Labor Management Partnership

What if every organization and every union had a labor management partnership like ours?

It’s not as far-fetched as it sounds. On Aug. 16, more than 250 union, business and government leaders from all over the United States gathered in Chicago for Partnership Day, a meeting hosted by the Federal Mediation and Conciliation Service at its biennial conference—and offered a realistic look at the ups and downs that occur in partnerships and what it takes to launch and sustain them.

“We know partnership can make a difference,” Allison Beck, FMCS director, told the gathering. “This is not some fantasy that happens in a make-believe world.” She should know. As leader of the FMCS, the federal agency that mediates labor disputes across the United States, she’s seen firsthand how acrimonious relationships can ruin companies and unions—and how more open and respectful ones can help them both succeed.

The partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions is the longest-lasting and strongest one in the nation, so conference participants asked many questions about how it operates.

A race to the top

Dennis Dabney, KP's senior vice president of National Labor Relations and Office of Labor Management Partnership, told the packed room he spends a lot of time on the phone with leaders from other companies interested in starting and strengthening partnerships.

“I've seen so many companies engaged in a race to the bottom,” Dabney said. “I'd like to see more engaged in a race to the top.” If he has any regrets about Kaiser Permanente’s partnership, he said, it's that we didn’t create unit-based teams sooner.

Two people—one, a white woman, the other, a black man from the West Indies—witnessed the crucible of new workers who arrived by the tens of thousands at the Kaiser shipyards during World War II. Together, they laid the foundation for an extraordinary photographic record of the organization’s history.

Ann Rosener was a San Francisco Bay Area local whose assignment with the Office of War Information included writing and photography. Emmanuel Francis Joseph was born on the island of Saint Lucia. He settled in Oakland in 1924 and became the first professional black photographer in the Bay Area. Both artists brought a keen eye to the history unfolding before them and chronicled the often-overlooked working lives of women and people of color.

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.

The patient at the center of the Value Compass isn’t always a KP member, as two Colorado RNs proved on a flight home from the Mid-Atlantic States region last fall—and the experience they shared in the air also brought a fresh appreciation of their shared values and commitment to partnership.

Debbie Zuege, Colorado’s senior director of Nursing and Women’s Health, and Becky Sassaman, a nurse at the Arapahoe After-Hours clinic in Denver, work together as co-leads for the Nursing Partnership Council but had never teamed up clinically. That changed on their return flight from the Mid-Atlantic States, where they had talked about partnership with a group of union stewards.

Shortly after takeoff, Zuege was settling in and starting to read a magazine when something caught her eye.

“A flight attendant came down the aisle, holding an oxygen tank,” Zuege said. She alerted Sassaman, and they joined the flight attendant, who was tending to a woman lying down in the aisle. The woman was pale, sweating excessively and seemed confused. She’d been sick to her stomach. Two physicians on the flight joined in to help move her to the back of the plane.

The hastily formed team concluded the woman was dehydrated. Her pulse was weak. They elevated her feet and gave her liquids to drink; Sassaman placed an IV into her hand to administer fluids they found in the onboard medical kit, and Zuege administered oxygen. The woman responded well, with her pulse and color returning to normal. The doctors and nurses decided she’d be fine for the duration of the flight, and the attendant rearranged passengers so Sassaman could sit with her. The team kept the IV in place, suspending the fluids from a hanger hooked to the overhead bin, and gave her medicine for her nausea. Zuege and the two physicians checked in throughout the flight.

“The lady was so incredibly sweet and grateful,” says Sassaman, who helped her get clean, found her jacket and even lent her a pair of workout pants. “She kept saying ‘Thank you’ and ‘How can you do this?...I made a scene.’ I told her we are nurses, and it is what we do.”

Have you ever broken your glasses just days before leaving for vacation? Or before your driving test? Or before a big, important meeting?

You’re not alone—for the frontline staff and managers at Kaiser Permanente’s Vision Essentials clinics throughout Southern California, encountering patients facing these situations is a regular occurrence. The problem was, they had no way to speed up orders for new glasses. Patients ended up unhappy. Some would simply take their prescription to a competitor who promised glasses in a day.

The Vision Essentials business council—the regionwide Labor Management Partnership governing body with representatives from five unions and managers from optometry, ophthalmology, retail clinics and the optical lab—decided something had to be done. Their solution? The express service program.

Piloted in the Fontana and San Diego medical center areas, it allows patients to get their glasses in three days instead of the usual seven for a small fee. The service is so successful, it will be rolled out to the entire region by the summer.

Red Sharpies and gold spray paint

The keys to success were red Sharpies, gold spray paint and the tools provided by the Labor Management Partnership. The Value Compass—with the patient at the center—provided a key organizing principle.

“We were asking, ‘How do we improve our turnaround time?’ ” says Jeff Zeidner, the optical lab manager. “It might not be possible to improve our overall turnaround time, so let’s be selective about this.”

Alex Mendez, labor co-chair of the lab’s unit-based team, says, “We knew our customers needed some sort of express service.”

But a lofty ideal about putting the patient at the center does not magically re-engineer a huge supply chain involving 42 retail clinics spread over hundreds of miles and a manufacturing plant that churns out 7,000 pairs of glasses every day, five days a week, from 5 a.m. to 10 p.m.

When some of the labor members of the business council broached the idea of an express service, they were met with skepticism.

It can’t be done

“There was a lot of, ‘We can’t do that’ and ‘It’s too expensive,’ ” says Mary Cavanaugh, an optometrist and labor representative. Cavanaugh is a member of the Kaiser Permanente Association of Southern California Optometrists (KPASCO), which is part of UNAC/UHCP. 

Finally, the council asked the optical lab UBT to propose ideas on how to make express service a reality. The catch: The service couldn’t delay turnaround time for normal orders, couldn’t increase breakage rates and couldn’t require more staff or overtime.

The brainstorming commenced.

“Everyone had different ideas about prices and parameters,” recalls Mendez, a member of SEIU UHW.

Should the promised turnaround be one day? Two? Three? How about charging an extra $10? That might attract too many requests. Maybe $50? The UBT recommended $50. Another idea to emerge from the brainstorming—shimmery gold spray paint on the trays containing the express order lenses, so they could be easily spotted in the lab and moved to the head of the line.

Conveyer belts and lazy susans

The Vision Essentials optical lab is quite literally on the wrong side of the railroad tracks in an industrial section north of downtown Los Angeles, sharing a service road with a strip club. Hefty pieces of plastic that look like clear hockey pucks begin their journey here. Brightly colored bar-coded bins, including the gold ones, carry the lenses-to-be along conveyer belts for their various stops. Four huge lazy susans hold the tools for smoothing and polishing. The grinding machine spews out big puffs of white shavings that look like fake snow. At the end of the process, optical technicians pop the lenses into frames. Then the glasses are off to the shipping department to head back to where their trip began—the clinic where a grateful patient will pick them up.  

The frontline staff and managers at the Fontana Medical Center, where the first pilot was launched, were an integral part of planning and executing the express service initiative. After all, they were the ones who dealt directly with disappointed customers. The opticians there contributed another color coding trick: They annotated express orders with a red Sharpie.

“It’s like a hot potato,” says Nadia Arce, a receptionist and a member of Steelworkers 7600. Attractive tent cards on the receptionists’ desks announce the availability of express service.

Express service adds an extra step for the clinic-based staff, who now have to call the lab to ensure the materials needed for rush job lenses are available.

“We don’t want to promise something we can’t deliver,” says Mikhail Mgerian, an optician at Fontana and a member of Teamsters Local 166.

Building rapport

Trissy Basin, the business line manager, estimates there are about 150 express service clients out of 20,000 jobs a year; regionwide, the number of express jobs per year is expected to be 5,200. While the numbers aren’t huge, she says, “the process of doing an express job is significant.”

The process of creating the program in partnership also was significant.

“It is a lot better having the LMP,” says Chris Leyva, the management co-lead of the optical lab’s unit-based team, who has worked at Kaiser Permanente for 18 years. “There isn’t the banging of heads. The partnership smoothes our rapport.”

Adds his labor co-lead Mendez, “I feel comfortable giving my input and feel it gets taken into consideration.”

Danny Pollack, an optometrist and labor co-chair of the business council, says the union’s shared leadership role meant proponents of express service had a venue to keep pressing until the issue got taken up.

“It was perseverance, not pounding on the table,” says Pollack, a KPASCO member. “This project is a great example of how labor can initiate an idea and, with the support of management, roll out a new service that benefits our members.”

“What’s holding you back?”

Fresno Medical Center leaders asked their 50 unit-based teams that question directly late last year, at the same time they asked the teams to assess themselves on the new Path to Performance standards.

The answers mirrored what facilities everywhere say are challenges: training and sponsorship. Of the seven attributes of high-performing teams laid out in the Path to Performance, those two are consistently the most problematic.

Across the organization, many teams had their Path to Performance ranking lowered as a result of the 2010 year-end assessment—including Fresno, which UBT Tracker identified as having the highest percentage of high-performing teams in the organization. Fresno saw its number of Level 5 teams drop by more than half, from 27 to 14.

But Fresno had a plan for 2011.

“Early on, when we got a look at the Path to Performance, we created a strategy,” says Rick Senneway, Fresno’s director of performance improvement. “The Path to Performance helped focus us. (It) became very clear what we needed to work on.”

Even before they had the assessment results, Fresno leaders devised a 2011 UBT strategy for team development and performance improvement. It includes specific steps for moving teams at both ends of the spectrum along the Path to Performance.

“We’re engaged with our union partners at all levels,” says Jose DeAnda, medical group administrator. “At the UBT departmental level, (and) at the LMP Council level, by having each council member be a sponsor of UBTs and by having the sponsors report out at council meetings on how UBTs are performing.”

The goals were twofold: Move at least six teams up from Level 3 to Level 4 or 5 by the end of 2011, and help five teams achieve measurable improvement. Year-end assessments were not yet finalized when Hank went to press, but there’s optimism about the results.

“We did some good projects this year, and our affinity groups really helped,” says Navneet Maan, Fresno’s UBT consultant, referring to a system where teams working on similar projects met and shared ideas.

With a mandate to increase the number of high-performing teams by 20 percent in 2012, other teams and facilities might glean some ideas from Fresno’s three-pronged approach. 

Improve the support network for teams

One of the first things Fresno did was to revamp its sponsor network, including:

• Assigning sponsors to work in labor and management pairs and matching them so they share similar work areas;
• Reducing the number of teams sponsors work with to no more than four;
• Establishing new agreements that give sponsors more flexibility for how they meet with teams (in person or via email); and
• Setting quarterly deadlines for reporting on team status at LMP Council meetings.

The new agreements clearly defined expectations for sponsors, says Lynn Campama, Fresno’s assistant medical group administrator: “The role of the sponsor is about the performance of teams,” not about team management. “Everybody is accountable.”

Rather than trust that sponsors know how to be effective, Fresno used council meetings as a training opportunity. Sponsors received updated materials, ranging from a new form to help teams with meeting basics to information on the use of metrics and SMART (strategic, measurable, attainable, realistic/relevant, time-bound) goals. They also got forms to help collect team success stories and to help teams better manage UBT Tracker, the organization-wide system that helps teams report on and find effective practices.

In addition, “local resource network” members documented their particular expertise—be it UBT development, performance improvement, issue resolution and interest-based problem solving, attendance, service and workplace safety—and were assigned to teams needing that expertise.

“We took sponsorship to the next level,” says Lorie Kocsis, Fresno’s union partnership representative, LMP Council union co-lead and SEIU UHW member. “We tried to make their role easier for them to understand and to help them feel that they aren’t alone.”

Ron Barba, the director of the outpatient pharmacy and sponsor for the respiratory, inpatient and outpatient and surgery specialties teams, has noticed the difference.

“They gave us the training we needed to help the teams,” Barba says. “I feel more effective.”

Improve team training

To address training gaps identified by the teams, Fresno developed a brochure that puts all the offerings in one place—classroom, “just in time” and web-based training available through KP Learn—and groups the offerings by audience. That makes it easy to see what’s available for team members and what’s there for union and management co-leads.

At the same time, a request form for just-in-time training was developed, and both the brochure and the form were posted on Fresno’s intranet website. A clear process for requesting training was put in place, with team members instructed to submit their requests to Kocsis and Maan.

It didn’t stop there: Teams also got training in key partnership and performance improvement methods. A one-hour, just-in-time version of the eight-hour Consensus Decision Making (CDM) course was conducted with teams that requested or needed it. Teams working on non-payroll projects, such as reduction of inventory, were encouraged to take Northern California’s new business literacy training.

“Training had been one of our big downfalls keeping teams from higher performance,” says Debby Schneider, Fresno’s LMP consultant.

The brochure has heightened awareness of what’s available.

 “It helps us see at a glance what we need to take,” says Jeannine Allen, the administrative services supervisor and co-lead for the Adult Medicine UBT. “It’s been kind of a road map.”

Prioritize projects

To maximize the teams’ performance improvement impact, Fresno guided them toward projects that were achievable, would impact facility or regional goals, and were aligned with the Value Compass.

Teams used a  prioritization matrix to help them pick projects. That exercise sharpened teams’ focus and enabled members to “see how the work they are doing impacts the entire service area—not just their departments,” says Maan.

Teams shared ideas with their sponsors, who connected teams with other resources, including the experts in the newly established local resource networks and the affinity groups.

The experience of the Health Information Management team illustrates why such connections are invaluable. Its SMART goal was to improve customer service by way of a survey. Jeremy Hager, a care experience leader, was assigned to help the team.

He introduced the fishbone diagram to the team co-leads to help them identify which metrics the team should focus on to reduce customers’ complaints. He also helped them correctly interpret survey data. 

The affinity groups also helped teams. The six unit-based teams that made attendance a priority, for example, received tips, tools and specific training around the “six essentials of good attendance” identified by Ann Nicholson, LMP attendance leader for Northern California.

They also looked at their data going back several years, which “really made a difference,” says Eileen Rodriquez, assistant manager for OB/GYN. “It was an ‘aha’ moment.”

The team is meeting its attendance goals. With 6.17 sick days per full-time employee as of the first pay period in December, the team members exceeded the region-wide goal of 6.50. What made the difference? Managers are more flexible, and workers are more aware of the impact of missed days.

Staff members “feel comfortable coming to us,” says Norma Costa, department manager—and the team’s union co-lead, Lisa Madrigal, a medical assistant and SEIU UHW member, concurs.

“I know that if I need to take time off, I can go to my manager and talk with her about it and that she’ll do everything she can to accommodate me,” Madrigal says.

What's next?

Attendance will continue to be a focus of the facility’s UBT strategy for 2012—as will making it easier to use UBT Tracker. Refreshers on UBT basics will be provided, new tools introduced, and new affinity groups created.

And while local union steward elections will affect the sponsor pairings, sponsors will continue to get training and will continue to serve on the LMP Council in labor and management pairs.