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Twenty years ago this fall, Kaiser Permanente and the Coalition of Kaiser Permanente Unions formed the innovative Labor Management Partnership—a new way of working that now includes more than 150,000 managers, physicians and union-represented workers across Kaiser Permanente.

To commemorate this event, California Governor Jerry Brown has issued a proclamation congratulating Kaiser Permanente and the Coalition of Kaiser Permanente Unions for 20 years of successful partnership and collaboration.

“This model has resulted in improved patient outcomes, workplace innovations, process efficiencies, and measurable service and quality enhancements while creating a safer, healthier work environment with opportunities for health care workers to improve their skills and advance their careers,” said Governor Brown, “I commend all of the organizers and participants in this process for making the Golden State a better place to live and raise our families.”

The Labor Management Partnership is proof that labor unions aren’t just about making things better for workers, but improving outcomes for everyone. In just the first six months of 2017, partnership teams launched nearly 10,000 self-directed projects to improve Kaiser Permanente’s quality, service, and affordability. Departments with strong employee engagement report:

• 60 percent fewer patient falls with injuries
• 38 percent fewer workplace injuries
• 21 percent fewer lost work days
• 13 percent improvement in patients’ overall hospital satisfaction

In 2016, the partnership also helped Kaiser Permanente to keep costs down, with teams working together to save more than $48 million, on top of $35 million saved in 2015. 

More than 74 percent of Kaiser Permanente’s workforce is unionized. By contrast, 6.4 percent of private-sector workers nationwide belong to a union, according to the Bureau of Labor Statistics. Union representation is supported by a growing number of Americans, an August 2017 Gallup poll suggests. Sixty-one percent of adults surveyed say they approve of labor unions, the highest percentage since the 65 percent approval recorded in 2003.

Working together, Kaiser Permanente and the Coalition of Kaiser Permanente Unions will continue to improve health care for members and the community overall. Together we thank our workers, managers and physicians for their dedication, and appreciate Governor Brown’s recognition of their accomplishments.

Forty percent of U.S. marriages end in divorce after an average of eight years. Most business partnerships fail to meet expectations. And most campaigns end when they achieve their goals or the world moves on.

But the Labor Management Partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions has beaten the odds: October 2017 marks the 20th anniversary of the partnership’s founding, making it by far the largest, longest-running and most sweeping such partnership in the country.

We’ve accomplished a lot together. And in a world of change, sustaining a healthy long-term relationship is an achievement in itself. A key to our success has been the willingess to honestly reflect on our successes, failures, and opportunities to improve. 

By working in partnership, says Kaiser Permanente Chairman and CEO Bernard Tyson, “We have tapped into the potential of smart people all over the organization coming here every single day trying to figure out, ‘How do I improve quality, how do I improve service, how do I improve affordability?’ That’s an incredible competitive advantage for the organization.”

Marking a milestone

This fall Kaiser Permanente and the union coalition will be celebrating those achievements with special events and employee outreach. It won’t be all cake and balloons, however. LMP regional councils, unit-based team sponsors and co-leads, and others will host reflection sessions where workers, managers and physicians can share their experiences, pain points and suggestions for the future of partnership. Participants will consider three questions:

• What is different since we created partnership? (Or, what do you see as the top accomplishments of partnership?)
• What are the greatest challenges it faces today?
• How might we address those challenges, to strengthen partnership now and in the future?

Getting results

Partnership is not easy, and the parties don’t always agree on things. So what’s kept it going?

“It’s nice if we can all get along,” says Tyson. “But most important, we’re here to get results.” Here are some of the results achieved in partnership:

• Performance improvement: More than 50,000 team-led improvement projects since 2007, with measurable gains in quality, service, the work environment—and cost savings exceeding $48 million in 2016.
• Best place to work: Industry-leading wages and benefits, a voice in decision making, and an Employment and Income Security Agreement providing retraining and redeployment for displaced workers.
• Joint marketing: Strategic engagement brought strong gains in KP membership, union coalition membership, and more than $108 million in revenue for Kaiser Permanente in 2016.
• Job training and career advancement: More than 300,000 professional, academic and skill-enhancement courses taken by 104,000 coalition-represented employees since 2007.
• Systems collaboration: Joint implemention of multiple complex programs and systems, including KP HealthConnect, Claims Connect, ICD-10 and call center reorganization.

Lessons for success

All of the above have garnered attention from business, union and academic leaders over the years.

“The Labor Management Partnership is a shining example of how you bring labor and management together to produce results,” said Liz Shuler, secretary-treasurer of the AFL-CIO. “What I love about this model is the notion that, no matter where you work in the system, you have a place at the table and your voice is heard.”

Working in partnership also holds lessons that apply outside of work—including lessons that might have saved some of those failed marriages.

“If you are going to be a good partner and have a successful relationship, with a partner, kids, friends,” says a facilitator from 2015 national bargaining, “you have to have your partner’s needs in mind as well as your own.”

To learn more about LMP anniversary activities, visit the 20th Anniversary How-to Guide.

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.

You get to a certain age, and it’s time for a makeover. Surely you understand.

We heard you whispering. In fact, it inspired us to conduct a statistically valid survey to make sure what we’d overheard was a true reflection of what you thought. Some of it was a pleasant surprise—such praise! But you were blunt, too: Awkward size. Overly long articles. Not enough variety. And so on. 

So, here’s our equivalent of slimming down and building some muscle. (Amazing what walking a half-hour a day will do!) With our new ’do, you’ll find:

• shorter articles and more of them
• more tips and tools, information you and your unit-based team can put to immediate use
• more coverage from all the regions
• and some fun

While we’re on the subject of our virtues: Our paper is certified by the Forest Stewardship Council, ensuring the use of responsible forest management methods that address social, economic and environmental issues.

Why does that matter? Well—working in partnership addresses profound social and economic issues, too. We hope you like our makeover because we want to serve you—the frontline workers, managers and physicians of Kaiser Permanente—well. Because what was achieved this spring in National Bargaining, the subject of this issue’s cover story, makes it clear what an extraordinary journey we are on together.

For the first five years after the Permanente Foundation Health Plan opened to the public, there were no separate regions. Three hospitals—two in Northern California and one at the Fontana steel mill in Southern California—served the new members.

Northern California

The Oakland hospital opened on Aug. 21, 1942, and the Richmond hospital opened nine days later. Once the plan went public, the International Longshoremen and Warehousemen’s Union and other unions were prominent among the early member groups. Oakland city employees, union typographers, street car drivers and carpenters also embraced the plan. In 1953, state-of-the-art hospitals opened in San Francisco and Walnut Creek, as well as Los Angeles. Today, three union locals in Northern California belong to the Coalition of Kaiser Permanente Unions: SEIU-UHW (28,800 members), OPEIU Local 29 (2,400 members) and IFPTE Local 20 (1,300 members).

Southern California

Harry Bridges, the ILWU president, wanted a hospital in the San Pedro area in 1949, and it was his promise of a large and stable membership that convinced health plan leaders to expand. He proved as good as his word, and KP became the sole supplier of medical care to ILWU’s 6,000 West Coast members. The Southern California Permanente Group was established in 1950. In 1951, the 15,000 members of the Retail Clerks Union Local 770 in Los Angeles, at the time the largest local in the country, joined the plan. Today, there are 13 coalition locals in Southern California: SEIU-UHW (18,000 members); UNAC/UHCP (16,000); United Steelworkers Local 7600 (6,000); OPEIU Local 30 (4,000); UFCW locals 770 (a descendant of the clerks union), 324, 135, 1428, 1442 and 1167 (3,860 total); Teamsters Local 166 (500); KPNAA (350); and SEIU Local 121RN (200).

Northwest

Health plan enrollment opened to the community in 1947 with the opening of an outpatient facility across the Columbia River from the closed Kaiser shipyards. It became a region in 1951 and has been at the forefront of several innovative practices. In 1964, it launched the Center for Health Research to advance evidence-based medicine. In 1974, it became the only KP region to provide prepaid dental services. In 1991, the Northwest started Kaiser-on-the-Job, a workers’ compensation program that has since spread to all regions. Coalition locals in the Northwest are: OFNHP/ONA (3,400), SEIU Local 49 (3,900), UFCW Local 555 (900) and ILWU Local 28 (65).

Hawaii

Hawaii opened in 1958—before the territory became a state—with strong support from the building and construction trades, which benefited strongly from Henry Kaiser’s hotel and housing projects. It was the last region to join the partnership, in 2009. The Hawaii Nurses Association, OPEIU Local 50 (800 members), belongs to the coalition.

Ohio

The Ohio region was the first organizational expansion of the health plan outside the western United States. The Community Health Foundation in Cleveland—which had been established by the Meatcutters and Retail Store Employees Union and had a structure similar to KP’s—merged with Kaiser Permanente in 1969 to form the Kaiser Community Health Foundation. The region left KP in 2013.

Colorado

Colorado also joined Kaiser Permanente in 1969, after requests from a group of labor, medical, university and government leaders. The United Mine Workers had regional headquarters in Denver, and Kaiser Permanente had longstanding relations with UMW through the Kabat Kaiser Institute in Vallejo, later known as the Kaiser Foundation Rehabilitation Center, where injured miners were treated. Today, SEIU Local 105 (3,500 members), UFCW Local 7 (1,800) and IUOE Local 1 (23) belong to the union coalition.

Mid-Atlantic States

In 1980, KP acquired the failing Georgetown Community Health Plan and, through the use of existing community hospitals, began to operate profitably within two years. Kaiser Permanente believed locating in the Washington, D.C., area would provide high visibility regarding health care legislation. The effort was successful: In 1992, Jim Doherty, president of the Group Health Association of America, the professional organization for HMOs, remarked that the move “did more for the HMO movement than any single act since the HMO Act of 1973.” In 1984, the region opened its first pharmacy and changed its name to Kaiser Foundation Health Plan of the Mid-Atlantic States. In 1996, it acquired Humana Group Health Inc., one of the country’s oldest HMOs. OPEIU Local 2 (3,800 members) and UFCW locals 400 and 27 (1,600 total) belong to the coalition.

Georgia

The Georgia region opened in 1985. Its first medical director was Harper Gaston, MD,
a Northern California physician and Georgia native who was proud to return home and serve the initial 265 members. In 1988, the region experienced dramatic growth when the state of Georgia came aboard as a major account and Kaiser Permanente acquired the financially ailing Maxicare Georgia HMO; within a year, the region celebrated its 100,000th member milestone. UFCW Local 1996 (1,800 members) is part of the Coalition of Kaiser Permanente Unions.

Visit Kaiser Permanente's 70th anniversary mini-site.

Kaiser Permanente and the Coalition of Kaiser Permanente Unions began national bargaining on March 30—and the negotiations have gotten attention from the press in California, including an article in the Sacramento Business Journal and a report on KQED public radio.

The negotiations are likely to be the largest private-sector contract talks in the United States this year. Some 150 negotiators are coming together from all over the country every two weeks through June to craft the new national agreement, which serves as the union contract for more than 100,000 Kaiser Permanente workers represented by coalition unions.

Hear from union members, management and union co-leads and see how the next national agreement is being created: Watch a three-minute video that captures the spirit of the National Bargaining kickoff and view this slideshow from the first negotiations.

Stay up to date at bargaining2015.org.