National Agreement

Equipping frontline workers with the skills and knowledge for tomorrow’s jobs—an essential element in preserving Kaiser Permanente’s competitive edge—is the focus of the Work of the Future subgroup at National Bargaining.

The negotiations this year focus on three topics, in addition to wages and benefits:

• Workforce planning
• Training and development
• Innovation and technology

“Health care is changing,” says Hal Ruddick, the executive director of the Coalition of Kaiser Permanente Unions. “We have a huge new influx of members because of the Affordable Care Act. We have to meet their needs differently—and we can do that through the solutions we create bargaining in partnership.”

Planning for change

Flexibility, foresight and planning are essential to developing a workforce that is ready for coming changes in the health care industry, said Zeth Ajemian, the director of Workforce Planning and Development for Southern California and Hawaii.

“To prepare our workforce for the future, we need to align staffing with current care delivery transformation, innovation and new technologies that meet the evolving needs of our members,” he says. “We're entering a tremendous era of change. A portion or all of an employee's work will change and their skills, training and experience will need to change to fit that job.”

Creating career pathways that allow current KP employees to move into new roles is essential, says Brian Lockhart, security lead at Sunnyside Medical Center in the Northwest and a member of ILWU Local 28.

“We want some flexibility around the experience component,” says Lockhart, who explained that employees who have trained for new roles are sometimes unable to move into them because they don’t have the necessary work experience.

Role of technology

Leveraging technology to meet the emerging needs of our patients will be another key issue for the bargaining team, says Dennis Dabney, senior vice president of Labor Relations and the Labor Management Partnership.

“We need to decide how we bring that new technology into our work environment,” he says. “We need to react more to what our patients want, rather than what we want to give them.”

Whatever innovations are designed and implemented in the future, frontline workers need to be engaged from the start, say union partners.

“Kaiser Permanente is on that bullet train toward the future and if the labor movement is not on that train, we are going to be left behind,” says Janis Thorn, interim president of United Steelworkers Local 7600.

Work of the Future is one of three subgroups tasked with crafting the next National Agreement. The other two are Total Health and Workplace Safety, and Operational and Service Excellence in Partnership.

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“Interest-based bargaining is not a utopia and not always a win-win. It’s taken Kaiser and the unions a lot of hard work to get where they are,” says Linda Gonzales, director of mediation services for the Federal Mediation and Conciliation Service, Southwest Region. “[But] to resolve difficult issues in partnership is a strength.”

Because of interest-based bargaining, Kaiser Permanente and the Coalition of KP Unions have been able to go well beyond wages and benefits—the subjects of traditional bargaining—in  negotiating four program-wide contracts. These National Agreements have developed industry-leading approaches to worker sick leave, safety and training and workforce development. They have created unit-based teams to improve patient care and service, set standards to hold teams and their sponsors accountable, and pioneered programs for the mutual growth of KP and the unions.  

Interest-based bargaining pays off in other ways as well.

“To understand one another’s interests, you have to engage in inquiry and listening, and you have to resist jumping to conclusions about the other party’s intentions,” says Harvard Business School Professor Amy Edmondson. “Doing this develops leaders who better understand how the organization works.”

“People in health care look to Kaiser Permanente as the showcase for working together,” says Gonzales, who helped facilitate bargaining for the first National Agreement in 2000.

The mediation service last year recognized a handful of cases of successful interest-based bargaining. Our Labor Management Partnership was one of them.

Picture a large room with 150 people. Hands are raised. Everyone gets heard. It is pushing midnight and exhaustion is setting in, but everyone maintains a sense of mutual respect and serious purpose.

It’s not the United Nations but the Common Issues Committee (CIC). The CIC is a representative group—made up of Kaiser Permanente workers, managers and physicians as well as delegates from the Coalition of Kaiser Permanente Unions—who take on the responsibility of negotiating a new National Agreement. The program-wide labor contract covers the 28 locals in the union coalition.

This inclusion is part of what makes our negotiations different from other labor contract negotiations—because how we bargain greatly affects what we bargain. By seating RNs and regional health plan presidents with lab techs and program managers during negotiations, interest-based bargaining at KP opens up new issues for discussion and creates deeper support for the final agreement.

“I personally learned a lot from the different perspectives voiced by all of the individuals representing their fields,” says Dr. Varoujan Altebarmakian, a medical group representative on the 2012 CIC. What he learned during bargaining, he says, made him an even more active advocate for partnership at Fresno Medical Center, where he is physician-in-chief.

A new CIC is formed each bargaining year. KP and union leaders select members and assign each to a subgroup to address a topic area. This year, those topics are expected to include Total Health, Work of the Future, and Operational and Service Excellence in Partnership.

Each subgroup is co-led by a management and union representative. Instead of taking hard-line positions, subgroup members stake out their common interests. Over the course of five bargaining sessions, assisted by outside facilitators, they identify interests and develop options.

In 2010, that process led to development of the Path to Performance, which established a uniform way of rating UBTs. “It was a defining moment in partnership,” says LaMont Stone, a labor liaison for Local 29 in Northern California who participated in 2010 and 2012 bargaining. “Before it was case by case, region by region.”

At the final bargaining session, each subgroup brings its proposals to the full CIC for discussion and agreement; the full CIC also negotiates wages and benefits. The finalized contract then goes to KP management for approval and is ratified by the members of each local in the union coalition.

When I was asked to serve on the national bargaining team in 2012, I was a newbie. I had never done bargaining before and didn’t know what interest-based bargaining was. I quickly learned it is a skill that would serve me well, both in the bargaining sessions and in my career beyond that event.

Bargaining began with a significant investment from the company providing both labor and management representatives with education sessions to understand interest-based bargaining. Part of this education was to understand the landscape of Kaiser Permanente and how we were doing in the industry. It also included a look at the future, as well as the history of KP and the value of the partnership. Bernard Tyson (KP’s chairman and CEO) made it clear that partnership is an asset to KP and it wasn’t going away.

I worked on the Growth team, which was to find ways to help grow KP and union membership. We practiced together with scenarios, using the interest-based problem solving tools—a great way for the team members to start to trust each other.

As we went through the process, there were times we disagreed, and we worked through that. Getting through those tough conversations really showed that although we might be coming from a different place, we had the same commitment and common interests.

One of the interesting aspects of working with a national team was meeting folks from across the KP program. Although I am from Colorado, it was interesting to see that the concerns we had from our region were similar to those of Mid-Atlantic States.

I was a little concerned going into the process that we’d get stuck on some of the local issues. When specific regional issues came forward, we were able to quickly work through them and refocus. I was impressed with my labor partners, who really helped us move from the local issues to the strategic.

Honestly, there were times when I wondered if we were going to be able to get through it. The process was a reaffirmation that we are all on the same page. Other companies haven’t been able to do what we do. We stumble and fall back on traditional methods at times, but there is power in the KP model of how we do things.