration

• 4 hours (classroom)
• 30 minutes (online)

Who should attend

People engaged in problem solving at the unit-based team level up to regional Labor Management Partnership committees should attend this training, along with any union and management staff members working on issue resolution and corrective action. Job categories who can take this class are labor, management and physician members of a unit-based team, Labor Management Partnership and unit-based team consultants, improvement advisers and Union Partnership Representatives.

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.”

When the leaders of Kaiser Permanente and the Coalition of Kaiser Permanente Unions shook hands on their Labor Management Partnership 20 years ago, they weren’t sure where it would take them. Today, it is the largest, longest-running partnership of its kind. It is also the most studied by university researchers.

A new book published by the Labor and Employment Relations Association (LERA) and Cornell University Press shows that the partnership remains a model for workplace innovation. “The Evolving Healthcare Landscape: How Employees, Organizations, and Institutions are Adapting and Innovating” devotes three chapters to LMP’s history, accomplishments and challenges.

Lessons for others

Adrienne Eaton and Rebecca Givan, professors at Rutgers University, and Peter Lazes, a director and researcher at The City University of New York, studied six health care partnerships, including LMP. They were struck by:

“…the extent to which unions have been proactive in driving [all] these efforts....Another development in health care partnerships has been a significant deepening of the role of labor relations staff in operational matters.

“It is [also] important to note that the cases described here have influenced one another because the key stakeholders have directly learned from each other....[For example,] union and management stakeholders in Los Angeles [Department of Health Services and SEIU Local 721] as well as union leaders from the University of Vermont Medical Center have looked to Kaiser for answers.”

Another chapter, by Jody Gittell of Brandeis University and KP Northwest staff members Joan Resnick, Sarah Lax and Eliana Temkin, reports on regional efforts to promote collaboration across work teams. KP was selected for the study in part for what the authors call its “record of leadership and innovation [including] in patient care delivery, health information systems and labor-management relations.” Several strategies, including “living room huddles”—an informal, building-wide get-together—and job shadowing across departments led to higher employee engagement and patient satisfaction scores.

An inside look

The chapter “Leading Change Together” by Jim Pruitt, vice president of labor relations for the Permanente Federation, and Paul Cohen, LMP senior business consultant, explains the conditions that gave rise to the partnership, the need to implement it consistently across the organization and the way it achieves results:

“By bringing together diverse points of view and providing a framework for joint problem solving, the Labor Management Partnership has helped Kaiser Permanente tackle difficult issues....The partnership formed because conditions demanded change. It has endured because it has achieved measurable results. And it continues to flex and grow because we follow a few key principles and practices [including] self-directed work teams, interest-based problem solving and honest conversations.”

All of which explains why outside experts continue to take an interest in the joint efforts of KP and the union coalition. Pruitt and Cohen quote Thomas Kochan, a professor at MIT's Sloan School of Management, who put it this way in a 2013 study:

“Kaiser Permanente is now one of the nation’s leaders in the use of frontline teams to improve health care delivery....The Labor Management Partnership continues to serve…as a model for health care delivery and improvement.”