DECEMBER 2005JUNE 2006

In This Issue:

Billing Turnaround

Many Hands, One Voice

Got iPod?

And more...

Does thisagreement have muscle?

FRONTLINE NEWS FOR KP WORKERS,MANAGERS AND PHYSICIANS

Hank has added “award-winning” toits description, as the InternationalAssociation of BusinessCommunicators has honored Hankwith its annual Gold Quill award ofexcellence.

Hank, the magazine of the LaborManagement Partnership at KP,received one of only five highesthonors in the Publications categoryof the Gold Quill awards from IABC,a global network serving more than13,500 members in 67 countries and10,000 organizations. Only 56 GoldQuills were awarded out of 1,175entries submitted worldwide.

Hank was one of two Gold Quillsthat KP won this year. KP won asecond Gold Quill for its 2004 annu-al report, “Health is Not OurIndustry, It’s Our Cause,” which wasreleased in spring 2005.

Entries are judged by stringent crite-ria that consider strategic alignmentand tangible outcomes as key meas-ures of excellence. Winning entrieswent through two rigorous rounds ofjudging by a team of top seniorcommunicators globally. The finalselection was made by the BlueRibbon Gold Quill judging panel thatincluded 30 communication expertsfrom the Philippines, Canada,Switzerland, United States, Sloveniaand Mexico. Hank was recognizedfor demonstrating “world-class stan-dards in strategic communication.”

“Hank tells it like it is,” added MikeDowling, OLMP communicationspractice leader. “This award is a trib-ute to our outstanding LMP communi-cations staff, and to all the people inKP who contribute their diverse sto-ries and opinions.”

Kaiser Permanente has beennamed a co-winner of this year’s

prestigious Labor-ManagementAward from the AFL-CIO.

The award, given by the AFL-CIO’sUnion Label & Service Tradesdepartment, recognizes employerswho demonstrate commitment tocollective bargaining and to produc-ing competitive, quality union-madeproducts or services.

KP received the award at the AFL-CIO’s “America at Work” show(http://www.americaatwork2006.com/index.html), which was held May 5-7 in Cleveland, Ohio. KP had anexhibit booth at the show, whichhighlighted union-made products,services, and jobs. Past shows havedrawn more than 200,000 attendees

interested in learning more aboutunion companies and products.

AFL-CIO affiliated national or inter-national unions nominate employersfor the annual Labor-ManagementAward. KP was nominated by notone but three Coalition unions:

n Michael Goodwin, president,Office and Professional EmployeesInternational Union.

n Gerald McEntee, president,American Federation of State,County and Municipal Employees.

n Edward J. McElroy, president,American Federation of Teachers.

In addition to an exhibit booth, KPhad a health screening booth at theshow that was staffed by registerednurses from OPEIU and the OhioNurses Association.

KP Wins AFL-CIO’s Labor Management Award

Just the FactsAbout HankWhat: An award-winning jour-

nal dedicated to telling our sto-

ries, reflecting our diversity of

opinion, saluting our successes

and helping us learn from our

failures, and telling it like it

is—because momentary pain is

worth the long-term gain.

For Whom: The 120,000 work-

ers, managers, physicians, and

dentists involved in the Labor

Management Partnership

across KP.

Where: At KP’s 400-plus work-

places.

When: Six times a year.

Why: Because we all agree on

one thing—we are making KP

the best place to receive care,

and the best place to work.

And because our namesake,

Henry J. Kaiser, had that in

mind from the very beginning.

Winner of the 2006 IABC Gold

Quill for international excel-

lence in communications.

Published by Kaiser Permanente& Coalition of Kaiser

Permanente Unions, AFL-CIO

Communications DirectorsMaureen Anderson and

Michael Dowling

StaffPatty Allison, Janet Coffman,

Paul Cohen, Jennifer Gladwell,Vince Golla, Kyra Kitlowski, Julie Light, Chris Ponsano,

Neal Sacharow, Gwen E. Scott

Graphic Design: Design Action CollectiveCover Photo: Scott Braley

Hank Wins PrestigiousInternational Gold Quill Award

Contents

3 No Pain, No GainSo Far, National Agreement

Work is Real—Yet Not Real

Quick.

6 Catch Me if You CanA Steward Reflects on

Her Busy Day.

8 Many Hands, One VoiceSpirited Delegates’ Conference

Highlights Organizing,

Leadership.

10 Lemonade Out of LemonsA Partnership Response to

Big Trouble.

Hank Survey Says:

10 of You areWinners!

Thank you to the2,500-plus readerswho responded tothe Hank/ProgramOfficesCommunicationsand ExternalRelations survey inthe March 2006 edi-tion of Hank. Wewill present the sur-vey results in ournext edition.

Ten of you, drawnat random, have won our surveyenticement prizes: Five iPod Nanos,and five $100 Amazon.com giftcards. Congratulations!

And the winners are:

Winners of an iPod Nano: ElliottGonzalez, Zion (SCAL); AlonnaMontgomery, Stockton (NCAL);Lena Yee, Santa Clara (NCAL); ChiD. Tu, Dental Lab (Northwest),Cheryl Shemanski, Zion (SCAL).

Winners of a $100 Amazon.com giftcard: Brenda Perdue, South Bay(SCAL); Loa Prophet, SouthSacramento (NCAL); AlexHernandez, Redwood City (NCAL);Pat Hernandez (NCAL), and TracyGuess, Roseville (NCAL).

2 | HANK JUNE 2006

JUNE 2006 HANK | 3

It is happening.

It is not happening quickly.

Yes, that really is part of the plan.

Yes, there is a plan.

And yes—oh yes—we are reallydoing it differently this time.

No Pain, No GainSo Far, National Agreement Work is Real—Yet Not Real Quick

“It” is implementing the 2005National Agreement for the 130,000-plus employees, managers, andphysicians covered by the LaborManagement Partnership. The severalhundred employees toiling to makethe National Agreement real havehundreds of challenges ahead. Nearthe top of the list: Convincing folksat the front line that it is happening.

After all, cynics need only point toone thing: As of July 1, 15 percent ofthe time covered by the five-yearNational Agreement will have passed.While the two things that 86,000employees probably find most tangi-ble—improved wages and benefits—are already in force, and while somekey elements (such as the attendanceprogram in Southern California) have

been launched, many things in theNational Agreement exist only on thepaper it’s printed upon.

“I think some of the cynicism at thefront line has existed since (thePartnership) began,” said WillClayton, administrative vice presidentfor SEIU United Healthcare Workers-West. “People say, ‘I just want to seesomething, to feel something.’ Wejust have to show the workers thatwe are on the road (to implementa-tion) and we are moving forward.

“We’re further along than we werein 2000—because we never did any-thing like this then,” he adds. “Am Isatisfied with where we are? Ofcourse not. But I think that it isprogress.”

Converting Agreement to Action

The trick of course is showing peo-ple what “this” is: The enormous,programwide effort that 250 employ-ees, managers, physicians, and UnionCoalition staff kicked off in March toconvert agreement—not just imple-menting a plan, but establishing thePartnership as KP’s operating strate-gy—to action in the coming monthsand years.

How enormous? Whenthose 250 people leftSan Francisco aftera three-day work-ing sessionMarch 21-23,they left behind16 draft workplans thataddressed 146deliverablesspelled out in theNational Agreementthat must be plannedand executed. These arereal projects, planned by real peo-ple, who—because they also havetheir day jobs to do—are really busy.

Those Implementation Action Teammembers identified many of thecomplex issues that will beaddressed across KP to effectivelyimplement the National Agreement— for instance, the launch of unit-based teams, a key building blockfor the Partnership. The teams willalso address the roll-out of the newAttendance program, the details oftwo workforce development trusts,

the logistics of budgeting and back-fill, performance improvement, anda host of other issues.

As the Action Teams developdetailed work plans, KP and UnionCoalition leaders have mapped out aplan for what gets done when, tak-ing into account regional priorities.Based on factors such as whether aninitiative is critical to the work ofother Action Teams, or whether an

initiative has specific dead-lines imposed by the

National Agreement,or an initiative’s

measurablereturn on invest-ment, the workof some teamsmay get a jumpstart.

That all soundsinteresting, and

promising…andyet so bureaucratic.

Why is this differentthan the unevenly imple-

mented 2000 National Agreement?

Bulging Biceps Ahead Many union and management lead-ers acknowledge that the 2000National Agreement wasn’t fullyimplemented. What’s different thistime, they say, is that this agreementhas “muscle”—in the form of theKaiser Foundation HealthPlan/Hospitals’ Boards ofDirectors—and that muscle hasalready put a mighty grip on themanagement, Union Coalition, and

medical group executives who haveto report their progress at everyboard meeting.

Here’s how it works:

n The Implementation ActionTeams—frontline workers andmanagers, many of whom wereinvolved in National Bargaining—were responsible for coming upwith detailed work plans and pre-senting them to their leaders byJune 1. Those plans must includetimelines, benchmarks, and metrics.

n A project management office coor-dinates the effort and maintains apainstakingly detailed “dashboard”showing which initiatives are ontrack, and which are fallingbehind. A “green” project is ontrack. A “red” project is not—andstands out like a sore thumb.

n The LMP Strategy Group—a teamof the top 30 union, management,and physician leaders across KP—will review and approve thosework plans in July. Five strategygroup members comprise theCommon Issues Action Team,which directly oversees imple-mentation and reports to theStrategy Group and the KFHP/Hdirectors.

That gives this implementation the“muscle” that the 2000 effort neverhad. Others prefer to refer to theprocess with the A-word:Accountability.

“I heard the A-word many times(during National Bargaining),”Clayton says.

I see this implementation process asa big, big part of the A-word. TheAction Teams, the Action Plans, thedashboard—all of those will all helpwith accountability.”

By muscle, or accountability, or byany other name, the ImplementationAction Teams who met in Marchexpressed eagerness to finally dosome hands-on work, but also anoverwhelming sense of how muchof a workout they have in store.

Failure Is Not An Option“We have a heck of a lot of work todo. I feel a little bit of anxiety; thereare some pretty aggressive timelineswe have to follow,” said KathyPetersen, Northern California laborliaison and the Union Coalition co-lead for the Staffing, Budgeting andBackfill Team. “But it’s not anoption to not get it done.”

There’s certainly the commitment toget it done, says Catherine Futch,regional compliance officer inGeorgia and a member of the Scopeof Practice team. “It’s early to sayafter just one meeting but there’s a lotof energy in our team and across allthe teams as a whole, and I expectthat to carry over,” she says. “I’m verycomfortable that we will achieve whatwe need to achieve—there’s no rea-son to think we wouldn’t.”

The trick, notes Cesar Villalpando,management co-lead of the staffingteam and executive director of CareManagement in Southern California,is to get it done within an organiza-tion of KP’s size and complexity.

“There’s a tremendous level of com-plexity to our organization and weneed to be thoughtful and practicalin our work to get through the manylayers and layers of the tens of thou-

4 | HANK JUNE 2006

Implementation progress is measured in a“dashboard”—green is good, yellow warnsof issues, red gets prompt attention.

“I’m very comfortable thatwe will achievewhat we need to

achieve—there’s noreason to think we

wouldn’t.”

Rose Cohan facilitates the Joint Marketingteam's work at the March 21-23 ActionTeam launch.

PHOTO: SCOTT BRAILEY

JUNE 2006 HANK | 5

sands of people without losing theintent,” he said.

One troublesome byproduct of allthat work, though, is that frontlineemployees and managers hearthere’s work going on—but theydon’t see it happening.

Outgoing Union Coalition ExecutiveDirector Peter diCicco addressed justthat impatience when he addressedthe Implementation Action Teams inMarch.

“If there is anything we’ve learned inall the experience we’ve had, both inthe Partnership and otherwise, it’s totake the time to do the fundamentalwork upfront,” he said. “If we do thatright, not only do we do it better, butwe have better outcomes and we doit faster in the end.”

Frontline employees and managersinvolved in National Bargaining lastyear apparently are aware of thegreat challenge—both to implementthe National Agreement and toassure colleagues that it’s happening.An impromptu email survey of allBargaining Task Group and CommonIssues Committee members fromNational Bargaining 2005 illustratedthis pretty clearly. About 20 percentof the 350-plus BTG and CIC mem-bers responded, among them front-line workers and managers, andPermanente Medical Group employ-ees. Among the results:

n 46 percent thought we’d be fartheralong in implementing theNational Agreement than we aretoday; 41 percent said we’d beexactly where we are, and only 3percent thought we’re fartheralong than they expected at theend of National Bargaining.

n 19 percent said that KP and theUnion Coalition “absolutely” willfully implement the NationalAgreement, while 49 percent said“probably,” almost 29 percent said“probably not,” and only 3 percentsaid “absolutely not.”

n 52.8 percent said that theircoworkers were very or somewhatoptimistic about implementation;41.3 percent said their coworkerswere very or slightly pessimistic.

n When asked to guess what per-centage of the National AgreementKP and the Union Coalition willhave implemented by 2010, theaverage result was 66.3 percent, orjust less than two-thirds.

n When asked what factors posedthe greatest risk to fully imple-menting the National Agreement,the most frequent answers were“inability to release enoughunion/Coalition staff for just imple-mentation activities” (40 percent),followed by “insufficient unioncapacity” (31.7 percent), followedby “inability to convince managersto champion the NationalAgreement” and “uneven imple-mentation of National Agreementby regions” (both 28.3 percent).

KP’s senior leaders leave little doubtthat they’re serious. “If anyone ques-tions whether Kaiser Permanente iscommitted to the full implementationof the National Agreement, let me putthat to rest,” said Bernard Tyson, whoin January became KP’s senior vicepresident for health plan and hospitaloperations. “We are fully committedto it. That is not a question.”

“Truly This Is Showtime”Lon O’Neil, senior vice president forhuman resources at KP, ended theImplementation Launch with a frankdiscussion of how the 2000 NationalAgreement wasn’t fully implement-ed, and how this time around willbe different.

“In essence, the last seven yearswere all about getting ready for‘now,’” he said. “Perhaps we over-promised and underdelivered in2000. We didn’t know what we

“As a union mem-ber and a stewardI’m trying to helpeducate othersabout the agree-ment. Because themedical records

department was hit the hardestwith KP HealthConnect, a lot ofmembers were nervous about los-ing their jobs. We need to workhard to help them understand howthe agreement protects them.”

Richard CruzFile clerk and SEIU-UHW West stewardSouth San Francisco Medical Center

“Build and have areally good rela-tionship with yourshop stewards andbusiness reps.We’ve been work-ing closely togeth-

er with some of the issues that wedon’t have clarity around regardingthe National Agreement. Also, pro-vide official communications, in atimely manner, to just let us knowthat issues are being worked on,and that dialogues are happening.”

Susan MillarDirector, Radiology ServicesOakland Medical Center

“Get the word outand promote thisagreement! This isthe best agree-ment in the worldand people shouldknow about it. I

think departments should have anopen forum for their employeesand allow people to ask questionsand get answers.”

Aimeon HolsomeStore Keeper 2, Materials Management,and chief shop steward, SEIU-UHW WestSouth San Francisco Medical Center

“Understand it. Ifthey don’t under-stand they need toask questions. Askyour manager, askyour union stew-ard.”

Shaifali RayService Unit Manager, Imaging ServicesSouth San Francisco Medical Center

VOXPOP Hank gets an earful from thepeople of Kaiser Permanente…

That’s what others say; let us know what you think. E-mailHank at: hank@kp.org. Or fax your comments to 510-267-2154.

What’s the one thing that you thinkanyone could do, this month, to helpimplement the National Agreement?

needed to know to win. Now, trulythis is showtime.

“We (KP management) are commit-ted to the National Agreement andwe entered into it honorably, open-ly, and with every intent to makethis work,” he added. “Great organi-zations learn how to learn, and learnhow to change. We are going tochange and evolve and win. But theonly way we’ll do it is through thefull implementation of this agree-ment.”

For John Kolodny, a labor leader forclinical operations in Ohio and amember of the PerformanceImprovement BTG last year, it’s amatter of applying the “90-10 rule”and keeping people focused.

“The 10 percent are the hardest tochange. The (other) 90 percent real-ize it’s a culture change, and it takesyears to change a culture,” Kolodnysays.

This implementation plan is a hugestep forward, he adds. “I really likethe structure of what they did. Tworesponsible people—one labor, onemanagement. You don’t have to tryto figure out who in the world isresponsible for making it happen.And you also know who to reachout to in the regions.”

Pressed to characterize his thoughtsabout implementation as either opti-mistic or pessimistic, Kolodny says,“If there is no word in between… Iwould say ‘optimistic’.”

This just in:The 2005NationalAgreementis availableto down-load fromthe LMPwebsite!

The PDF, which includes both thefull text of the agreement and allassociated exhibits, can be down-loaded in seconds by web users withhigh-speed connections. Dial-upusers can download the documentin less than one minute

Point your browser athttp://www.lmpartnership.org/today to download the NationalAgreement.

Several tools and documents are inthe works that can help you under-stand the 2005 National Agreement.Check www.lmpartnership.orgfrequently for updates. We’ll high-light the latest news in Hank, also.

Who’s to say when a shop steward’sday begins—or ends?

“When I look at my calendar, it justoverwhelms me,” she says with alaugh.

Minasian’s passion for helping herco-workers is obvious. Her strongbelief in the Labor ManagementPartnership and commitment to herrole as union advocate are equallyevident. She says it comes from alifelong desire to stick up for theunderdog.

“When I was growing up, when kidsat school were being picked on Iwould always stand up for them,”she says. “It wasn’t fair for someonebigger to attack someone smaller. Ifthey didn’t have a voice I would tryto be their voice for them.”

Later in life, working for differentemployers before coming to Kaiser

Permanente, she always spoke hermind. “If you don’t speak up [aboutan injustice], nobody is going toknow,” she explains.

When she walks the halls of thehospital she could be mistaken forthe mayor of the medical centerrather than a working phlebotomist,as she’s known to just about every-one from hospital administrators toEVS workers, many of whom seekher advice.

Her colleague and co-chair of theWoodland Hills stewards’ council,Kathy Gayle, says the two are“joined at the hip.”

“She’s one of those people who areextremely articulate, fair, and able topull the layers of the onion apart toget the heart of the matter,” saysGayle, an LVN in the pediatricdepartment. “She gets to the rootcauses [of an issue] more than most.”

Madlena Minasian is a quiet

dynamo. In addition to working as

a phlebotomist, the SEIU-United

Healthcare Workers-West member sits on

numerous LMP committees at Woodland Hills

Medical Center. She arrives at the medical

center before 8 a.m. and leaves after 6 p.m.

She gets paged about every two minutes by

union members, managers, and others who

need her advice. Most days, she scrambles to

squeeze in committee meetings or one-on-

one sessions with members. She takes her

pager home with her—and keeps it on.

A Steward Reflects on Her Busy Days

CATCH Me If You Can

6 | HANK MAY 2006

Gayle says Minasian is not just a com-rade in arms but also a friend. “Sheholds a confidence and is funny as alloutdoors. She makes me laugh.”

A Union Partner Respectedby Management

Minasian is equally respected by hermanagement partners. “She’s anincredible gift to the medical centeras far as her Partnership approach,”note Cathy Casas, who “tri-chairs”the Comprehensive WorkplaceSafety Management Program steeringcommittee with Minasian and anoth-er labor partner. They also worktogether on the ComprehensivePerformance Improvement Project(CPIP) and other LMP efforts.

Of course, the two have at timesfound themselves on opposite sidesof an issue. But Casas says her laborpartner never makes it personal andoften is able to see an issue fromdifferent perspectives. She says thetwo have a pact to “agree to dis-agree” and not assume that one is

right and the other wrong. At thesame time Minasian is known as astaunch advocate for the interests ofher fellow union members.

Despite the high praise from herpartners in both the union and man-agement, there aren’t many whowould trade places with Minasianbecause of the heavy load she car-ries. She advises newer stewards,and admits that there is a shortageof stewards at Woodland Hills, likemost places.

A Mentor to Her PeersA typical day for Minasian is allabout people. Recently, despitepunching through her voicemail firstthing in the day, by lunchtime shehad a dozen messages waiting. Afew were logistical: a film crew wascoming to the hospital looking forfrontline workers to interview aboutattendance; a colleague wanted toknow if a meeting was still on. Butthe rest involved counseling co-workers.

For example, she was scheduled torepresent a union member in anissue resolution. And a young col-league in the lab was concernedabout a dispute with a co-workerthat had escalated to the departmentmanager. Minasian met in personwith her colleague and counseledthe lab employee to try to work outthe conflict directly with the co-worker. She drew on her knowledgeof the National Agreement and localcontract, labor law, issue resolutionskills, and a host of otherPartnership tools, but she says thetools she reaches for most are hercompassion and her good senseabout people. If the manager wereto get further involved, Minasiantold her co-worker, “Don’t hesitateto call me, I can go into the meetingwith you.” The young lab workerwas clearly reassured.

Do Stewards Have a Life?Minasian insists that she is not allwork and no play. But she also seesherself as a victim of her own com-

petence. “The motto here is ‘themore you do, the more you getasked to do,’” she says. But shemakes sure that she takes vacationsand makes time for friends and fami-ly. Her load at home is easier nowthat her 20-year old son is grown,though he’s still living at home whileattending college. Minasian has beena single mother since her son wasthree. She says he doesn’t say muchabout her steward work, but sheknows he notices her accomplish-ments. “He’s impressed by what I’vedone, what I’ve achieved.”

Despite the challenges, Minasiansays she cannot imagine life any dif-ferently. “I can’t see myself not edu-cating [people] or not involved inhelping others.”

Editor’s note: Shortly after Hank visited

Woodland Hills, Madlena Minasian was

offered, and accepted, a job as the medical

center’s learning consultant. Though she will

no longer be a steward, she says she’ll

remain actively involved in the Partnership

and hopes to put to good use all the skills

she learned as a steward.

r Busy Days photos by Robert Gumpert

You Can

MAY 2006 HANK | 7MAY 2006 HANK | 7

8 | HANK JUNE 2006

It was the start of a Union Coalitiondelegates’ conference unlike anyother.

Held March 31 to April 2 in LosAngeles, the annual conferencedrew 600 delegates, staff, and visi-tors who learned about everythingfrom implementing the NationalAgreement to the fundamentals oforganizing at the front line.

It was a different kind of conferencefor the Coalition of KaiserPermanente Unions. It anticipated afuture without diCicco, who had ledthe coalition since its formation in

1996 as 30 unions learned to work incollaboration, the basis of the confer-ence’s “Many Hands, One Voice”theme. It was bigger, with 200 moredelegates than normally attend theannual conference. It featuredkeynote speakers and workshopsabout leadership, workplace mobi-lization, and union priorities such asunit-based teams, staffing, workforcedevelopment, and attendance.

And it launched an ongoing coali-tion campaign with clear objectives:

n Expand union capacity.

n Identify what a successful imple-

mentation looks like for unionmembers.

n Mobilize the 86,000 members ofthe coalition to implement theNational Agreement, somethingunion delegates, through a pre-conference questionnaire, saidthey feared could be underminedby barriers ranging from manage-ment inattention to inadequatestaffing to “frontline workers notunderstanding how the NationalAgreement affected them” and“labor not being a team player.”

The conference also introducednew leadership on both sides ofthe Partnership. Delegates heardfrom Bernard Tyson, the newlyappointed senior vice president ofhealth plan and hospital operationsand LMP executive sponsor, whogave a ringing address to delegateswho had grown comfortable withLeslie Margolin, whose long-timecommitment to the LMP was con-stant and obvious. The conferencealso heralded the arrival of newUnion Coalition Executive DirectorJohn August, a former line worker,steward, and local union presidentwho went on to serve as a hard-driving health care organizer andleader for several internationalunions.

Winning SolidarityAugust pledged to assume hisduties, if not at warp speed, thenquickly. “The way I plan to learn isto learn from you,” he said duringhis keynote speech. “I’m not goingto start slow; we’ve got to hit theground running and make thingswork.”

As on other occasions, August com-plimented union leaders for theirlong-standing coalition and notedthat they seem to defy nationwidetrends that have employers’ winningpay and benefit concessions toimprove market positions. “WhileKaiser Permanente is engaging inPartnership, the rest of the countryis going in the exact opposite direc-tion,” he said, followed by the moreominous “Consequently, we are notonly leaders, we are a target.”

August spent the conference learn-ing from delegates as he talked one-on-one with them, joined them atmeals, on the dance floor, and at acelebration for diCicco. He also leda well-attended workshop on organ-izing that emphasized the basics ofmapping worksites, assessing unioncommitment, and collaborating tosolve problems.

Outgoing Union Coalition Executive Director

Peter diCicco announced the 30 unions one

by one, and the applause steadily grew to a

roar that overwhelmed the packed meeting room.

Finally, finishing the roll call, diCicco had to shout

over the raucous scene. “You are the leaders of the

Coalition of Kaiser Permanente Unions!” he said, as

delegates rose from their seats, shouted, and clapped

their hands in a slow rhythm that accelerated to a

deafening staccato.

Spirited Delegates’ Conference Highlights Organizing, Leadership

Many Hands, One Voice

N E W L E A D E R S F O R L M P

Tyson, August Take the Reins

Two executives, one a Kaiser Permanente veteran and one a longtimenational union organizer, have taken over executive sponsorship for theLabor Management Partnership as National Agreement implementationmoves to the front burner.

On the Kaiser Permanente side, Bernard J. Tyson has taken over as sen-ior vice president of health plan and hospital operations. In late JanuaryTyson succeeded Leslie A. Margolin, who resigned from KP after lead-ing Common Issues Bargaining 2005 and other key initiatives.

For the Coalition of Kaiser Permanente Unions, 30-year organizing vet-eran John August took over as executive director as of April 10. He suc-ceeds Peter diCicco, the founding executive director of the UnionCoalition when it was created in 1996.

These two appointments are critical because, as union and managementexecutive sponsors of the LMP, August and Tyson will work closelytogether to lead the implementation of the National Agreement and allother high-level LMP initiatives. August and Tyson also both serve onthe Common Issues Action Team, which must report periodically to theKaiser Foundation Health Plan/Hospitals’ Boards of Directors and theUnion Steering Committee regarding the National Agreement.

Tyson is well versed in both the LMP and KP operations, as he has heldseveral nationwide executive posts in the organization. Most recently hewas senior vice president for brand strategy and management; the“Thrive” image advertising campaign was launched under Tyson’s lead-ership. He started in KP in 1985.

August comes to the Coalition from a 30-year career in union manage-ment and organizing. As diCicco said in his note introducing August,“From coast to coast and many points in between, [August] has organ-ized and represented social workers, bus drivers, airline mechanics andflight attendants, school employees, printers, and virtually every type ofworker in hospitals as well as nursing homes and home care.”

Most recently, August served as deputy director of the SEIU’s HealthSystems division. August started April 10; however, his unofficial com-ing-out party came March 31-April 2 at the Union Delegates Conferencein Los Angeles (see story, this edition, page 8)

JUNE 2006 HANK | 9

“Pick something winnable,” headvised during the workshop.“People think they have to take onhuge battles. Small victories areimportant. Sometimes you win soli-darity one person at a time.”

Breathing PartnershipdiCicco deservedly basked in trib-utes and picture-taking as heentered semi-retirement. He intendsto continue to advise the UnionCoalition and Kaiser Permanente.

“Peter breathes, eats, sleeps thePartnership,” said Jaki Bradley, amember of the UFCW Local 400 anda nurse practitioner at the NorthCapital Medical Center inWashington, D.C.

“He gave us all a great sense ofhope and confidence about thePartnership,” said Marti Batchelder, apsychiatric social worker at the PointLoma (Southern California) MedicalClinic, and vice president of SEIUSouthern California Mental HealthProviders Local 535.

But before the roasts and toastsbegan, diCicco sounded fire andbrimstone on the first day of theconference as he discussed account-ability. “One of the big differencesbetween 2000 and 2005 is ourapproach to implementation,” hesaid. “To make sure people areengaged on the work level in imple-mentation, we must hold manage-ment accountable. Believe me,they’ll hold us accountable.Management must adequately budg-et, must adequately communicatethe importance of the agreement,and must support it as a businessstrategy if it is to succeed.

“That’s why we need to mobilize,”he said. “We need to exert pressurefrom the bottom up to match thepressure that’s coming from the top

down. Acting together and speakingwith one voice need to be morethan just words.”

All Roads Lead to Unit-Based Teams

More than 70 delegates attended theworkshop on unit-based teams, whatworkshop co-leader and UnionCoalition National Coordinator SteveFrancy likes to call “the mechanismof a democratic workplace.” Unit-based teams are the ultimate visionof the Partnership, promising to sup-port increased participation andtransform the traditional roles ofstewards and supervisors so they actmore like frontline leaders, coachingand mentoring their colleagues as theteam tackles workplace issues. Allroads lead to the unit-based team.

The National Agreement requires theteams to be established in everydepartment by 2010, so Francy andhis colleagues used the workshop tosolicit advice about the teams.Participants suggested standards tohelp create a common employmentexperience among the regions andnoted that staffing and backfill werethe major barriers to unit-basedteams, a reality borne out by theNorthwest’s experiments with teams.

Backfill is a huge problem in theNorthwest, says Kate Pingo, a coali-tion partnership representative origi-nally from SEIU Local 49. Unionmembers face additional require-ments to complete six courses oftraining, including PartnershipOrientation, Interest-Based ProblemSolving, and Maps I and II beforethey can participate. There’s nostreamlining for them.

But they have learned a valuablelesson. Originally their unit-basedteams were based on a representa-

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Bernard Tyson, left, and John August, center, chat with Peter diCicco.

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An audit of KP’s fee-for-servicebillings to Workers’ Compensationand government payers hadrevealed serious problems in billingsystems in California and elsewhere.Chairman and CEO GeorgeHalvorson ordered the systems shutdown until the problems were cor-rected. That meant turning off thetap in California on about $114 mil-lion in 2005 billings. Few peoplepredicted a happy ending.

“People were shocked by the audi-tors’ report,” recalls RobertHochberger, LMP NationalCoordinator and then the regionalLMP co-lead for Southern California.“It had huge implications, in termsof financial impact on the companyand for the hundreds of peopleworking in those [billing] jobs.”

“We didn’t know what to expect, orhow we would approach a solu-tion,” says Patti Harvey, RN, directorof risk management and patientsafety. “There was a sense of fore-

boding about what it would meanfor us and our positions.”

Heads rolled. Right?

Wrong.

What happened instead was a LaborManagement Partnership initiative tofix the problem and retrain hundredsof employees and managers. SinceJanuary, Southern California hasbegun to gradually resume its non-governmental billings. And, ratherthan shipping off jobs to an outsideservice, KP has retrained frontlinestaffers and created new employmentopportunities in the region.

“There was no finger-pointing orblaming or punishment,” says KathyWeiner, senior project manager inSouthern California. “Labor andmanagement shared an interest infixing the problem, and dealt with itin a cooperative way.”

As a result of this joint problemsolving, the Southern Californiaregion has

n Developed a skilled force ofbillers and coders

n Created a newcareer path for

employees and a pipeline forhard-to-fill positions

n Introduced new systems that allowKP to submit bills in compliancewith all regulations.

In Northern California and theNorthwest., which had similar billingissues, union and management lead-ers are likewise digging in to solvethe problem together.

Follow the DollarAs part of Kaiser Permanente”sCompliance program, KP hiredaccounting firmPriceWaterhouseCoopers to auditbilling systems in Northern andSouthern California, and otherregions.

At issue was KP’s billing procedurefor services to nonmembers or tomembers covered by third parties,such as Workers’ Compensationinsurers. Most health care providersuse certified medical coders—oftenfrom outside companies—whoreview every medical procedure per-formed and assign the correct codefrom several thousand choices forinpatient and outpatient services.The industry standard is then foremployees in a separate departmentto generate the bill. However, withfee-for-service business representinga very small percentage of KP’s totalrevenue, most regions had notinvested heavily in these systems. As

a result, billing agents in Californiadid double duty as coders—a poten-tial conflict of interest in the view ofthe auditors.

The solution—to separate the billingand the coding functions—was obvi-ous, yet far from simple. It involvedcreating a new job classification,providing specialized training, anddevising a clear process for allowingemployees to apply for the higher-skilled, higher-paying coding jobs.

Making It WorkEven before the suspension of billing,Southern California Chief OperatingOfficer Greg Adams suggested that aregionwide senior group of unionand management leaders join to ham-mer out a solution.

“It was clear to me from the begin-ning that the issue had significantimplications for the organization andfor our employees,” Adams says.“We needed to move to correct theproblem with determination, speed,and alignment. I never second-guessed the Partnership as the wayto tackle the issue.”

Union Coalition leaders also pushedfor a broad-based group, includingfrontline workers and supervisors, towork the problem. Ultimately aBilling Steering Committee formed,with more than 40 managers andstaff, including members of SEIUUnited Healthcare Workers-West,OPEIU Local 30, and United

Steelworkers Local 7600.

FIELD NOTES

LEMONADE OUT OF LEMONSA Partnership Response to Big Trouble

10 | HANK JUNE 2006

In May 2005 alarm bells rang in executive suites

across Kaiser Permanente.

“We had senior institutional laborleaders involved in the work fromthe beginning,” Adams says.“Expanding the work group toinclude frontline workers andsupervisors was ultimately the keyto our success. They had theopportunity to understand theproblem and to engage with seniormanagement and senior labor lead-ers as thought partners in identify-ing solutions.”

“The crisis forced both sides to sitdown together and figure out howto get things up and runningagain,” Hochberger adds. “Unionmembers themselves understoodthe need to separate billing fromcoding, and agreed that the codersshould be certified [by an outsideagency]. What had to be workedout was the best way to provideopportunities for training, how tobuild the infrastructure, make thenecessary system fixes—every-thing.”

The steering committee agreed ona comprehensive, 23-day trainingprogram for coders: 10 days ofcoding basics, 5 days of skillsevaluation, and 8 days of prepara-tion for the certification exam. Thecost of the training—includingrelease time, program develop-ment, and delivery—exceeded$500,000. That investment haspaid off. To date, 117 of 135employees have been certified bythe American Association ofProfessional Coders. That’s a passrate of 87 percent, far surpassingthe national average of 65 percentfor the AAPC exam.

“Our pass rate shows that we haveexcellent people,” says BerthaAviles, regional director of PatientBusiness Services. “Frontline staffand managers from across theregion came together in partner-ship, were very committed, andwere able to raise the level of per-formance of the organization.”

It was an emotional experiencefor employees who took theexam. “The training was veryintense, but it was first-class,” saysDannielle Estrada, a cancer regis-trar and UHW steward at BaldwinPark Medical Center. Her job wasbeing eliminated due to a reorgan-ization of the Southern Californiacancer registry, and though shewas assured of a comparable posi-

tion, thanks to the Employmentand Income Security Agreement,she was not happy about thechange. However, medical cod-ing—something she’d studiedbefore joining KP nine yearsago—was appealing. “It’s impor-tant work, and an opportunity fora new start,” she says. “Trainingand promoting from within wasthe right way to go.”

Building New SkillsAs certified coders began theirwork, the region faced anotherhurdle: digging out from an enor-mous backlog of bills. ByNovember 2005, with most of thebilling system still paused, nearly17,000 bills were waiting to beissued to customers. State WorkersComp insurers demanded that KPsignificantly reduce that number—fast. The steering committee set atarget to cut the backlog by morethan half—to 7,500 bills—within 30days. At the time it took more than60 days, on average, to turnaround a bill.

Union and management leadersagreed on a way out of themorass that included voluntaryovertime, borrowed staffing fromregional medical centers, and tem-porary outsourcing. “No one wasreally sure it was doable,” saysHochberger. But within 30 daysthey beat the target, cutting thebacklog to less than 4,000 bills.

As a quality control measure, theSouthern California region is usingan outside consulting firm toreview the accuracy of StateWorkers Compensation bills.

So far, the story is a win-win—andis having an impact beyond thebilling and coding departments.For instance, the initiative willbecome “a platform for launchingunit-based teams in local serviceareas, to help set directions andpriorities and resolve other work-flow and workplace issues,” saysAviles.

“We see what’s possible when KPand the unions work together,”says Dannielle Estrada, who admitsto being skeptical about thePartnership in the past. “We couldhave these kinds of successes moreoften, but both sides have tobelieve it’s possible, and be willingto work at it.”

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tional model, but they discovered itwas more of the same with only afew staff participating. Only whenthey used a democratic model didthey fully engage frontline workersand supervisors.

“If you keep it [the unit-based teamstructure] in the representationalmodel, nothing changes,” saysPingo. “As long as people have avoice in how they do their work,they feel they are part of thePartnership. People all want to beinvolved or they cannot see or feelor understand our Partnership.”

Or resolve attendance problems.While Francy and Pingo discussedunit-based teams, Walter Allen, exec-utive director of OPEIU Local 30,and Ralph Cornejo, SEIU UHW-WestKaiser Permanente staff director,stressed accountability in one of twoworkshops on attendance.

Making Attendance WorkThe average KP worker takes offmore time than workers employedby other health care providers,reported Allen. And the average KP worker carries only nine days in a sick bank, a number smallenough to be only incidentallyhelpful in the face of a serious illness or accident.

Cornejo provoked a discussion aboutwhy people call in sick—short staffing,illness, burnout, poor scheduling, poormanagement, unsafe working condi-tions, a second job, entitlement—before examining how to turn thetables. Participants mentioned theneed for backfill, and the importanceof educating workers about how call-ing in sick affects the entire staff.Changing the work environment, pro-viding incentives, and applying disci-pline were mentioned as solutions.

“We’re on a team. If you don’t likethe team, if you’re out sick chronical-ly—don’t bring down the rest of theteam,” said one of the participants.

Then they discussed attendance lan-guage in the National Agreement: flex-ible personal days for most unions,front loading of sick days at the begin-ning of the year instead of accrualover the course of the year, and theability to cash out unused sick days at50 percent of their value once a work-er has banked 10 days of sick leave.

The final provision, said Allen andCornejo, means that workers can addto their take-home pay at the end ofthe year by using sick leave wisely.

“At the end of the day, it all boilsdown to accountability,” Cornejosaid. “We will change the culture. We won’t change it overnight, but we can make progress, incre-mentally.”

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