LMP Processes

Course description

This course shows how to use consensus decision making in the partnership and unit-based team environment and explains the critical elements in a consensus decision.

Path to Performance

Level 1, 2

Duration

• 90 minutes (classroom)
• 30 minutes (online)

Who should attend

Anyone seeking a basic understanding of consensus and how the consensus decision-making process works. This includes labor, management and physician members of a unit-based team, Labor Management Partnership and unit-based team consultants, improvement advisors and Union Partnership Representatives.

Course requirements

Labor Management Partnership Orientation (LMPO)

Su-Xian Hu and Runeet Bhasin make partnership look easy. The telemetry team co-leads at Downey Medical Center in Southern California share a relaxed rapport that belies the time, planning and occasional friction that are part of running a busy inpatient unit. 

Together for more than a year, the pair attribute the success of their budding relationship to communication and a commitment to partnership principles—especially consensus decision making. Those core values came in handy recently when a disagreement arose about the best way to educate patients about medications. 

Nurses preferred a less overwhelming one-page sheet, but managers wanted to switch to a detailed three-page form that had been adopted by other units in the hospital. 

“It was a major issue,” says Bhasin, RN, a staff nurse and member of UNAC/UHCP who is the team’s labor co-lead. “We had to come up with a solution to fulfill management’s needs and labor’s needs.”

At the time of the disagreement, UBT members turned to consensus decision making to determine next steps they all could support. A subsequent test of change resulted in a short-term fix: Nurses used the short form with patients, while the longer handout was provided as a resource guide in patient rooms.

New to partnership

Managing in partnership was a new experience for Hu when she joined the team in April 2016 as assistant clinical director and became a co-lead. She previously had overseen a Kaiser Permanente inpatient nursing unit that was not part of the Labor Management Partnership. Bhasin, a co-lead with two years of experience, served as mentor and coach.

“Runeet was wonderful with helping to bring me onboard,” says Hu, who is also an RN. 

Both say LMP training has given them a shared understanding of their roles as co-leads, the purpose of UBTs and how to use consensus decision making. A business literacy class both took proved especially fruitful: With the information they brought back, the team tackled an affordability project that reduced overtime costs by more than $95,000 last year. 

“The UBT classes,” says Bhasin, “made me realize the real meaning of partnership, the collaboration of labor and management to work toward the same goal to provide high-quality care and to have a great work environment.”

The pair’s approach seems to be working. Their 75-member UBT is at Level 4 on the five-part Path to Performance, and it has earned accolades for outstanding patient care and gains in workplace safety and affordability. 

“We want what is best for patients and for staff,” says Hu. “We might have differences, but we always come together with open and professional communication, sitting down together to solve those issues.”

Our 2012 National Agreement established the conditions for creating the healthiest workforce in the industry.

One of the key innovations in the 2012 National Agreement is the Total Health Incentive Plan, a voluntary program that rewards employees for collective participation in confidential health screenings and improvements. 

The 2010 agreement includes uniform performance goals and metrics for unit-based teams, an enhanced sick leave cash-out option and stable funding for workforce development trust funds.

If you print the PDF out on 8.5" x 11" paper, each sheet will have one two-page spread of the bound contract. 

“The No. 1 reason for the success of our teams has been personal engagement,” says Alan Kroll, a primary care area administrator in Colorado who co-sponsors nine unit-based teams with his labor and physician partners. “Everyone needs to buy into the process to make partnership work.”

Building engagement and ensuring a consistent work experience have been goals of the Labor Management Partnership since the beginning. But, at the same time, there’s been a good deal of variation around these efforts from location to location across Kaiser Permanente, to the frustration of many managers, workers, and KP members and patients.

That’s why the 2015 National Agreement mandates partnership training for everyone, including the mid-level managers and union leaders who guide others. Early versions of the partnership training for mid-level leaders, which will be available this year, have gotten high marks from UBT sponsors and other leaders who have taken it. 

Consistency counts

The agreement calls for “a learning system that supports sustained behavior change, partnership and performance.” This includes joint training and refresher courses—delivered in-person
and/or online—to “achieve the same partnership and employment experience wherever one works in KP.” 

The new training for mid-level leaders will include segments on: interest-based problem solving examining the forces that support or undermine partnership core partnership behaviors and principles the strategic importance of the LMP 

Joint training is key 

The programs are designed to develop successful leaders who can model partnership and spread successful practices—and to ensure that the managers or union representatives helping teams have what they need to support those teams.

“It is very powerful for managers and union leaders to be in training together,” Kroll says. “It sends the message that everyone is important, and sets a foundation to work from when an issue gets stuck.”

The training served as a reminder that good partnership practices also are good leadership practices. 

“People want to hear from their leaders,” he says, and to “know what issues we are dealing with and that we can help remove obstacles.”

See the 2015 National Agreement, section 1.E, Education and Training (pages 31–33) for additional information.

Our 2000 National Agreement created the joint LMP Trust Fund. It also created the Performance Sharing Program. It began with these prophetic words:

"This National Agreement was created through an extraordinary collaboration with the input of hundreds of Kaiser Permanente employees at every level. We created this document the way we will work in the future—jointly. The Agreement embodies our collective vision for Kaiser Permanente. The language of this National Agreement cannot begin to fully capture the energy and collective insights of the hundreds of people working long hours to establish this framework. But as work units apply these principles, we trust that their commitment and expertise will make our vision a reality."

Beyond excellent wages and benefits, the 2015 Coalition National Agreement sets industry-leading standards for quality, service, affordability, workplace health and safety, and professional development. Coalition union members, their managers, and the physicians who work with them should read the agreement and be familiar with its intentions and the path it lays out for achieving high-quality, affordable heatlh care while creating a great place to work. 

Management and union representatives in Southern California were at odds when they gathered in March 2015 to settle a UNAC/UHCP grievance over the working conditions of registered nurses in Home Health, Hospice and Palliative Care. 

Because of the dispute’s complexity and scope, involving nurses regionwide, it was moved from the grievance process into issue resolution.

“When they started, it was the Mason-Dixon Line. It was management on one side and labor on the other side,” recalls Marcia Meredith, who works as a neutral facilitator in Southern California. She gets called on when “sticky and contentious” issues come up involving the Labor Management Partnership, which is celebrating its 20th anniversary this year. “It was pretty tense.”

Months later, managers and union representatives were working side by side, forging consensus on key issues. 

Key to their success was the issue resolution (IR) process spelled out as part of the partnership between the Coalition of Kaiser Permanente Unions and Kaiser Permanente. It incorporates interest-based problem solving (IBPS) and consensus decision making (CDM) to provide a framework for settling disagreements collaboratively—providing a modern-day take on Henry J. Kaiser's line, “Problems are only opportunities in work clothes.” 

Bringing order to chaos

They also benefited from the fact that Southern California—after watching people struggle for months and sometimes years without resolving their problems—recently had clarified how the process was to be used and had added a clear path for escalating issues.  

“Issue resolution helps you focus on what the problem is and the possible solutions,” says Meredith.

The nurses and managers eventually agreed to make changes to assignment workflows, improve communication and enhance training opportunities for frontline workers. “They came up with good things that they’re still using,” says Meredith. 

Crafting Southern California's appeals process took months of hard work. Key stakeholders included regional LMP Council members, coalition union leaders and Human Resources administrators.

Before escalation changes took effect on Jan. 1, 2015, the issue resolution process had tended to spin out of control. 

‘It was like the Wild West’

“It was like the Wild West. Everybody did their own thing,” recalls Ilda Luna, an SEIU-UHW service representative for Glendale Medical Offices in Southern California. 

Alex Espinoza, the Coalition of Kaiser Permanente Union’s national coordinator for Southern California, agrees.

“People would email whomever they thought would resolve the issue,” he says, citing examples of individuals who leapfrogged layers of union and management intervention to appeal directly to leaders at the national level.

During national bargaining in 2015, Southern California representatives shared the region’s appeals process, and the subgroup working on the issue recommended a similar process be created in every region.

The approach calls for resolving issues at the lowest possible level. For stubborn disagreements, there is now a standardized process for escalation the aggrieved parties can turn to, with 30-day deadlines for resolution at every step of the way.

In Southern California, for issues that can’t be resolved at the facility level, a nine-member regional SWAT team made up of management and union representatives serves as a court of last resort before the matter heads to national leaders. 

But since the process was adopted two years ago and local LMP Councils and union leaders were educated about how to use it, no issue has been referred to the regional team. 

That’s good news, says Maryanne Malzone Miller, senior director of Human Resources in Southern California and a SWAT team member. 

“I like to believe we’re pushing it to the level where it should be resolved,” Miller says. 

“It’s a success,” agrees Espinoza, also a SWAT team member. “Folks are engaged and are talking to each other.”