In 2018, the Alliance of Health Care Unions reached Labor Management Partnership Agreement with Kaiser Permanente.

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When Henry J. Kaiser and Dr. Sidney Garfield created a health plan for Kaiser’s shipyard and construction workers in the 1930s and ’40s, they laid the foundation for Kaiser Permanente.

From an initial customer base consisting almost entirely of union members, Kaiser Permanente grew to be the largest nonprofit health plan in the country, serving a wide range of members. Today, the Labor Management Partnership, an innovative relationship among Kaiser Permanente managers, workers and physicians, is the largest and most comprehensive partnership of its kind.

The Labor Management Partnership started in 1997, emerging from mounting strife between Kaiser Permanente and its unions that threatened to derail the organization. Instead of continuing a traditional approach and launching a campaign against KP that ultimately could damage the organization—and the workers it employed—the Coalition of Kaiser Permanente Unions approached KP leaders with an idea for how to do things differently.

Today, the 1997 agreement continues as the guiding document between KP and the Coalition unions. In 2018, after the Alliance of Health Care Unions formed, a new 2018 Labor Management Partnership Agreement was reached between KP and the Alliance unions. Under these partnership agreements, the parties agree to work collaboratively to improve the quality of care for Kaiser Permanente's members and communities and help KP lead the market in health care — while providing job security and the best place to work for its employees.

Working in collaboration

On a day-to-day basis, partnership means that workers, managers and physicians share decision making and problem solving by staying grounded in their common interests. Employees, managers and physicians work in unit-based teams — collaborative work groups that, in the course of their ongoing work, improve quality and service and make KP more affordable. Partnership is credited not only with improving patient care and satisfaction, but in making Kaiser Permanente a better place to work by giving employees a voice on the job. 

Over the years, the parties have worked together on such policy issues as nurse-to-patient staffing ratios and health care reform and ratified groundbreaking accords such as the Employment and Income Security Agreement. Perhaps the most ambitious endeavor was the 2005 launch of 3,500 unit-based teams that work on improving care, service and affordability every day. Together, Kaiser Permanente and the unions have bargained a series of groundbreaking National Agreements, including the ones in force today with the Coalition of Kaiser Permanente Unions and the Alliance of Health Care Unions. All used an interest-based approach.

As we move toward the “next normal,” the Labor Management Partnership has played a key part in supporting COVID-19 vaccinations.

Frontline workers, doctors and managers have come together to get shots in arms. These fruitful collaborations point the way forward as Kaiser Permanente and the Partnership unions work to transform fear into confidence, confusion into clarity, and hesitancy into bold action.

Look at the data

A joint effort between SEIU-UHW and physicians pushed vaccination rates of the union’s members from less than 50% all the way up to 64% within 3 months. It began when union leaders crunched the numbers — and didn’t like what they saw.

At the beginning of February, less than half of SEIU-UHW members at Kaiser Permanente were vaccinated against COVID-19. For instance, only 40% of union employees were vaccinated in the Emergency Department at Downey Medical Center in Southern California, where Gabriel Montoya works as an emergency medical technician.

Montoya and his fellow union members — working with physicians and managers — wanted to raise those rates, so they pulled together labor-doctor huddles. Union members were scared, confused and hesitant.

Building trust

At first, they considered joint physician-labor rounding. But they realized being in patient areas wouldn’t support those conversations, so they pivoted to huddles — short, informal team meetings.

Carol Ishimatsu, MD, a pediatrician with the Southern California Permanente Medical Group, was one of the first doctors to join a huddle in Downey.

“Vaccines are our most important intervention,” says Dr. Ishimatsu, who participated in the clinical trials for the shots when they were being tested.

To build trust, Dr. Ishimatsu emphasized her shared experience with SEIU-UHW members as warriors on the front line. “I told the employees: I do the same thing you do after work,” she says, describing her ritual of removing her clothes in the garage and putting them directly in the washing machine before entering the house. “We are in different professions, doing the same thing.”

Joel Valenciano, an Environmental Services manager at Downey, helped organize huddles at outlying clinics.

“I encouraged the staff to be honest, relate their fears and doubts, anything holding them back,” he says. “And they really opened up.”

“We did it in partnership,” says Montoya, the emergency medical technician. “The labor partners led the huddles and introduced the doctors.

I can’t imagine that happening in a nonunion hospital, or even a non-Partnership hospital.”

Our 2012 National Agreement established the conditions for creating the healthiest workforce in the industry.

One of the key innovations in the 2012 National Agreement is the Total Health Incentive Plan, a voluntary program that rewards employees for collective participation in confidential health screenings and improvements.