Kaiser Permanente Concepts

When I was asked to represent The Permanente Medical Group at 2012 bargaining, I leapt at the opportunity. My own experience with partnership at Fresno Medical Center showed me what great things could be accomplished with collective problem solving.

I sat on the subgroup that looked at how to improve partnership to enhance performance and Kaiser Permanente’s operational agility. I was amazed at seeing so many people with different backgrounds sharing their thoughts and shaping the outcomes. From the highest levels of Kaiser Permanente and union leadership to the front line, everybody was around the table, and they were all equal in this venue. Everyone was heard and engaged.

I personally learned a lot from the different perspectives voiced by all of the individuals representing their fields. I strongly believe that collective wisdom is better than individual wisdom, and that with collective wisdom you can achieve anything in life. Interest-based bargaining, which assembles voices from all levels and reaches of Kaiser Permanente, is a great example of collective wisdom.

Another thing that struck me—how much folks craved the physician perspective. When I spoke, all 25 to 30 people in that subgroup really listened. And there were issues where a physician perspective was critical. That was a strong message I brought back to physicians. In most unit-based teams at Fresno, there is physician involvement. The intention is to bring those perspectives together to enhance the care for our members and patients. But does that mean if I walk into a UBT meeting I’ll see a doctor? Maybe yes, maybe no.

I’ve worked at Kaiser Permanente for 34 years, and I saw the pre-partnership years. They were contentious ones. We’ve had relative peace with coalition unions since partnership. That’s not to say that working in partnership is perfect in every way. It can’t be done without trusting each other. And how do you develop trust? Through transparency. The whole bargaining process was about transparency; essentially, everybody could share everything. That doesn’t mean people didn’t disagree.

The interest-based, collective approach takes into account everyone’s perspectives to reach a better outcome, which is ultimately a common goal—superior care for our members and patients.

Sheryl Miller, a licensed practical nurse and a member of SEIU Local 49, is the technology coordinator for the Coalition of Kaiser Permanente Unions for the Northwest region. She’s worked for Kaiser Permanente for 30 years and has been involved in most of the major electronic changes of our time—including implementation of KP HealthConnect®—and has helped the organization with the challenge of integrating electronics into our everyday work. She was interviewed by LMP Communications Consultant Jennifer Gladwell.

Q. What did you learn working on KP HealthConnect?

A. I look at the people component of technology. If people are paralyzed with fear, they’ll never use the technology. With KP HealthConnect, we learned that peer-to-peer training, sponsor support and funding for labor flex teams—which have the people who do the job become subject matter experts—was a model for success.

In the 1980s, you did not learn typing as part of your schooling as a nurse. When we implemented KP HealthConnect, we had significant generational gaps. Some employees didn’t type. Through the labor flex teams, we ensured peers were training each other around work they understood.

Technology impacts workforce planning. We have to think ahead so we don’t become extinct. Roles will change, but through the partnership and workforce planning, we can plan for the changes and redeploy impacted staff.

Q. How is technology affecting roles today?

A. Self-check-in kiosks are rolling out in the Northwest clinics. This is what some of our patient population has been asking for. Registration representatives are a group of dedicated employees that have been doing customer service behind a desk. Now, they are being asked to be a concierge, a greeter, as well as answer complex benefit questions.

The Visual Dermatology Assist project is being piloted at two clinics in the Northwest. Medical assistants are being trained, following the provider’s order, to take a picture of a skin irregularity on an iPhone and send it to Dermatology. Sixty-eight percent of the photos were reviewed, diagnosed and had treatment plans within 24 hours. A typical appointment could take six to eight weeks to schedule. This is improving access.

Q. Have you been able to spread effective practices from the KP HealthConnect implementation?

A. ICD-10, the new coding system, goes live in October. We’ve been able to engage UBTs and labor so they are part of making the decisions and determining processes. We’re using peer-to-peer training and trying to break down barriers early on so our staff and members have the best possible outcome.

Q. All this technology is great, but what about privacy and security?

A. It keeps me up at night. I have spoken to steward councils about privacy. We are seeing an increase in social media violations that could result in people losing their jobs or being fined. We have to be very careful about what we’re posting in social media. It’s so easy to vent about a bad day, but you have to be vigilant to ensure you are not revealing patient information. I am here for the patient and to educate employees on privacy and security.

Q. You’re a chief steward, yet you seem adamantly in favor of management policy. How do you explain that?

A. I work off of fact. It’s a policy that we do not go into our own medical record or those of others unless we have a business need to do so. I am a union member, but I will never lose sight that I am here for the company, patient and union, and we all have to work together to be successful.

Q. After so many projects—what’s the secret to success?

A. I work with great people, locally and nationally. I’m not a technology expert, but if you remember the people behind the technology, it works really well. If I can help someone in care delivery enhance their ability to take care of our patients, then I’ve done my job. Technology and people are not going away—so we have to be willing to advance with it.

Louise Dempsey is the business representative for UFCW Local 1996 in Atlanta. She spoke with LMP communications consultant Laureen Lazarovici about her experiences as a union activist in the South.

In the late ’60s and early ’70s, my mom worked for the Social Security Administration. She transferred often for her job, so we moved a lot. She was in the union, and she organized two of the offices she got transferred to in order to get better benefits. One was in the hills of Tennessee, where there were a lot of coal mines and a lot of poverty. She once worked for a group of attorneys and mobilized her co-workers to get better wages. There was a lot of disparity in pay in terms of gender and race. Sometimes, they didn’t exactly like her. She earned the reputation as the go-to person. People would say, “If anybody can get it done, it’s Mildred.”

Unions at Kaiser Permanente

And today, here we are in the South. It is not strong union territory. Because of Georgia’s so-called “right to work” law, employees can work for KP here whether they join the union or not [in contrast to KP regions in other states with stronger worker protection laws]. But people join because they know that the stronger we are, the more we can stand up for ourselves. We have to talk to folks about the benefits of working for a unionized company. I worked for KP as an LVN before there was a union. Our wages were all over the place and assignments were based on favoritism. We’ve had people come to work for KP because it’s unionized.

When they hear about the Labor Management Partnership, they say, “I’ll sign up.” They understand they have a voice, they can be part of a UBT, they can affect the direction their team is going, and say what they need and want and be heard. Sure, we have to educate managers, but we have to educate employees about unions, too. When I talk at new employee orientation, I tell them we are there as a mediator, facilitator, advisor. You are not by yourself anymore. I’ve got your back and your front and your side, too. With the Labor Management Partnership, KP is always offering opportunities for employees to learn, like the Ben Hudnall Memorial Trust. I have been in the medical field for 30 years, and folks are always thirsting for more knowledge.

Getting used to a new way of doing things

Folks in management come into Kaiser and they are not used to unions or the partnership. We have to educate them: We have a union, we have a contract, we have a partnership. We educate them about a union environment and also that we are not the traditional head-butting adversarial union.

Normally, when I go into a meeting at KP, there is not a whole bunch of posturing. People want to get to a solution. There is no name-calling, finger-pointing or yelling. It makes a difference. Partnership benefits the local because I have open access to the employees. I went to five facilities recently. I was not stopped once. It is always, “Hi, how are you, who do you need to see?” My co-workers at the local who represent employees at other companies don’t all have that. KP has not relegated me to a break room or to certain hours. I can have a bulletin board in the break room. I have the time to speak with new hires during orientation. They don’t censor the questions the employees ask or the ones I answer. That’s partnership.

When Webster Parker brought his prescription glasses back to the clinic in Redlands (Southern California), he thought he just needed to replace a lens that had fallen out. But when Parker reported his eye was watering excessively, optician Alicia Rendon spotted a red flag in Parker’s Kaiser Permanente HealthConnect™ record and, within the hour, set up an eye-saving appointment with an ophthalmologist.

“The prescription was fine,” says Rendon, a Teamsters Local 166 member whose unit-based team recently embraced a new workflow, including use of KP’s electronic health record system, to troubleshoot their redos—instances where patients return eyewear purchases. “Once I looked into HealthConnect, there was this big stop sign.”

Her review of the record suggested that Parker, 85, might need a common surgical procedure to lower the intraocular pressure in his right eye, a condition often associated with glaucoma. An old eye injury exacerbated the problem, and Parker’s ophthalmologist had set up a flag in the system to watch for changes to the eye.

“I had surgery that week,” says Parker, a retired pharmacist who once ran a drugstore with his pharmacist wife. “The eye feels better. It feels normal. They did a wonderful job.”

Looking at the whole system

Focusing on redos not only saves KP in terms of the cost of materials and labor but also helps improve service scores. By bringing in ophthalmologists and optometrists, who examine eyes to treat disease as well as prescribe the lenses that opticians dispense, the team could better identify redos linked to eye-health problems rather than product defects—as in Parker’s case.

But opticians, used to handling paper charts and focusing on frame styles, were reluctant to try one of the team’s first tests of change: using KP HealthConnect to rule out medical reasons for unsatisfactory eyeglasses.

“We got buy-in” to overcome the initial resistance, says management co-lead Darren Smith, site supervisor for optical dispensing and a former optician. “It takes just two or three to really commit and spread the practice. Now, it’s not just a retail store where you come and buy something. Here, we are talking about your health.”

Educating patients and staff

To protect patient privacy, opticians' access in HealthConnect was mostly limited to conditions related to eyeglasses' prescriptions rather than a broader range of eye issues. Now the optometrists and ophthalmologists help the optical UBT members spot problems and counsel patients on practices that will protect their eyesight and enhance their eye care.

“Not everyone is going to be able to see 20/20,” says Trissy Bastin, business line manager for Vision Essentials. She directs the service area’s five optical clinics and serves as sponsor for the UBT. “The patients have to be reminded of that. You have to be able to see what kind of eye conditions they have.”

Parker has been a KP member for just seven years. But three decades in the health care industry fostered his appreciation for the electronic patient record—and cooperation and coordination among caregivers.

“What makes Kaiser special is that any doctor can have your complete record at his fingertips,” Parker says. “They can track problems and make recommendations.”