Why we need to succeed

As of December 2011 there were 1,000 high-performing teams

For Kaiser Permanente and the Coalition of Kaiser Permanente Unions, 2011 ended on a high note: We substantially surpassed our goal for achieving high-performing unit-based teams. The National Agreement charged all of us with the achievement of 658 high-performing teams (level 4-5) based on the Path to Performance standards established in the Agreement. As of late December we had some 1,000 high-performing teams in place! While we still have a long way to go, and our success exists with some variation across the program, it is safe to say that we’re being true to our goal of transforming Kaiser Permanente to transform health care in the U.S.

It is also very important to take stock of just how important this work is.

We are engaged in work that is virtually unique in the world: progressive, labor-management improvement work in the world today is defined by the concept of deep collaboration in a few places, such as in Scandinavia, Germany and Brazil. In other places across Europe, collective bargaining is evolving into what is called “social dialogue” requiring that workers, employers and government must have equal responsibility at the table of economic and social planning.  But you have to look far and wide for unions and management that are succeeding at this. I have had the opportunity to meet union and management leaders in United Kingdom, Ireland, Australia, the Netherlands, Spain and India, and I can tell you that their attempts at true labor-management collaboration have been rocky to non-existent.

 Old-style labor relations

Over 100 years ago, Frederick Taylor applied “scientific” principles to production processes and workforce management. He designed the theory and practice of taking a production process and parceling it out to its most simple components. That simple, usually repetitive process was called a “job.”

Further, Taylor postulated that there were “thinkers” and “doers,” and that the two should never mix.

This industrial process came to be known as “Taylorism.”

So, while we find this approach to industrial engineering odious, the grim reality is that the labor movement and management around the world actually accepted this fundamental concept and have been battling with each other for more than a century over “jobs,” not over the production process itself; who owns it, who controls it and, most importantly, the value and sustainability of the goods or services that the process produces. Lost in this history is also an emphatic loss of the importance of the equitable distribution of wealth created from production.

The U.S. lost its industrial base over the last 40 years and with it most of its economic sustainability. Without good-paying jobs and the corporate and personal taxes that such an infrastructure creates, it is no wonder that everyone is in debt and we have deficit-spent our nation into crisis. It is not that helpful to spend another 40 years trying to figure out who was at fault for this disaster; rather, it is time to recognize that we must have a wholly new set of premises upon which to rebuild an economy based on social and economic justice for all!

The History of the Future

Think of what has happened to health care in the U.S. We know that a big part of the problem is profit and bad management; but the real driver of the high cost and low value of health care is that the fee-for-service delivery system does not work for the population as a whole. The delivery system must be redesigned for population outcomes, driven by evidence-based medicine, prevention, and decentralization of primary care services close to the neighborhoods where people live. Kaiser Permanente’s system is the largest delivery system in the U.S. designed to produce successful outcomes for the whole population. The pre-payment model ensures that there is no incentive to drive up the cost of care with unnecessary treatment; there is incentive to get more with less!

However, without a workforce that can really deliver high quality and affordability, the KP model could crash and burn, too. Our economic crisis and uncertain public policy future create a treacherous marketplace. We cannot afford to fail as a model of care, especially when we recognize that our model has also produced the best jobs in the industry. We have shown that collective bargaining works extremely well!

We are leading a redefinition of labor-management relations. It is very challenging! In larger measure, we are succeeding because the dedicated staff and physicians at the front lines of care delivery love it! And we are seeing more and more health care and public sector organizations, both from labor and from management, coming to us for help. The economic crisis has finally gotten some thoughtful leaders to question where they are going.

It remains extremely difficult for leaders to jointly lead on the basis of true value creation, but unless we do, the frontline role in the production process doesn’t change.

Yet we are doing it and we are being successful. As we begin a new year, it’s important to remember the impact we are all having for our members, our patients, ourselves, our communities. And in doing this work we’ve also become leaders in the national and international movement to transform health care, and create economic justice our country.