Labor unions and healthcare management find success in working together

Several years ago, Kaiser Permanente, the nation's largest health maintenance organization, and the AFL-CIO forged a unique partnership designed to improve the quality of healthcare for Kaiser members and their communities.

It has taken a while, but this collaboration between labor and management - in which each party must share information, responsibility and decision-making pertaining to patient care at Kaiser facilities - is beginning to yield results.

Kathy Geroux, president of the Oregon Federation of Nurses and Health Professionals (OFNHP) and a member of AFT Healthcare's program and policy council, calls the partnership "a work in progress."

"We are going in a great direction, but it didn't happen overnight. We've been working at this for years," Geroux explains. "The hardest thing to do - on both sides - is to listen to the interests of others."

The national agreement between Kaiser and the Coalition of Kaiser Permanente Unions was negotiated in 2000 and ratified by the 25 participating local unions, including the OFNHP. More union locals have become involved in the partnership since then. Today, the contract covers more than 75,000 union members.

Every union member can opt to participate in union partnership training, which is aimed at giving stewards and activists a deeper understanding of Kaiser's history, how it runs as a business and its relationship to the union. The training encourages participants to become more engaged in partnership activities.

"The training gives members a big picture of our goals and why we are doing what we're doing. The more we understand about the business, the easier it is for us to focus on the effectiveness of the patient care delivery system," says Geroux.

"This is the largest, most complex [labor-management] partnership in the U.S.," says Alan Moore, an OFNHP organizer. "It's a totally different world from what most healthcare workers experience, and we are beginning to awaken the public and other healthcare workers about the benefits of the partnership."

Seeing is believing

This winter, AFT Healthcare's program and policy council had a chance to take a firsthand look at the labor-management partnership when it met in Portland, Ore., and visited Kaiser Sunnyside Medical Center, where nearly 2,000 OFNHP members work.

A collaborative staffing project at the facility was of particular interest to PPC members. The national agreement calls for union members and managers to work together to recommend joint staffing plans for each work unit. Kaiser Sunnyside has a pilot project for safe staffing in three areas: emergency, medical-surgical and the step-down unit. So far, staffing changes the partnership has implemented are improving both the quality of care and the hospital's bottom line. For example, the number of patients sent to other hospitals because of staffing shortages in the emergency room has been greatly reduced since the union became involved in setting staffing protocols for that unit.

The union looked at the number of patients diverted from the Kaiser emergency room to other hospitals and used its findings to advocate for more RN staff, says Don Thomas, an ER charge nurse and labor liaison for the partnership.

"Diverting patients is very expensive for HMOs, and the new staffing plan translated into immediate savings," notes Geroux.

The union also is working with management on workplace safety. The hospital expanded its patient lift team this year, for example, to reduce injuries to nurses and techs when moving patients.

Marilyn Terhaar, a pediatric outpatient nurse who is working full time as a labor liaison for workplace safety, says the initiatives have changed the culture of the hospital. "Practices that are deemed a hazard to patients and workers are now stopped immediately," she says.

Although the main focus of the partnership's safety initiatives is on establishing preventive programs and reducing workers' compensation claims, there also has been a push to provide alternative jobs for healthcare workers injured on the job.

Through the partnership, the union has negotiated policies that eliminate the cancellation of shifts and the use of mandatory overtime. In the Northwest, the incidence of shift cancellation is very high. The partnership found creative ways to solve the problem. At Kaiser Sunnyside, healthcare workers are reassigned to other departments or work on partnership activities to avoid the loss of their shift. Nurses usually are floated within the medical-surgical, family nursing or critical care units. The practice has significantly lowered the use of agency nurses to fill vacancies and saved millions of dollars.

Under the "no mandatory overtime" policy, healthcare workers are required to stay beyond their scheduled shifts only during a state of emergency.

The level of union involvement in how the hospital is managed is impressive, says Candice Owley, chair of the program and policy council and an AFT vice president. There has been labor-management cooperation in traditional areas such as working conditions, Owley says, but now labor and management are broadening their efforts, "which is unique and unusual in a healthcare setting."

"There is a stark contrast between a unionized facility that accepts the input of its workers and nonunionized facilities that don't listen to them" even though the latter facilities are struggling to retain workers, says Ann Twomey, president of Health Professionals and Allied Employees in New Jersey and a member of the program and policy council. "The ability to work with management is a win, win, win situation for healthcare workers, the patients and management," notes Twomey, also an AFT vice president.

A brighter future

Although the partnership is not utopia, working conditions have become decidedly better.

Before the collaboration, the unions and Kaiser had a traditional labor-management relationship, says Geroux. "Only certain things were discussed with management. They didn't have to talk to us about anything outside the NLRB box or share information about their business practices," says Geroux.

With partnership, "everything is on the table for discussionÑfrom staffing to the budget," says Moore.

"It is empowering. It has given members a voice," Geroux points out.

Still, management and labor do bump heads on occasion.

"Traditionally, power has been with management, but we are changing that culture; and there are some managers who don't want to relinquish control or share the power," says Geroux.

There also has been resistance to funding union activity. For example, the unions are forming steward councils at their facilities to share information about partnership activities and identify union activists to get involved in the joint effort.

"The biggest learning curve is getting management to see the connection between our work and their business. Some in management don't understand why the company should pay for union activity," Geroux explains. "Unions have to have some way to communicate with each other. It is a must for us at this point in the partnership."

The connection between each of the unions within the coalition has been much easier to create, although it requires a lot of maintenance and the ability to quell tensions, says Geroux.

By sharing power, we can save money and increase the quality of care at the same time, says Jeff Harris, an ICU nurse and president of the nurse bargaining unit at Kaiser Sunnyside.

That is what the partnership is about, says Geroux. Staffing agencies may pay their workers more, but healthcare workers in the partnership see that it provides the whole package: good wages, a voice at work and ever-improving working conditions, she says.

It's clear that the partnership's efforts are working at Kaiser Sunnyside. In the last three years, the RN vacancy rate has been clearly cut in half. In March 2001, the rate was 8.7 percent. By March 2003, the rate dropped to 4.9 percent.

The standards at Kaiser are miles ahead of community standards, says Moore. "A year from now, Kaiser Sunnyside will be the best hospital in the Kaiser partnership."

"OFNHP has been organized for 25 years, and we're more engaged in union work than ever.  The dream is to change the environment and to have a voice," says Geroux.

At Kaiser Sunnyside, many union members believe that the labor-management partnership just might be the closest thing to a dream come true.