Partnership has given Kaiser Permanente a competitive advantage that other health care organizations don't have, because partnership is designed to achieve the other "p-word": performance.

With partnership, performance isn't just a management concern. The quality of the total patient experience is determined by performance and innovation.

"We (union members) are Kaiser Permanente, and performance—which only means quality, service and affordability—are our issues!" says union leader Sal Rosselli.

To secure KP's future, it is vital that employees, physicians, unions and management unify their efforts and work together with a consistent, coherent operating strategy.

KP's mission

The Value Compass expresses that strategy. It is a visual reminder of Kaiser Permanente's mission—to provide affordable, high-quality health care to our members and the communities we serve—but it is more than that, too. The center of the compass provides a road map for how we achieve those goals.

By placing the member and patient at the center of everything we do, the Value Compass becomes a tool for decision making and problem solving. 

"The image is a powerful reminder, especially for group decision making," said Paul Staley, the Colorado region's management co-lead for UBTs. "The focus is not on what labor wants, not on what management wants, but—what's good for the patient?"

Guide for performance improvement

By establishing priorities, the Value Compass provides direction for the performance improvement efforts of hundreds of unit-based teams in every region.

Unit-based teams "must have clarity of direction around their focus and their goals," said Dan Ryan, the Union Coalition's national coordinator for Colorado and labor co-lead for UBTs. Small teams need to be aligned with their department's goals, and the department's goals needs to be aligned with KP's regional and national goals.

The teams also keep a focus on metrics: Achieving top quality in ways that can be measured will allow us to share best practices and get even better.

In Colorado, the regional pharmacy's UBT identified a performance shortfall that was slowing service to members. A year ago, technicians spent one to four hours per day per pharmacy tracking down prescriptions that lacked the necessary electronic stamp from a pharmacist. Using the "plan, do, study, act" improvement process, the team developed new methods that have cut the number of orders requiring research by 75 percent.

Redirect resources

The changes "allowed us to redirect our resources for more direct patient service and care," said Luanne Petricich, management co-lead. "It helped the staff not have redundant work that didn't add value."

Such improvements, multiplied thousands of times across KP, amount to a transformation of how all of us at KP work.

"Transformation, to me, means 'Be the change you want to see in the world'—what Gandhi said," said Alicia Moore, department secretary in Facility Operations at Oakland Medical Center and an OPEIU Local 29 steward. "Be someone who wants good outcomes and communication and transparency and trust—be that person and you will get it right back from others."

The focus is not on what labor wants, not on what management wants, but—what's good for the patient?

Paul Staley, Colorado UBT co-lead

Perspective on work

All of us at KP, whatever our position, are learning to think about our jobs differently. We are learning to:

• Remind ourselves every day that we have two primary responsibilities—to do our work well and to figure out how to do our work better.
• Gain new skills in critical thinking, rapid improvement methods, learning while doing and problem solving.
• Engage all team members in problem solving and decision making and always put our patients' and members' needs first.
• Provide a positive experience for every patient and member we serve every day.

By the end of 2010, all of us will be working in high-performing unit-based teams. UBTs will engage the skills, knowledge and experience of every employee, manager, physician and other care providers. Even employees not represented by a coalition union will be working in and with unit-based teams.

In the end, transformation will bring us full circle, reminding us of our common purpose and our roots: To be part of something larger than ourselves, to provide quality care in a mission-driven, nonprofit organization—to act on the Value Compass.

"It's not about me or the budget or getting to lunch on time. It's about the patients," said Mynell Harper RN, the nurse manager for the 3 North unit at Sunnyside Medical Center (Northwest). "When there's resistance, now I say, 'What's best for the patient?'—because people can't argue with that."