Colorado

When the region revamped how it assesses unit-based teams’ Path to Performance rankings in 2014, some teams dropped down on the five-point scale. But the National Agreement and the region’s Performance Sharing Plan motivate teams to reach high performance, and UBTs are rallying around the more objective and accurate evaluation method. The downgrades are proving to be temporary. One Level 5 team is the Cardiology department at the Franklin Medical Office, which improved access by streamlining the referral review process for patients.

Georgia

Musicians aren’t the only ones who go on tour. Loretta Sirmons, a Total Health labor lead, and Tracie Hawkins-Simpson, a contract specialist, who are both members of UFCW Local 1996, hit the road to encourage people to complete the Total Health Assessment. They were joined by their business representative, Louise Dempsey, and Russell Wise, the Coalition of Kaiser Permanente Unions national coordinator for Georgia. “We blitzed the facilities,” Wise says. “For those who hadn’t taken the THA, we explained its importance.” They visited during the work day, dropped in on farmers markets and held cyber cafés. Wise credits the collaboration for increasing regional participation in the THA: In May, it stood at 37 percent. By September, it had increased to 63 percent.

Hawaii

The Hawaii region is partnering with 25 local labor trusts to enhance its members’ benefits and build loyalty to Kaiser Permanente. The new benefit, called Well Rx Hawaii, makes drugs for high blood pressure, high cholesterol and diabetes available free of charge for enrolled members. “Union leaders like it because it shows the value they bring to their members,” says Harris Nakamoto, KP’s director of labor and trust sales for Hawaii. “We like it because it emphasizes the strength of KP's integrated delivery system—and helps members with chronic conditions save money and stay healthier.” KP is funding the program through expected savings in future medical costs and is tracking enrolled members’ compliance with medication, follow-up care and any decrease in emergency room visits or hospital stays.

Mid-Atlantic States

The supply closets for the Physical Therapy department at the Woodlawn Medical Center in Maryland were “in disarray,” admits Dexter Alleyne, materials coordinator and member of OPEIU Local 2. “The overabundance of supplies was money not being used.” Using the 6S method, the inventory operations team took responsibility for the closets—organizing them and setting par levels while preparing to use OneLink for ordering supplies. The team created a spreadsheet for surplus supplies and sent an “up for grabs” email to colleagues at its own medical center and beyond, says Jennifer Hodges, inventory operations supervisor for the Baltimore area. Purging four closets over the summer is yielding savings. The team plans to spread the success throughout Woodlawn and to three nearby medical centers.

Northern California

Concerned by the slow pace of growth in the number of high-performing unit-based teams in the first part of 2014, both the Northern and Southern California regions piloted a SWAT team approach to accelerate the development of Level 4 and 5 teams. The results were impressive. In June, Northern California temporarily reassigned UBT consultants and union partnership representatives from high-performing service areas to assist the consultants and UPRs working in three struggling service areas. As a result, from June to September 2014, the region moved 42 UBTs in the targeted service areas to Levels 4 and 5, out of a total of 90 teams that moved up to high-performing status. During the same period in 2013, 15 UBTs had become Level 4 and 5 teams in those same areas.

Northwest

The Northwest is the only KP region to offer dental services to health plan members—and its dental program is celebrating its 40th anniversary. The idea for the program, which launched in 1974, came from Mitch Greenlick, then director of the Center for Health Research, KP’s medical research unit. Today, Greenlick is a state representative in Oregon—and more than 800 KP dental staff and dentists provide more than 234,000 people with dental care and coverage. The program is home to 19 unit-based teams, almost all of them high performing. Sunset Dental UBT reduced unfilled appointments by creating a wait list and calling patients when a spot opened up. Unfilled appointments improved by 22 percent in 2013, and team members have sustained the result. Get some quick facts and figures on the dental program.

Southern California

Taking a SWAT team approach to boost the number of high-performing unit-based teams, Southern California concentrated resources on several strategically selected facilities. By October, the percentage of UBTs at Levels 4 and 5 was 59 percent, up from 34 percent in January. A key component of the approach was hiring seven new union partnership representatives, including Elsie Balov, an SEIU-UHW member who is aiding teams at the South Bay Medical Center. “It is really important that labor is helping with this work,” Balov says. “We are pulled from the front line to help, so we know the obstacles and the challenges and can work with the UBT consultants on those.

Colorado

The Metabolic Surgical Weight Management unit-based team at the Franklin Medical Office is saving money and improving efficiency by reducing unnecessary lab tests for patients. The team researched current literature and discovered that its process was not adding value to patient care. As a result, the team went from 40 to 50 tests each day to 10 to 12 a day, saving more than $700,000 in one year. The project helped propel the team from a Level 1 to a Level 5 on the Path to Performance. The team won the UBT Value Compass Award for the first quarter of 2015.

Georgia

When the Georgia region sought to promote compliance initiatives while engaging frontline workers, it copied an idea from an existing regional program. “We already have workplace safety champions, so we mirrored what they did to birth this little baby,” says Kim King, fraud control, privacy and security officer. As of December 2014, each of Georgia’s 30 medical centers and its medical records facility boast a compliance champion on site. The goal is to increase under-standing of possible compliance lapses, such as an unlocked door or allowing an unknown person into restricted areas. “Frontline staff—and the majority are union representatives—raise awareness and do monthly walkthroughs of the facilities,” says King.

Hawaii

After she helped set up a network of safety champions at the Moanalua Medical Center and medical offices in the Hawaii region, registered nurse Christy Borton won the individual award for Creating a Safer Workplace at Kaiser Permanente’s Workplace Safety Summit in late February. Borton, the workplace safety co-lead and a member of HNA OPEIU Local 50, is mobilizing colleagues around the region’s renewed focus on safety conversations and safety walk-arounds. Frontline staff share safety tips via a weekly safety newsletter. She also is working with the Safe Patient Handling Committee to spread the use of HoverMatts, which help prevent injuries to both patients and employees.

Mid-Atlantic States

Workplace safety leaders in the Mid-Atlantic States region are committed to investigating incidents in partnership. Ensuring that a labor representative can meet soon after an employee injury was a key to the boost seen over the last several months. In January, 89 percent of incident investigations were performed in partnership, a 10 percent increase over December and significantly better than in October, when fewer than 70 percent were investigated in partnership. Another improvement is that incidents were reported in an average of four days in January compared to an average of eight days in December. “If we don’t keep ourselves and each other safe, we won’t be there for our patients to provide the care they deserve,” says Samantha D. Unkelbach, RN, the labor lead for Workplace Safety/Integrated Disability Management for the Baltimore area and a member of UFCW Local 27.

Northern California

Before moving to a new facility in San Leandro, members of the Pulmonary Sleep Services Center in Hayward took action to raise their patient satisfaction scores from the bottom third to upper third. They asked patients what needed to improve and even visited some members at home. By listening, the unit-based team identified nearly 50 points of confusion patients face from the moment they arrive for treatment to when they go home. From February to August 2014, the UBT began letting patients return diagnostic equipment at their own convenience and staggered lunch breaks to ensure that patients could receive respiratory therapy around the clock. These changes helped transform the team from a Level 1 to a Level 4 on the Path to Performance.

Northwest

Building on the region’s success in exceeding the goal of 75 percent completion of the Total Health Assessment in 2014, Total Health leaders are taking more steps to create a culture of wellness. Cynthia Beaulieu, the region’s Total Health labor lead and an OFNHP member, along with her management partner Lauren Whyte, employee wellness consultant, work with unit-based teams to celebrate team approaches to health. They round on teams with leaders to acknowledge and learn from team efforts. One fun project was collecting “healthy selfies” to showcase on the region’s internet site. Beaulieu and Whyte are encouraging the more than 300 employees who submitted photos to share them on social media using the hashtag #KPHealthie.

Southern California

The region is adding a new dimension to its popular and effective reward and recognition program for inpatient Medical/Surgical and Maternal Child Health unit-based teams: a special award for teams that sustain their strong service scores for an entire year. For the performance year that recently ended, winners were Anaheim Medical Center for Maternal Child Health and Woodland Hills 4 West for Med-Surg. After celebrating their achievements, the teams are expected to help spread their successful practices to their peers at their own facilities and region-wide. Strategies they are considering are a one-day conference with presentations by the winning teams, hosting visits from other UBT co-leads, and monthly webinars.

Each day, every day, Kaiser Permanente’s 3,500 unit-based teams are providing ever-better patient care and advancing our mission. Now, under the 2015 National Agreement, UBTs will have an even greater role to play—and higher expectations to meet.

The new contract, which took effect Oct. 1, 2015, calls for UBTs to bring the voice of KP members and patients into their work. Teams also will be making total health and safety a greater part of their activities. And they will undergo more rigorous, face-to-face performance assessments.

To help them meet the new expectations, there’s a cadre of expert peer advisors and coaches they can call on—unit-based team consultants and union partnership representatives (UPRs) trained in performance improvement methods. Both UBT consultants and UPRs support unit-based teams, but UPRs, who are coalition union-represented employees, also specifically mentor and support labor in UBT and performance improvement work. Both help teams sharpen their communication, data collection and analysis, and other skills needed to advance on the Path to Performance.

It’s a unique system to support workplace learning and innovation.

“I’ve learned a lot about how to build teams and how to use performance improvement tools,” says Gage Martin, an SEIU-UHW member and union partnership representative at the Santa Rosa Medical Center in Northern California. “I take that learning and help teams do projects in all areas of our Value Compass. It’s a great job.”

The UBT consultant and UPR roles were created, as a test of change, in 2008. Since then, they have helped KP set the standard for quality, service and the workplace experience, and delivered tens of millions of dollars in cost savings.

As we strive to deliver the promise of One KP—providing each member and patient with the best care experience, every time—we also need to have One LMP, with each person working in partnership, having the same resources available to them and the same accountability to upholding the National Agreement. UBT consultants and UPRs help make that happen.

I’ve had the privilege of working for Kaiser Permanente for more than 30 years, and it was clear to me from day one that there is something different about our organization and the people who work here.

We’re big, with more than 175,000 employees and 18,000 physicians who provide coverage and care for more than 10 million members. What makes us unique, though, is our mission—to provide high-quality and affordable health care and to improve the health of our members and the communities we serve—and the actions, behaviors and decisions we take to support our mission. We walk the talk.

Our success these past 70 years has been the result of a lot of tremendous work and effort, individually and collectively, by hundreds of thousands of people. Today, we are fortunate to have great people working in all parts of the organization who are well-informed, highly motivated and focused on fulfilling our mission. We have leaders at every level who are delivering better health for all.

Early in my career at Kaiser Permanente, I gained an appreciation for the important role labor has played throughout our history. In fact, labor plays a broader and very different role at Kaiser Permanente than it does in many companies across America. Part of the reason we have worked well with labor is that even when we’ve had disagreements, unions have demonstrated a lasting interest in the success of Kaiser Permanente and the employees they represent, especially during challenging times.

I also have a personal appreciation for the role of labor in our society. My father belonged to a carpenters union. Unions were a voice advocating for the American dream for my family—saying my father should get work, he should be fairly paid, he should be treated right. My father had the jobs he had and the job protection he had because of the unions stepping up and speaking out.

At Kaiser Permanente, we place a tremendous value on creating and maintaining an environment where people not only feel comfortable speaking out but are encouraged to do so—and the Labor Management Partnership unions are actively supporting this culture. We want everyone in this organization sharing their best thinking every day, so we can create the best experiences for our members and patients, no matter where, when or how they come in contact with Kaiser Permanente—which is the essence of One KP.

As we look to the future, we need to continue to bring our best thinking forward during a time of dramatic change in health care. We need to have the mindset that we are going to embrace this change and lead the industry in charting the course for 21st century health in this country, so we can carry on the legacy of Kaiser Permanente for many years to come.

“Henry J. Kaiser’s Permanente Foundation Hospital in Oakland, built to provide pre-paid medical care for 100,000 shipyard workers, has been opened to the public,” the San Francisco Chronicle announced on July 21, 1945—a momentous shift for a health plan that had been serving only employees and their families.

With World War II coming to an end, the plan’s future had been in doubt. Sidney Garfield, MD, the sole proprietor of the Permanente Foundation Health Plan, argued for its continuance, as did ex-Kaiser workers and their unions in the San Francisco Bay Area. Henry J. Kaiser, always open to bold moves, said: “Well, why shouldn’t we open the plan to the public and see if it works?” While other industrialists had adopted programs to improve their workers’ health, Kaiser was the first to embrace the public.

The plan came under attack—doctors in private practice called it “socialistic.” But support from key labor leaders made the difference that ensured the plan’s success.

Kaiser’s long history of supporting labor—an ethical and business decision he’d come to when handling huge government contract projects—became even stronger in his remaining years. In 1965, the AFL-CIO presented Kaiser with its Murray-Green Award, the first businessman to be so honored by organized labor.

Relations between Kaiser Permanente and labor unions have experienced ups and downs since then. But as the early history of unions at KP and the advent of the Labor Management Partnership in 1997 make clear, there is no health plan in the country with a richer and more positive relationship with working people and the organizations that represent them.

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

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.

Ten weeks of national bargaining between Kaiser Permanente and the Coalition of Kaiser Permanente Unions concluded Saturday, June 6, when 150 union and management representatives approved a tentative 2015 National Agreement. The agreement now goes to the 28 union locals that compose the coalition for ratification and to Kaiser Permanente senior leaders for approval.

The three-year tentative agreement is designed to help unionized workers and managers achieve quality, affordability and safety of care; prepare for jobs of the future; and develop innovative solutions to health care challenges. The agreement also will enable our 3,500 unit-based teams to better deliver award-winning care and service to Kaiser Permanente’s more than 10 million members and patients.

“This is an outstanding agreement that deepens our ability to provide affordable, high-quality care to our members and patients,” says Dennis Dabney, the senior vice president of National Labor Relations and Office of the Labor Management Partnership. “Kaiser Permanente leads the industry because it is a great place to work and a great place to receive care—and the two are inseparable.”

“We’re on year 18 of a remarkably successful strategy,” says Hal Ruddick, executive director of union coalition. “Our contract is better than ever, Kaiser Permanente’s quality and service scores are higher than ever, and the organization and unions are both healthy and growing. Partnership pays off for workers, consumers and mission-driven organizations like Kaiser Permanente.”

Agreement highlights

The agreement includes wage increases in each year of the agreement (see specifics below), provides operational flexibility and bolsters joint problem-solving capabilities. It builds on the successful 2012 National Agreement, strengthening provisions for workplace health and safety, providing additional funds for workforce training and development and ensuring the consistent application of partnership principles.

The new three-year tentative agreement includes:

• Across-the-board wage increases in each year of the agreement: All employees in Northern and Southern California represented by a coalition union receive 3 percent increases in the first two years and 4 percent in the third year. Employees in the regions outside of California represented by a coalition union will receive a 2 percent increase each year of the three-year agreement. In addition, they will receive a 1 percent increase at the end of the third year.
• Enhancements to benefits such as dental coverage, life insurance and tuition reimbursement. The tuition reimbursement was increased to $3,000 per employee per year. For the first time, tuition, dental coverage and life insurance are standardized for coalition union members across all regions.
• A long-term solution that protects retiree medical benefits for current and future retirees, with no net increase to retirees’ out-of-pocket expenses, while reducing liabilities associated with those benefits.
• Increased funding to the Ben Hudnall Memorial Trust and the SEIU UHW-West and Joint Employer Education Fund to ensure career development for Kaiser Permanente’s diverse workforce.
• Improved methods for assessing unit-based team performance and for spreading and adopting successful practices.
• Updates to our groundbreaking Kaiser Permanente Total Health Incentive Plan,  which rewards employees for healthy behavior and provides incentives for collective improvement.
• Joint participation on community health projects by the coalition unions in KP’s local and regional Community Benefit programs.

Next steps

Our agreement is the largest private-sector contract in the United States this year. Once it is approved by Kaiser Permanente senior leaders and ratified by union members this summer, it will take effect Oct. 1, 2015, and be in effect through Sept. 30, 2018.

The impact of the agreement “goes beyond the words on paper,” says Jerry Vincent, the Northern California region’s director of Labor Relations. “It lays the foundation for us to continue to provide quality, affordable care for many years.”

“There were some tough moments,” Denise Duncan, RN, the executive vice president of UNAC/UHCP, says of the negotiations. “But people came back together. It was a reminder that our national agreement—and our partnership—is very strong, and we keep making it better. There’s nothing like it anywhere else.”

For more information, see www.bargaining2015.org.

Improving performance and strengthening partnership is the work of the Operational and Service Excellence in Partnership subgroup—one of three subgroups in national bargaining.

At the third session of national bargaining, members of the subgroup made recommendations on topics including improving learning, accountability, problem solving, consistency, flexibility and support for unit-based teams.

The many perspectives represented at the table—with all regions and a wide range of job types in the mix—enriched the group’s discussions.

“We are really making progress. We’re having good discussions that can help people back at work overcome barriers in their day-to-day UBT work and make their lives easier and better,” says Holly Davenport, a union representative for UFCW Local 770 in Southern California. The group is investigating ways to improve the spread of practices from one team to another and to ensure that UBT assessments accurately reflect performance.

One LMP

The subgroup is also looking at ways to improve partnership at all levels of Kaiser Permanente and at the elements—from tools to training—that affect its success.

“Our group is trying to establish the principles of partnership and ensure they’re applied consistently across regions,” says Rita Essaian, an executive administrator with Southern California Permanente Medical Group.

“No matter what region you’re in, the partnership should be the same,” says Ruby Robley, a respiratory therapist at Antioch Medical Center in Northern California and an SEIU-UHW member. “We need One LMP, just like One KP.”

First-timers excel

Many of this year’s negotiators are new to bargaining in partnership, including manager Casper Yu, the director of Dental Sales and Marketing in the Northwest. “I love how this process works,” he says. “We negotiate and still come out with great personal and working relationships. I tell people, ‘This is what it truly means to be in partnership. I get it now.’”

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

Visit bargaining2015.org for more information, videos and slideshows and to sign up for bargaining updates.

Finding ways to help Kaiser Permanente employees enjoy long, healthy, productive lives is the mission of the Total Health and Workplace Safety subgroup.

The subgroup, one of three in national bargaining this year, will expand upon the achievements of the 2012 National Agreement. It will also address how Kaiser Permanente and the Coalition of Kaiser Permanente Unions can partner to improve the total health of the communities we serve.

Delivering exceptional care and service and supporting a healthier, injury-free workforce go hand in hand. “We can’t provide quality, affordable care to our members and communities unless we first provide a safe and respectful environment that promotes the collective health of our workforce,” says Kathy Gerwig, Kaiser Permanente’s vice president of employee safety, health and wellness and the management co-lead for the subgroup.

Personal and collective health

In 2012, negotiators established the groundbreaking Total Health Incentive Plan. The wellness program encourages employees to assess their own health and aim for collective improvement in measures like cholesterol and body mass index. In addition, healthy employees can serve as role models for Kaiser Permanente patients.

This year, the parties will suggest ways to create a healthier, safer work environment by improving employee access to services such as wellness coaching and better understanding trends in workplace violence and prevention. Another goal is to encourage employees to eat healthily, exercise at breaks and prevent workplace violence and intimidation.  

Expanding wellness to communities

In a first for national bargaining, the subgroup will also suggest ways to bring a holistic approach to wellness into communities Kaiser Permanente serves, especially those with limited access to healthy food, affordable health services and places to exercise.

“Our union members tend to live in communities that have high needs around health or issues around violence,” says Meg Niemi, the president of SEIU Local 49 and also a union co-lead for the subgroup. “So our members have an interest in their communities being healthier and safer further upstream, before they need critical care.”

The other two subgroups tasked with crafting recommendations are Work of the Future and Operational and Service Excellence in Partnership. (For more on Work of the Future, watch this slideshow and read this article.) Negotiators are developing a tentative agreement that will become the National Agreement after it is approved by Kaiser Permanente leadership and ratified by union locals this summer.

Visit bargaining2015.org for more information, videos and slideshows, and to sign up for bargaining updates.