Kaiser Permanente: The World's Largest Labor-Management Partnership

My perspective on healthcare is that of an insider, both in terms of receiving my health care from Kaiser Permanente, being a provider of health care at KP, and being an integral part of the Partnership between labor and management that has been growing in scope and power at KP since 1997.

I am a member of a coalition of 82,000 union members from six Internationals and 29 local unions who operate in partnership with 20,000 KP managers and 12,000 physicians at Kaiser. I participated in bargaining the second five-year National Agreement between KP and its union members in 2005; an agreement which supplements each union's local labor contract.

Kaiser Permanente and unions have a linked history. Back in the 1940s, Kaiser Permanente was built with help from unions who were dedicated to providing, for the first time in American history, affordable, quality health care for 30,000 workers building ships for the World War II. In fact, KP was so closely associated with the unions that in the 1950s, the American Medical Association was openly hostile to the organization.

Now there are 8.3 million Kaiser Permanente members. The majority of hospitals are located in Northern and Southern California but Kaiser also provides services in Colorado, Washington, Oregon, Georgia, Hawaii, Maryland, Virginia, Ohio, and Washington DC.

Kaiser is the only HMO health provider that maintains its own dedicated staff (members of the Permanente Medical Groups), its own hospitals and clinics, and its own health plan. There is no insurance paperwork to be completed by members. Plans are available for individuals, families, businesses, and Medicare recipients. Access online is available for instant insurance quotes, applications, location of services. Even non-members can access information on Mind & Body Health and Drug and Health Encyclopedias. Members can also make appointments, choose a physician, contact their primary care and specialty physicians, and refill prescriptions online.

The current goal of the Partnership per our National Agreement is to have even department at every hospital or clinic lead by a joint labor and management team. Who knows more about patient needs than front line staff? Solutions reached by labor and management teams do produce superior outcomes for patients and for employees. So far the Partnership has increased access time, raised patient satisfaction scores, reduced costly staff turnover, reduced workplace injuries (and thereby, the overall cost of healthcare for the consumer), and designed more efficient operations (even entire hospitals).

The Partnership has also led the battle for provision of universal health care for all citizens. Countries, like Britain, with socialized medicine models have come to Kaiser to see how they might improve the quality and efficiency of their own health care operations.

Jeffrey Pfeffer, in his new book, What Were They Thinking? Unconventional Wisdom About Management, reports that the positive outcome of unionization can be most clearly seen in health care delivery. He cites a 2004 study of deaths from heart attacks in 344 acute-care hospitals in California. Facilities with unionized nurses had a 5.5% lower mortality rate than non-union hospitals. He attributed this outcome to the increased level of joint decision making leading to better patient care. In the same study, the gain disappears when there are adversarial relationships between the unions and management.

Pfeffer cites Kaiser Permanente, Southwest Airlines, and the former Cingular Wireless as models of positive workplace relations. Following years of labor strife in the 1980s and '90s, he notes, "the Labor Management Partnership has helped KP improve member and employee satisfaction, reduce workplace injuries in many units, and achieve operational savings of more than $100 million."

Maintaining the Partnership requires constant work and vigilance. Those of us on the labor side are doing our part to encourage and train our members to be partners with management. Managers are doing their part to accept a new form of leadership.

The winners are neither labor nor management but the members or patients themselves because the only common goal of both labor and management can be the improvement of patient care.

The non-member public knows about Kaiser Permanente primarily through their THRIVE campaign. But beneath the snappy advertising is a labor force that has worked very hard to make Kaiser not only the best place to work but the best place to receive health care.

It is interesting to note that Kaiser, along with many other health care organizations, got dinged by Michael Moore in his latest film SICKO. The incidents he portrays were true and very regrettable. The only thing that I can say as an employee of the organization is that mistakes are not covered up but quickly recognized and addressed.