News & Views

Feature Story

The Real Health Care Revolution

September 1, 2017



workers at bargaining session A 2005 Kaiser Permanente bargaining session.

By Denise Duncan, RN, president, United Nurses Association of California/Union of Health Care Professionals and Dennis Dabney, senior vice president, National Labor Relations and Office of Labor Management Partnership at Kaiser Permanente

As health care and the labor movement face rapid change, we want to take this Labor Day break to share an approach that challenges prevailing thinking.

Twenty-two years ago, the health care industry was changing — and so was Kaiser Permanente. Facing a fundamental restructuring, the organization began cutting costs – and union workers began to strike in response. Kaiser Permanente and its union workforce were locked in an intractable disagreement, with no obvious way out.

But at the same time, a few labor advocates were exploring a new system that empowers people to bring to work the skills and insights to innovate and improve.  One that gives organizations and their workers a stake in each other’s success.

Leaders of what became the Coalition of Kaiser Permanente Unions decided to step back from the brink. They proposed a new way: to solve problems based on mutual interests — and, especially, in patients’ interests. Leaders of Kaiser Permanente agreed. Neither side was sure where this road would take them, but together they created our Labor Management Partnership. It is now the largest and longest running partnership of its kind in the country. And though it’s certainly not perfect, and often challenging, we think it offers important lessons for others.

photo of Dennis Dabney

Dennis Dabney

photo of Denise Duncan, RN

Denise Duncan, RN

Throughout the 20 years of LMP, we have learned, first, to acknowledge our doubts and uncertainty, and then to listen to our better selves — and each other. Over time, the organization has gained strength and stability. Our workforce now leads in wages and benefits in their respective parts of the country. Both sides have come to better understand and respect the other. And most workers love their jobs. We believe this is because they are unionized, not in spite of it.

We have also learned that high aspirations are not enough. We created a formal structure for involving unions and individual workers in decision-making and problem-solving — in our case, figuring out how to deliver the best patient care. At Kaiser Permanente facilities nationwide, self-directed teams, jointly led by union and management representatives, identify and tackle issues ranging from reducing patient wait times to getting joint-replacement patients home faster where they heal better.

And we have learned to focus on our shared sense of purpose, and to deliver results. The teams focus on making care more affordable, creating safer and healthier environments for workers and patients, and, along the way, engaging workers in more-fulfilling work and success for the organization.

Every industry is facing similar challenges, grappling with rapidly changing landscapes, trying to look years into the future to understand what’s coming next. Our teams aren’t just solving today’s problems. They’re helping us anticipate the future, creating new models of care and ways to deliver it. We’re adapting together, preparing for the next generation of nurses, technicians and workers who will have to be trained differently, think differently and possess skills they may not currently have.

Our framework may be of use to other companies looking for the next big thing. At Kaiser Permanente, we have the stability of a unionized workforce and the agility only possible when frontline workers are real partners and have a voice in how best to do their work. Yes, it is high-minded. And we have found that it works.

Happy Labor Day.