Union-Management Partnership: the Kaiser Permanente Approach

SHARE reps at Memorial talking with KP leaders
Earlier this month, Walter Allen, a representative of the Coalition of Kaiser Permanente Unions, asked SHARE leaders to imagine a meeting of hospital employees . . . and then to imagine the roles blurred so you couldn't pick out who among them was a manager. At Kaiser Permanente, Walter explained, their Labor Management Partnership (LMP) is creating this kind of culture. Employees and managers in their hospital network train up together to work side-by-side in partnership, to handle operations and make decisions at every level and throughout the entire system.


SHARE invited KP representatives from Kaiser Permanente’s Labor Management Partnership to come speak with our own EBoard and Reps (as well UMass Memorial's executive leaders and members of the hospital's Labor Management department), because their organization can claim one of the largest and longest-running Labor-Management partnerships in the country. (The Union Coalition itself consists of roughly 110,00 members.) Because that partnership has had made measurable improvements on the care-giving, culture, morale, quality, and profitability of their hospitals, we believe we have much to learn from their experience. Walter, along with a management counterpart from the LMP, Marie Monrad, gave us a lot to chew on.

This visit was part of a SHARE effort to understand what’s working out there, in the broader worlds of healthcare and labor, as we prepare for our upcoming contract negotiations. We want to change how it feels to come to work every day. We know that we need to replace the “command-and-control, shame-and-blame” culture that exists in so many departments. That change is essential for the long-term health of SHARE members, of our SHARE union, and our hospital. We know that those improvements will translate into a better environment for our patients, too. Walter and Marie came to help us think about whether and how deeper Labor-Management partnership could work for us toward those goals in our hospital.

Walter Allen and Marie Monrad from Kaiser Permanente with Nancy Bickford and Bobbi-Jo Lewis of the SHARE EBoard

A key feature of Kaiser Permanente’s approach to partnership is the Unit-Based Team, or UBT. They define the UBT as “a group of frontline employees, managers, physicians and dentists whose work brings them together naturally and who collaborate with one another to improve member and patient care. They are accountable for the performance of their unit and determine the methods and metrics of their performance improvement projects."

One thing that appealed to many SHARE leaders about the UBT model is that the teams required to hold certain principles in balance as they make decisions. So, when UBT's decide the best, most affordable quality and service, they continually balance those choices with their own interest in making Kaiser Permanente the kind of place where they want to work.

Marie Monrad (Vice President for Strategy and Operations Office of Labor Management Partnership, Kaiser Permanente), Walter Allen (Executive Director/CFO Local 30 & International Vice President Office & Professional Employees International Union, Coalition of Kaiser Permanente Unions), and Janet Wilder (SHARE Organizer)

Hospital system leaders at UMass Memorial are also researching a variety of options with the intention of transforming our hospital. Many SHARE members are already affected in their day-to-day work by the coming move to replace our current Information Technology system to EPIC.  And you may also remember that SHARE leaders have accompanied UMMHC leaders on visits to a Thedacare Hospital in Wisconsin, and have sat in sessions together at the Institute for Healthcare Improvement conferences, the largest gathering of its kind.
If this talk about transformation provokes in you some serious questions--about both your union and your employer--that’s good. Many SHARE members can remember a variety of “flavor-of-the-month” consultants brought in by previous hospital administrations to teach employees some method of improvement. Some of these efforts were better, some worse, and none of them fit deeply enough with our culture to last for long. Any solution that works for UMass Memorial is going to have to be home-grown, and everyone here must be involved.

The management-side representative from Kaiser Permanente, Marie, had only good things to say about their unions’ participation. While in Worcester, she made the case to UMass Memorial leaders that partnership was far more productive than the intense labor management fighting and adversarialism that had driven their hospital system to find this new approach in the first place.

SHARE believes that an employer needs a strong partner in order for partnership to be successful. A critical component to any employee engagement strategy is that the front-line workers need to be safe to participate.  A good employer can and should respect employees, but any employer’s goodwill and benevolence has its limits. Employees require their own, independent source of power.

Over the years, SHARE has developed an understanding of the real work needed to engage members in decision-making. Walter and Marie were insistent that the deep commitment to partnership at Kaiser Permanente often requires extreme effort, too. SHARE is going to have a lot of work to do if our next negotiations is going to maintain the kinds of raises and benefits that we’ve all come to expect, and, too, develop new structures that will change how it feels to come to work every day. There's much to figure out. We intend to do this right. And we’re going to do this together.

If you'd like to learn more about Kaiser Permanente and details about their Labor Management Partnership, you can ask your SHARE organizer or local rep what we've discussed, or contact the SHARE office. There are also a number of resources with information on the subject: