Editor's Letter
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A new day dawns
Welcome to e-Hank! The national Labor Management Partnership communications team is pleased to serve you in this new format, and we’re grateful to those of you who’ve reached out and said you miss the print editions of Hank. But until the crisis of the COVID-19 pandemic subsides, an electronic communication seems best.
This issue looks at how our Partnership — which now includes 2 union federations, with separate National Agreements — helped Kaiser Permanente meet the extraordinary challenges that a worldwide pandemic brought to our doors. We’ve never been tested like this before. And how we’ve responded in the last several months provides a look at how we will respond and grow and adapt to future challenges. The dialogue and collaboration that have been taking place during the pandemic are a model for the future.
In this e-edition of Hank, we’re also introducing 2 concepts we think will help strengthen the culture of partnership throughout the enterprise.
The first is a renewed focus on The Basics — tips, tools and stories that will help you understand the core philosophy of the Labor Management Partnership and what it means to work in partnership. New to the Partnership? These materials will help show why Kaiser Permanente and the Partnership unions that belong to the Alliance of Health Care Unions or the Coalition of Kaiser Permanente Unions are committed to it as an operating strategy. Been around for a while? Dive in and refresh your knowledge of the principles and processes that make our Partnership a success.
The second is a new focus on Joy in Work, a concept pioneered by the Institute of Healthcare Improvement. By Joy in Work, we don’t mean smiley faces or i’s that are dotted with hearts. We hope our Joy in Work stories and tools will help you connect with your deeper, personal motivations for working in the demanding health care field. The stats show that people who feel this sort of connection — this fundamental Joy in Work — are less likely to suffer from depression and burnout.
Lastly, don’t miss the back cover, which provides a quick refresh on a core principle that helps our Labor Management Partnership thrive: Free to Speak. It’s a reminder that your voice matters. Thank you for reading this and for all your hard work. Together, there is strength in partnership.
Strength in Partnership
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Labor and management collaborate to address pandemic
In 1997, the Labor Management Partnership turned strife between Kaiser Permanente and its unions into strength.
That strength is coming to the forefront again today. Decades of working in partnership are helping the organization respond to the COVID-19 pandemic, move forward together and provide a model for the health care industry.
With interest-based problem solving, a Free to Speak culture and performance improvement through unit-based teams, the Partnership has built a foundation that’s given leaders, managers and union members tools and relationships to collaboratively address this crisis.
Acting fast
Some of the response took place at the highest levels. Over a weekend, Kaiser Permanente and union leaders reached an agreement to temporarily enhance benefits for physicians and frontline employees.
“I’ve never negotiated anything as fast,” says Dennis Dabney, senior vice president of National Labor Relations and the Office of Labor Management Partnership.
Throughout the crisis, union leaders joined twice-weekly calls with top Kaiser Permanente leaders and played a central role with command centers and surge planning.
The key to making faster decisions was directly involving labor in operations meetings, says Hal Ruddick, executive director for the Alliance of Health Care Unions.
Having a voice
Partnership laid the groundwork for a nimble response in other ways, too. When COVID-19 hit, most vision appointments were canceled.
In Northern California, IFPTE/ESC Local 20 negotiated with management to have optometrists work in different roles. More than 120 optometrists volunteered to staff the COVID-19 test results call-in line.
“We showed our willingness to do alternative work — work that would be meaningful and keep our union members safe,” says optometrist John Corpus, a member of the local union’s optometry unit board.
Having a voice on the job equipped members to negotiate that deal, which included training, laptops and greater flexibility to work remotely.
“If our teams remain safe, are listened to and feel respected in the changes, they can live with the changes during this time,” Corpus says.
Improving workflows
At Beaverton Medical Office in Oregon, after COVID-19 testing began, managers saw that patients often needed multiple services. A new workflow was required — and the Nurse Treatment Room team’s registered nurses and medical assistants rose to the challenge.
“Everyone began sharing ideas and brainstorming possible solutions,” says nurse manager Cyndy Gillis. “The team formulated a plan that respected scope of practice, safety for the staff and patients, and a streamlined workflow that continues to adjust to new challenges.”
“It was the epitome of collaboration,” says team member Kellie Butchino, a certified medical assistant and SEIU Local 49 member.
Fighting together
One of the most vexing problems during the pandemic has been getting caregivers the personal protective equipment they need to safely care for patients. Working in partnership has helped.
“It’s not perfect,” says UNAC/UHCP member Andrew Calderon, a physician assistant at South Bay Medical Center in Southern California.
“But labor and management were there updating staff regularly and fighting to get us the materials we needed.
“We are able to provide the best care for our members because of partnership.”
Looking forward
Such collaboration across the enterprise will help Kaiser Permanente navigate the future — and inspire others, too.
In May, LMP leaders shared their pandemic experiences during a Labor and Employment Relations Association webinar, drawing praise from members of a 4-year-old labor- management partnership in Massachusetts.
“We are trying to proceed on the premise that there is no business case for adversarial labor relations,” says Bart Metzger, chief human resources officer for UMass Memorial Health Care. Partnership is “the only way we can push organizations such as ours forward.”
Partnership is an effective strategy for labor and management, Ruddick says.
“It’s harder, but it’s worth it because the results that you get are better.”
Transforming Care With Partnership Tools
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Behavioral Health teams pivot to virtual house calls
After government stay-at-home orders derailed their plans for a patient support group, members of Kaiser Permanente’s Marlow Heights Behavioral Health team in Maryland set up a video chat for vulnerable individuals sheltering in place.
“With the COVID-19 pandemic, we had to be open and receptive to connecting with our members in a different way,” says Dawn Anderson, a psychotherapist with UFCW Local 400 and union co-lead for the Level 4 unit-based team. “This way we’re still supporting patients with serious health issues.”
Propelled by the global pandemic, Behavioral Health teams across the Mid-Atlantic States are using partnership principles and tools to transform how and where patients seek care — resulting in changes likely to outlast the crisis.
Connecting with patients
Therapists are working from home and counseling patients via telephone and video. Unit-based team members are meeting virtually, too, using collaborative digital tools to identify challenges and solutions.
They’re also using such tried-and-true performance improvement tools as the Rapid Improvement Model to reveal the best ways to connect with patients by telephone and video.
“Sometimes I will connect with patients on video, then after 5 minutes something will cause a disruption and I’ll have to ask if we can connect via telephone,” says Anderson. “We are still adapting to telehealth technology.”
Adapting quickly
The rapid-fire changes haven’t been easy for team members, who are conducting assessments with patients by phone instead of in person because of social distancing requirements.
“We’ve done things in this pandemic season that we normally would not have done,” says Reuben Steele, Behavioral Health operations manager and management co-lead. “That has caused some initial anxiety but, ultimately, the team has been able to adapt and adjust quickly.”
Being heard
Team members agree having a voice in decisions about ways to deliver care is helping them cope with change. A key feature of the Labor Management Partnership is involving frontline workers and union leaders in decision making.
“The LMP is a great way to think outside of the box and figure out what we can do to meet people’s needs,” says Lindsey McDaniel, a psychotherapist, UFCW Local 400 member and labor co-lead for the Silver Spring Behavioral Health team, a Level 4 UBT in Maryland.
Anderson agrees.
“We’re able to ‘check egos at the door’ and come forth with ideas and suggestions. That’s what I love about the UBT setting,” she says. “Our UBT consultant and manager support us and are open to feedback on team projects and goals. This is the forum where I feel my colleagues and I are being heard.”
A Quest for Learning
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Building skills helps employees adjust to changes
Even during a pandemic, it’s important to keep learning.
When Kaiser Permanente storekeeper Vincent Woodard heard about skills days in May at Oakland Medical Center, he signed up.
“You’ve got to keep up with the times,” says Woodard, an SEIU-UHW member who orders and delivers supplies for doctors and nurses. “I’m always wanting to learn more. The more I know, the more I can teach and share.”
Kaiser Permanente encourages lifelong learning. With COVID-19 reshaping health care from the emergence of new roles to increased virtual care, the 2 Labor Management Partnership-supported education trusts are tailoring trainings to help employees adapt by building career resilience and digital skills.
Partnership Supports Upskilling
Northern California’s Workforce Planning and Development Committee was planning skills days when COVID-19 hit. The committee wanted to proceed. The administration agreed. In 2 weeks, labor and management organized skills days with the SEIU UHW-West & Joint Employer Education Fund.
“It’s a trying time with workflows changing to adapt to COVID-19,” says committee labor co-chair Sonya Allen-Smith, an SEIU-UHW contract specialist. “You have to stay skilled up because the work world is constantly changing.”
More than 80 employees participated in 2 Oakland sessions. Housekeepers, medical assistants and radiology techs met in a large conference room, wearing masks and keeping social distance, learning in person and virtually about communication, leadership and emotional intelligence.
Woodard, a 7-year Kaiser Permanente employee and longtime youth basketball coach, related to lessons about teamwork, bringing positive energy and managing frustrations.
“I’m definitely going to use this,” Woodard says. “You’re not always going to get your way. You’ve got to know when to walk away. Hold yourself accountable.”
Northern California is looking to expand skills days. Other regions also are exploring virtual skills days.
“This training is good for labor and management,” says Janis Cruz, support services administrator for the East Bay. “It helps develop soft skills to navigate uncertainty and ignite interest in continued learning.”
Building career resilience
To help adjust to changes, Kaiser Permanente and the education trusts offer online critical skills courses in collaboration, consumer focus, digital fluency and performance improvement.
In May, the Ben Hudnall Memorial Trust launched the Career Resilience Quest, an online course that explores the characteristics of resilience — the ability to adjust to workplace change as it happens.
“We’re experiencing drastic change,” says Ben Hudnall career counseling project manager David Rosenberg. “Developing resilience in general, and career resilience specifically, really helps to respond constructively.
“Career resilience characteristics are like muscles. We need to exercise those muscles, so they’re strong.”
Pharmacy assistant Sergio Romero, a UFCW Local 324 member in Southern California, knows the power of resilience. A few years ago, his mother and roommate died months apart.
He reflected on his career, worked with Ben Hudnall career counselor Jan Cummings, completed a certification program and then began the resilience course.
“With this pandemic, there’s a lot of hopelessness,” Romero says. “The resilience quest boosted me back up. It kept me going.”
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All Hands on Deck
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Labor pools fill staffing gaps
COVID-19 is testing partnership as never before.
Management and labor have had to work together quickly to retool the delivery system to support rapidly changing needs. Employees’ and physicians’ skills and talents are needed in new ways and in new places — so leaders from Kaiser Permanente and unions created labor pools to get KP employees to where they were needed.
It’s one of dozens of innovations made to provide top-quality care at a time when every day is bringing new challenges. The swift work was possible in part because of the foundation provided by the relationships and values of the Labor Management Partnership.
In Southern California's Riverside service area, “It’s all-hands on deck,” says Jiji Abraham, area chief financial officer. “Even physicians are in the labor pool.”
Partnership Sets Tone for Fighting COVID-19
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Open communication is more important than ever
As physician assistant Larry Rick, PA-C, made his rounds of the South Bay Medical Center one recent morning, staff stood at the hospital’s main entrance and screened members, patients, and employees for signs of cold- and flu-like symptoms. Like Kaiser Permanente facilities enterprise-wide, the Southern California hospital adopted the new procedure to protect patients and staff from COVID-19, the respiratory illness caused by the novel coronavirus.
A well-established approach is also helping: Frontline workers here say years of working collaboratively with managers as part of the Labor Management Partnership has better prepared them to fight the pandemic. The Partnership has saved money, improved care, and led to better service – and now will literally be saving more lives because frontline workers, managers, and physicians are working together.
An opportunity to speak up
“Partnership is a fantastic tool,” says Rick, a member of UNAC/UHCP, who has 34 years of experience fighting infectious diseases including H1N1, HIV, and sexually transmitted diseases to prevent the spread of HIV. “Every Kaiser Permanente senior leader has been responsive to our requests and has heard us. We’re working together and everybody is leaning in” to treat more patients now, while preparing for an expected surge. In response to unit-based team members’ concerns, for example, tape was placed in 6-foot intervals on pharmacy floors to help members and patients maintain social distancing while standing in line.
“We’re able to speak up as labor and help figure out the solution,” says Alejandra Navarro, a registered nurse in Maternal Child Health and a member of UNAC/UHCP.
Working in partnership together has also built trust between management and labor. That’s been key to maintaining open lines of communication now and helping counter misconceptions spread by social media, say frontline workers.
Education and support
“They’re educating us and giving us a lot of support,” said Lizz Burnett, a licensed vocational nurse in Geriatrics and a member of SEIU-UHW. “If I can help educate someone and they can tell their family, then maybe we can stop this.”
Tynikko Snyder, a registered nurse in Family Medicine at the Gardena Medical Offices, has 2 children with asthma and her mother suffers from chronic obstructive pulmonary disease. She is worried about the impact of her work on her family. “I am afraid, but I know that I need to step up to the plate and do what needs to be done,” says Snyder, who is a member of UNAC/UHCP. Rick says that can-do spirit is needed to combat the spread of the disease: “If we all do our jobs, we will save lives.”
How Unit-Based Teams Make Kaiser Permanente a Better Place to Work
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Positive results for KP members, patients and workers
Do teams get better results when frontline workers are engaged, free to speak and can influence decisions? Yes, say the people who know best — Kaiser Permanente workers and managers themselves.
Recent People Pulse surveys confirm that unit-based teams get positive results for health plan members and patients, the organization and workers themselves.
For instance, the 2017 People Pulse survey of more than 155,000 KP employees showed that when union-represented employees are highly involved in UBT activities, they get 29 percent higher scores on measures of their willingness to speak up — a key driver of patient and workplace safety and satisfaction. They also get 33 percent higher scores on questions regarding workplace health and wellness.
Improved safety and satisfaction
Further analysis, included in the 2016 People Pulse survey, showed that teams with high employee involvement have:
- 18 percent fewer workplace injuries
- 13 percent fewer lost work days
- 4 percent higher patient satisfaction
“Our findings show that employees who are highly involved in their unit-based teams feel more able to speak up and more encouraged to take care of their health,” says Nicole VanderHorst, principal research consultant with KP Engagement & Inclusion Analytics. “That makes them more likely to have better performance outcomes.”
A better way to work
Workers’ greater propensity to speak up and look after their health when they’re involved in team activities covers several questions (see chart below). For example, workers who are highly involved in their UBTs are far more likely to say:
- The Labor Management Partnership has helped improve organizational performance and working conditions.
- They can influence decisions affecting their work.
- They’re comfortable voicing differing opinions.
- Management uses their ideas to improve care.
- They’re encouraged, and encourage others, to take care of their health.
Click to enlarge.
Roots of workforce engagement
All these factors contribute to a better employee experience as well as performance. And UBTs reflect KP’s unique history with the labor movement.
“Henry Kaiser was perhaps the 20th century’s most worker-friendly industrialist. He supported organized labor and knew that people step up when allowed to exert their job experience, as they do with UBTs,” says KP archivist and historian Lincoln Cushing. “He trusted employees to make decisions that benefitted themselves and their organizations.”
If you belong to a unit-based team — and most union-represented employees do — talk with a team co-lead about ways to get more involved.
Rounding for Results: Creating a Free-to-Speak Culture
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Simple tool makes it easy to track issues surfaced in conversations
Alaine Lounsbury, RN, is proud of her nursing team at Downey Medical Center in Southern California. 4 West team members have worked together for decades, forming bonds that have led to high patient satisfaction rates and region-wide recognition.
Lounsbury, nursing assistant clinical director, attributes the team's success to rounding — the practice of engaging frontline workers in face-to-face conversations on the floor and listening to their concerns. Managers who round say it helps build a culture of engagement and dialogue, a key goal of the Labor Management Partnership between Kaiser Permanente and the Partnership unions.
“It’s about making a connection,” explains Lounsbury, who rounds quarterly on 90-plus staff members using Kaiser Permanente’s Rounding Plus online tool [KP Intranet]. “You want to hear the good with the bad.”
Removing roadblocks
With the tool, managers can use their mobile device to identify, track and escalate issues surfaced during rounding conversations. Program-wide, nearly 10,000 leaders and managers use the program.
At Downey, nurses used rounding conversations to speak up about a workflow issue. Because 4 West is the only unit with nurses qualified to give chemotherapy to adults, it meant staff members sometimes had to leave their department to administer drugs to patients. Their frequent absences meant more work for others.
“I heard them in rounding say, ‘You need to figure this out,’” recalls Lounsbury. She and her team developed new protocols to enable others outside the unit to give the medication. “That was a big satisfier.”
Getting visual
To help her systematically follow up and act on her team’s questions and concerns, Lounsbury uses a colorful poster, called the Stoplight Report, that assigns green, yellow and red colors to track the status of issues.
The poster was conceived by Downey Quality Coordinator Suxian Hu, RN, based on the color-coded reports managers receive through the Rounding Plus program. Last year, all of Downey’s inpatient nursing units began using it.
In 4 West, the poster hangs prominently in the conference room, where everyone can see it.
“Staff members know something is being done,” says Donielle Tresvant, RN, a staff nurse and member of UNAC/UHCP, one of the unions in the Alliance of Health Care Unions. “They know they’re being heard.”
Nurses say the information shared on the poster also fosters team communication and collaboration. “It keeps us updated about things at work and it helps us improve our care by being focused,” says Brianna Schneider, RN, a member of UNAC/UHCP. “It makes for a cohesive atmosphere.”
Inventing Better Care
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Unit-based teams are one of partnership’s gifts to our members and patients
Unit-based teams, or UBTs, are our engine for improving performance and creating the best place to work, and the partnership’s Path to Performance matrix helps guide teams’ development. Whether you’re new to the world of unit-based teams or a seasoned UBT consultant, the Path to Performance section of LMPartnership.org will give you the tips and tools you need to help your team succeed.
The ABCs of UBTs
If you’re new or need to explain UBTs to a new person, go straight to the UBT Basics page for an explanation of unit-based teams, information about roles and responsibilities, and more.
Already a superuser?
Go straight to any of the seven performance dimensions from the drop-down in the main navigation bar. You’ll get a thoughtfully chosen list of top resources as well as links to videos and stories that bring to life why the work matters.
Explore the Path to Performance
The Path to Performance matrix provides a consistent way for unit-based teams to continually improve their teamwork and how they do their work. It sets expectations for beginning Level 1 teams on through high-performing Level 5 teams in seven different performance dimensions.
Everyone benefits from this progression, because as teams become high performing, they have fewer workplace injuries and better attendance, service scores and quality outcomes.
Sounds good, right? Help your team move from Level 1 up to Level 5 by visiting our Introduction to the Path page — it will lead you to recommended next steps, customized by team level and performance dimension.