Change—why change, what to change, how to change—was the recurring constant at the annual Union Coalition Delegates conference held recently in San Jose.

The need for change was spelled out by a succession of top union and Kaiser Permanente leaders. How will Kaiser Permanente respond to the dramatic decline in access to health care in recent years? How will the organization and its union workers face the increasingly fierce competition in the marketplace? What is the best way transform KP and to transform US health care?

The big picture

Union Coalition Executive Director, John August, told delegates that the United States had moved from a nation that provides security for its people to one that forces them to assume risk around their economic wellbeing, their futures and their health. An estimated 50 million uninsured Americans assume this risk every day. So do the one-third of children in the US who have no health coverage.

August said the national debate misses the point. "The current debate tends to be about how much risk a person can take on. This is fundamentally wrong," he explained. "It must be about how we can provide security for all."

He pointed out that both Kaiser Permanente and the Union Coalition share the goal of universal health care, calling KP "the gold standard of comprehensive health care."

Sal Rosselli, President of SEIU United Healthcare Workers-West, agreed. He said the unions and Kaiser Permanente needed to join forces on health care reform.

"There's room for honest disagreement about what the new system should look like," Rosselli told the crowd. "But changes that shift the risks or costs of care evermore onto individual families—or that increase fragmentation or the perverse market incentives that limit access to care—are not good for people and not good for KP."

Serious concern

Meanwhile, many of KP's competitors, the delegates heard, are trying to knock Kaiser Permanente out of the running altogether. They offer employers incentives to eliminate their competition, including Kaiser Permanente—a strategy known as "total replacement" of health coverage. Those competitors would like to see the nation's largest integrated health care provider go bust.

The seriousness of the competitive threat was not lost on attendees.

"A lot of people at KP don't really know what the competition is doing to take away prospective members," noted Davis Rose, a medical technologist at Woodlawn Medical Center in Maryland and member of UFCW local 27. "There's a level of complacency."

Delegates were also supportive of Kaiser Permanente's response to the crisis in U.S. health care: compete by working in Partnership to offer better service and quality while staying affordable.

"KP is a great place to work and we have an opportunity in Partnership to influence the workplace to advocate for patient care," said Bruce Corkum, RN, OFNHP member and contract specialist in the Northwest Region. "But we need to change and innovate or competitors will roll over us."

Shaking things up

Bernard Tyson, Executive Vice President, Health Plan and Hospital Operations, told the delegates that continually improving quality and service were a top priority for both management and unions. He also emphasized that KP needs to stay affordable to effectively compete. He challenged union members and managers to use Partnership to work more efficiently and create $10 billion in savings by the end of the National Agreement in 2010.

"If you are not working on improving quality, service and/or affordability, you are working on the wrong agenda," Tyson said

Many of the 400 delegates who attended the April 20-22 conference say they are up to the challenge of guiding change in the workplace. They point out that health care workers are accustomed to adapting to dramatic changes.

"Medicine is changing rapidly," noted Anna Mulessa, an RN at Sunnyside Medical Center in the Northwest and OFNHP labor partner. "You can either change with it or change fields."

Her colleague Diane Terwilliger, an IV Technician and UFCW Local 555 steward, said she welcomes change. She described herself as a "surfer of changes," and said she meets with resistance at the frontlines only when there is a lack of information. Frontline workers need the full picture on why change is necessary, she explained.

Unit-based teams

Workshops at the conference focused on leading change, unit-based teams, attendance, performance improvement and workforce development. Information on how to use unit-based teams to bring about improvements in patient care and service was woven throughout the gathering.

"Unit-based teams are not a program," August told delegates. "They are nothing less than a platform of transformation."

Just how the transition to UBTs will work, however, was a question on the minds of many delegates.

"I hope to better understand what the company wants from UBTs and to hear a commitment across the board from my labor brothers and sisters that we all want to do it," said Mell Garcia, a lead UHW steward and medical assistant at the Hayward Medical Center.

She cautioned that demands on front liners need to stay clear and focused.

"Keep it simple," Garcia advised. "How are we going to tackle this? What results do we want, so that people can feel a sense of ownership and commitment?"