Although a lot is changing, many things are staying the same. For management, the duty to manage is still a key component of the job, which includes performance management, hiring and firing authority, and ensuring safe working conditions. Physician sponsors and leaders retain ultimate responsibility for clinical decision making. Union leaders retain the responsibility to represent. In other words—you retain the responsibilities of your role while working in a more collaborative way to solve problems.
What does that look like in action?
Management, physician and union leaders are jointly responsible for:
- Making sure employees provide a superior health care experience for health plan members.
- Success of the department.
- Success of Kaiser Permanente and the unions.
- Involving employees in effective decision making.
- Supporting the Partnership.
- Securing LMP and UBT training for employees.
- Establishing effective labor-management relations.
But each retains constituency-specific responsibilities, including those that follow.
Union leaders and stewards retain:
- Duty of fair representation.
- Grievance filing/handling.
- Contract enforcement/negotiation.
- Building solidarity within the union.
- Ultimate accountability for clinical decision making in the care of member/patients.
- Clinical supervision of allied health personnel.
- Responsibility for clinical quality.
- Personnel responsibilities, including final authority for hiring and firing.
- Performance management, such as setting goals, conducting reviews, giving rewards, overseeing development.
- Responsibility for a safe work environment.
Given the Case for Change, we know Kaiser Permanente has to move quickly to achieve its goals. We want to be the model for health care in the United States. To accomplish this, labor, management and physicians must collectively examine their behaviors and attitudes and refocus energy on the member.
All three constituencies will have to give up stereotypes about the other entities, as well as their own—and understand that everyone needs to change for us to be successful. If everyone changes a little, we all change a lot.
Joint decision making means joint accountability for labor, management and physicians.
To make joint decision making a reality, traditional mindsets will have to shift:
- Physicians will have to acknowledge that union members are well positioned to identify system problems and waste and create viable, sustainable solutions. Each member of the team contributes to the total member/patient experience. Physicians must hold themselves and each other accountable for top performance to ensure the viability of KP.
- Labor will have to acknowledge that physicians are ultimately accountable for clinical care and all employees must work upward within their scope of practice. Union members' role is to support the physician/patient plan, contributing to the best possible outcomes for patients/members.
- Management will have to acknowledge that management must be part of the team, coaching and empowering to achieve a balance between process, relationships and results. In order for labor to be a credible contributor, managers must be transparent with information and encourage participation in areas that are new to labor.