An out-of-whack schedule problem

The problem was obvious. Colorado's Telephonic Medicine Center was busiest at night and on the weekends. But most of the department's nurses were scheduled to work during the day, Monday through Friday.

The department's new manager, Sara Gray, quickly recognized that the schedule needed overhauling. But instead of making the shift changes herself, she asked a group of nurses to help.

The process of identifying the problem and a solution took just about six weeks. The nurses reselected their shifts in an afternoon. For such a sensitive issue, the process was remarkably smooth and quick.

How did they do it? For starters, both the nurses, who are members of UFCW Local 7, and Gray, were flexible. Gray's willingness to engage nurses in the search for a solution fostered a climate of trust. And within that climate, the nurses—even those with the most seniority—recognized that to meet their patients' and co-workers' needs, they would all have to work a weekend shift.

Gray said, "The staff was good about acknowledging that if they put their personal needs in front of the department needs, they and the rest of their colleagues were going to be unhappy at work."

That kind of flexibility is exactly what the 2005 National Agreement says promotes achievement and growth, both of which are necessary for KP's success.

Union and KP leaders agree they'd like to see more of it.

"Flexibility is one of the most underutilized clauses in the National Agreement," says Martin Gilbert MD, the associate executive director of operations strategy for the Permanente Federation.

He suggests that labor and management can be flexible by being willing to listen, consider and try new ideas.

"The safe place is to say 'no,' " Gilbert said. "But 'no' closes the door to transformation and opportunity."

John August, the executive director of the Union Coalition, speaking at the 2008 Union Delegates conference, said that incorporating flexibility into the workplace is crucial.

"We must...work diligently to enhance flexibility and labor contracts, and to willingly explore alternatives in our rules," August said. The 2005 National Agreement "doesn't say we're going to take our union contract and put it over here. It says we're going to find ways to be flexible. We all signed onto it."

At the Telephonic Medicine Center, the flexible approach had a direct benefit for KP members: In 2007, Gray said, patient callback times on the weekends dropped from 47 minutes to 11 minutes.

A few nurses didn't like the changes and left. But most of those who stayed think the new schedule is more equitable, said Janet Jackson RN.

Their contentment is reflected in the center's 2007 People Pulse Scores. The percentage of those participants who said the department usually had enough people to do their job right increased from 29 percent in 2006 to 65 percent.

"We are a more peaceful department as well as a more productive department," Jackson said.

Two departments into one

When the Service Partner position was eliminated at the Vallejo Medical Center (Northern California), Environmental Services absorbed the nearly 60 displaced workers.

For EVS management, the merger was a boon. It meant a larger housekeeping staff, greater flexibility in scheduling and less overtime. 

But some of the service partners—who, unlike housekeepers, cleaned patient rooms only—were worried it would be more difficult to get time off, said Darrel Bradshaw, the union co-lead of the team and an SEIU UHW-West steward. Others thought becoming a housekeeper was less prestigious than being a service partner.

"They felt like they were stepping back in life instead of going forward," Bradshaw said.

Negotiations were difficult and lasted nearly eight months—but in the end, they've paid off. From the management perspective, one list of employees is easier to manage than two. And having the larger pool of employees reduced 2007 EVS overtime costs by 2.5 percent compared with the year before, said Rick McBride, the EVS assistant manager.

Efforts are being made to address time-off concerns, and managers agreed to allow most workers to keep their current station assignments. There were other measures to balance things out. Some of the more senior service partners were allowed to continue cleaning patient rooms only, EVS Manager Brenda Robertson said.

Meanwhile, because there are more housekeeping shifts, the rest of the former service partners have more opportunities to increase their working hours—which can be hard to come by for newer employees.

We must...work diligently to enhance flexibility and labor contracts, and to willingly explore alternatives in our rules.

John August, executive director, Coalition of Kaiser Permanente Unions

Reducing sonographers' injuries—and increasing job satisfaction

It wasn't an easy process, but sonographers in Colorado got crucial changes instituted that improved working conditions—changes that management agrees are worth their cost.

Sonographers are at high risk of suffering a workplace injury: Statistics show that an estimated 80 percent of sonographers are likely to be injured during their careers. The Colorado sonographers, wanting to reduce that risk, asked management to reduce the number of patients they see each day.

A 14-month issue resolution process resulted in several changes. Management agreed to eliminate one patient slot per day, giving sonographers, who are represented by SEIU Local 105, a little more flexibility and control over their schedules.

The cost of seeing one less patient a day is offset some by having increased patient access through the department's extended hours. Instead of everyone working the same shift, one sonographer now comes in earlier than the rest and one stays later.

The department also added 15 minutes to each obstetric ultrasound appointment, in response to the sonographers' concerns that patients often felt rushed. In addition, a new supervisory position was created to manage scheduling and proper ergonomics.

The changes, sonographer Sue Cameron said, have made Kaiser Permanente a safer, more desirable place to work.

"Word is getting out...Kaiser is a place that cares about employees," Cameron said.

Initially, workplace injuries within the whole department went down, said Traci Parker, regional ultrasound manager. But recently two sonographers suffered elbow injuries, she said, prompting management to look at retraining employees in proper ergonomics.

The changes didn't come without a cost, said Radiology Manager Steve Mattson. The ergonomics consultants' fees were more than $10,000 and the new ergonomically sound equipment was $5,000 more, he said.

"It's a proactive approach," Mattson said. While some regions might not be able to afford what Colorado has done, the sonographers "feel more like they have control over their schedule, more autonomy."

The changes have "brought goodwill and harmony to the workplace and a more engaged workforce," Mattson said—a benefit that's hard to quantify.