Healing Together

Healing Together: The Labor-Management Partnership at Kaiser Permanente

Thomas A. Kochan
Adrienne E. Eaton
Robert B. McKersie
Paul S. Adler
Copyright Date: 2009
Edition: 1
Published by: Cornell University Press,
Pages: 272
https://www.jstor.org/stable/10.7591/j.ctt7zfxf
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  • Book Info
    Healing Together
    Book Description:

    Kaiser Permanente is the largest managed care organization in the country. It also happens to have the largest and most complex labor-management partnership ever created in the United States. This book tells the story of that partnership-how it started, how it grew, who made it happen, and the lessons to be learned from its successes and complications. With twenty-seven unions and an organization as complex as 8.6-million-member Kaiser Permanente, establishing the partnership was not a simple task and maintaining it has proven to be extraordinarily challenging.

    Thomas A. Kochan, Adrienne E. Eaton, Robert B. McKersie, and Paul S. Adler are among a team of researchers who have been tracking the evolution of the partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions ever since 2001. They review the history of health care labor relations and present a profile of Kaiser Permanente as it has developed over the years. They then delve into the partnership, discussing its achievements and struggles, including the negotiation of the most innovative collective bargaining agreements in the history of American labor relations. Healing Together concludes with an assessment of the Kaiser partnership's effect on the larger health care system and its implications for labor-management relations in other industries.

    eISBN: 978-0-8014-5936-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-xiv)
  4. CHAPTER 1 To Fight or Talk?
    (pp. 1-7)

    The union leaders came prepared for a fight on that cold December day in 1995. They represented a coalition of twenty-seven unions and 55,000 workers employed by health care giant Kaiser Permanente (KP), the nation’s leading not-for-profit health maintenance organization. Both sides faced enormous pressures—and an enormous choice.

    At the time, Kaiser was losing more than $250 million and was being advised by a management consultant to break itself up and to take steps to better match the cost structures of competing HMOs. But if he followed such advice, Kaiser’s CEO Dr. David Lawrence would be abandoning Kaiser’s historic...

  5. CHAPTER 2 Partnerships: Great Challenges, Greater Opportunities
    (pp. 8-24)

    The issues that engaged Peter diCicco and David Lawrence in 1995 in Dallas were symptomatic—then and now—of a crossroad facing U.S. labor-management relations. To put it bluntly, the nation’s labor law is broken.¹ Workers who want to join a union face enormous hurdles. Relations between labor and management have become increasingly adversarial, less innovative, and less responsive to what workers want not only from their jobs, but from their unions and employers as well.²

    When the Kaiser partnership effort began, relations between Kaiser and its unions were at a low point. Workers felt devalued and angry. Management faced...

  6. CHAPTER 3 To Fight or Partner: Forming the Partnership
    (pp. 25-49)

    Against such an uneven history of labor-management partnership success and with federal labor law increasingly working against organized labor, establishing a labor-management partnership between a coalition of twenty-seven unions and an organization as complex as 8.6 million-member Kaiser Permanente (KP) was no easy task. This was especially so because the choice to partner rather than to fight was made in an environment of growing anger and frustration among Kaiser’s workers, increasing competitive pressures on health care insurers and providers, and rising concerns about the quality of care of health maintenance organizations in general and Kaiser in particular.

    That the partnership...

  7. CHAPTER 4 Early Challenges, Early Wins—But More to Do
    (pp. 50-64)

    The structure—and hopes—for the Kaiser Labor-Management Partnership (LMP) were now in place. Now the challenge was to convert promise into measurable progress. That challenge was complicated by the financial pressures on Kaiser, which lost more than $250 million in 1997 and again in 1998. As Kaiser began a process of retrenchment, resources became scarce for implementation of the partnership. Further complicating the picture was the structure of Kaiser, which had a strong, ongoing tradition of decentralized management and regional autonomy. Layered on top of that was the institutional independence of the Permanente Medical Groups relative to the Hospital/Health...

  8. CHAPTER 5 Slow Diffusion
    (pp. 65-86)

    Given some early successes such as Baldwin Park, the partnership began to face perhaps inevitable growing pains. Despite strong support from top management as well as physician and union leaders, the partnership did not diffuse smoothly or widely throughout the decentralized Kaiser regions or operations over the first decade of its existence. Nor did the parties have great success in transforming the image and identity of the partnership from an effort to improve labor relations and to engage in labor-management problem solving to one in which partnership principles and processes became an integral part of health care delivery at Kaiser....

  9. CHAPTER 6 Negotiating in Partnership: The 2000 and 2005 National Negotiations
    (pp. 87-122)

    A major question facing labor and management is the relationship between a partnership and their collective bargaining processes. Do contract negotiations proceed as usual? Do partnership activities go into some sort of holding pattern? Do the parties go to the other extreme and find that formal contract renegotiations are no longer needed? In short, how do these two different processes co-exist and influence each other?

    We consider such questions by analyzing the parties’ experiences and the new ground they broke in negotiating two national labor agreements during the first decade of the Kaiser partnership’s existence. Their experience provides a clearer...

  10. CHAPTER 7 The Union Coalition
    (pp. 123-149)

    Ten years after its founding, the Kaiser union coalition was still together. It weathered countless internal debates over policy and structure; three rounds of bargaining in which internal negotiations were nearly as intense as negotiations across the table with Kaiser management; a break-up of the national federation (AFL-CIO) that left coalition member unions on both sides of the split; and a transition in leadership.

    If, as a large body of theory and historical experience suggests, coalitions are inherently unstable, then the fact that the Coalition of Kaiser Permanente Unions survived for at least a decade is in itself noteworthy. Although...

  11. CHAPTER 8 Leading in Partnership
    (pp. 150-174)

    To make this learning laboratory, and thus the partnership itself, succeed would require not just any, but a special kind of leadership. This chapter examines what it takes to lead a partnership—and what leading in partnership at Kaiser Permanente (KP) suggests about the type of leadership needed in modern, decentralized, and networked organizations, particularly in a health care setting.

    The very phrase, “leading in partnership,” may sound like an oxymoron as most people equate leadership with characteristics, behaviors, and actions of individuals. Isn’t leadership the job of the CEO in an organization? Indeed, for more than a decade, countless...

  12. CHAPTER 9 Partnership and HealthConnect
    (pp. 175-190)

    George Halvorson saw an opportunity to lead the nation in electronic health records (EHR) technologies when he joined Kaiser Permanente (KP) as CEO in 2002. In Epidemic of Care, a book he co-authored with George J. Isham, Halvorson wrote, “Real improvement in the quality and consistency of care will require the use of automated medical records that give doctors and patients full information about care and care systems right in the exam room. Every other profession makes use of computers to perform these kinds of services. Medicine will soon follow.” Halvorson would become the leading champion for moving aggressively to...

  13. CHAPTER 10 Partnerships on the Front Lines
    (pp. 191-202)

    If strong and creative leadership was essential to the success of the partnership, so too was the involvement of front-line workers. That engagement was especially important in achieving the first two goals in the list of partnership objectives: to improve the quality of health care for Kaiser members and communities; and to help Kaiser achieve and maintain market-leading, competitive performance.

    Such goals reflected the partnership’s original vision, which was not only to realize peace on the labor relations front but also to serve as a vehicle for improving the quality and efficiency of health care and organizational performance. Realizing this...

  14. CHAPTER 11 Scorecard
    (pp. 203-226)

    From the start, partnership leaders have sought to build measurement and evaluation into the effort. Indeed, one of the first committees formed in 1997 was the metrics committee; in 2008, resources continued to be dedicated to substantive, quantitative evaluation of the partnership.¹ In this chapter we present the best data available within and across regions to assess progress to date in some of the major indicators related to goals established in the 1997 partnership agreement. None of these measures are available in a useful way for the time period prior to the creation of the partnership and, for the most...

  15. CHAPTER 12 Partnerships: The Future
    (pp. 227-240)

    As we write this the United States once again appears to be on the brink of trying to address the crises in both labor relations and health care that we used to motivate this study in chapter 2. Thus, it is fitting to use this final chapter to first summarize what we have learned from our study of the largest and most complex labor-management partnership in U.S. history and then to draw out implications for the coming debates over labor policy and health care reform.

    The hardest question to answer is what would have happened at Kaiser if the partnership...

  16. Notes
    (pp. 241-248)
  17. Index
    (pp. 249-258)