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. 

Caretia Silva, a licensed clinical social worker, is a labor improvement adviser with the Alliance of Health Care Unions in Portland, Oregon, and a member of OFNHP. As many nonclinical employees prepare to return to the office, she offered advice about ways to reduce stress related to the latest challenges of COVID-19.

Many employees will soon return to the office. What feelings might they experience?

For some folks, working from home has been wonderful; for others, it’s been very stressful. Many people were managing a lot of competing priorities with children at home, online schooling, sharing “office” space with partners at home and extended family concerns.

Some people may experience anxiety, grief, excitement, anticipation — and many other feelings as they encounter unknowns — with returning to the office. For folks who have already returned to the clinics, they’ve had a gradual reintroduction and the process has been slightly more paced, although it hasn’t been without stress.

What tips do you have for staff preparing to return to the office and send their children back into the classroom?

There are bound to be challenges as we work out new routines. Anything you can do the night before to prepare for the next day is a good idea — set out clothes, load backpacks, make lunches. It can also be beneficial to have a consistent and routine bedtime, not just for your children, but also for yourself. If you have trouble settling down at night, try the Calm app.

In the morning, set yourself up for success for the day by building in “transition time” — this is time to get people from the house to the car, including all the needed gear for the day. Building in transition time allows for any last-minute items and reduces the stress of being late. If you arrive early at school with the kids, take advantage of the one-on-one time with encouraging words to pump them up for their day. It only takes a few minutes to make a meaningful connection with your kids.

How can team members set each other up for success in the workplace?

Coming back to the office or clinic is a major change compared to working from home.

And some folks never left the clinic. Everyone had their own unique experience over the last year and a half. This transition will take some adjusting. Fatigue among workers may be common due to the increased social interaction. In the beginning, people may feel some nervous energy bouncing off each other as they acclimate to the new environment. It’s important to give people the time and space they may need to reacclimate to an in-person work environment.

How can unit-based team co-leads support their teams?

People will acclimate to the office environment at different times. When people seem fatigued, be aware that they might need some space.

Sometimes people need to take a break and disengage from the group. It’s a process that allows them to realign and center themselves. Have empathy for staff adjusting to this change.

How can unit-based teams use LMP tools to help them through this time?

The Partnership behaviors are a solid foundation for teams to ground themselves, and the Free to Speak tools are also good to foster a culture of trust and engagement. This might be a good time for a UBT to take another look at its ground rules and see if the rules need updating. Interest-based problem solving can also be useful for teams struggling with processes that have been adapted or need to change.

What advice do you have for managers during this transition?

The success I’ve seen with managers is when they are authentic with their staff and allow themselves to be seen. They don’t have to reveal personal secrets, but when anyone is sincere and approachable, there is more trust and engagement.

What else is important to consider?

The world has changed in ways we never saw coming. The pandemic was catastrophic and, on top of that, we also dealt with social justice issues and political unrest. It’s important to acknowledge how these and other challenges — such as financial insecurity and housing insecurity — have contributed to stress and anxiety for many people. Self-care is crucial now more than ever.

How do I recognize signs of stress?

If close friends, family or loved ones have mentioned that you seem different, consider what they are saying. Are you more emotional — quick to cry, jump to anger or experiencing mood swings? Have your eating or sleeping habits changed? Changes and impacts to your daily living habits are signs that stress may be affecting you. Reach out to the Employee Assistance Program, find exercise you enjoy, or check out emotional wellness apps like Calm or myStrength.