Academic or Professional Institution
In the real world, health administrators at Kaiser Permanente must consider the rational and important choices set before them. Business and delivery management practices create an organizational environment that determines the enterprise’s decision, quality of performance, styles of bureaucracy and any formal changes which must comply with governmental regulations or reforms. This discussion covers five elements pertaining to the leadership coalition in terms of relations and functions of Kaiser Permanente. According to Kochan et al. (2013) this Kaiser Permanente (KP) partnership represents “the largest, most longstanding, and most innovative labor management partnership in the nation’s history” (p. 1). The task herein consolidates an understanding in the following five areas of concern: (a) Discuss whether aspects of labor-management relations specific to the organization, and which more readily fit into a partnership process, (b) Should management be less resistant to partnership initiatives? (c) Should unions be wary of partnerships? (d) Why do governments not more actively pursue or promote partnerships? (e) What overall strengths and flaws do you see in Kochan’s analysis? First, delving into the nature of the labor-management relationship helps to distinguish some value principles that apply to Kaiser Permanente’s Labor Management Partnership implementation.
Question #1
Each organization holds its specific distinctions and Kaiser Permanente is no different. Early on the enterprise sustained a unique record of what Kochan (in the report) refer to as “early achievements and limitations” over a decade in which an amiable labor relationship was built around a solidly significant financial performance. Setting the foundation, and perhaps the tone for future engagements between labor and executive management, early history carved out a pathway in a healthcare operations model from the beginning. According to the book, Kochan et al. (2009) a bit of a union fight in 1995 occurred prior to coming to any agreement to formally partner. The authors describe the financial state of the giant non-profit health maintenance organization at that time suffered hurting in excess of $250 million dollars. One unique aspect that solidified a common scope and purpose for Kaiser, communicated that both labor and management held a responsibility to the patients who depended upon “its hard-earned reputation as an employee and union friendly employer” (p. 1). As such, Kaiser Permanente was also in a unique position because intense conflict pressures surrounded labor union proponents and corporate executives pertaining to wages, and benefits reductions driving heated strikes to occur.
In an attempt to find neutral ground in order to reach a compromise, labor leader John Sweeney led the delegation to send warning signals to top Kaiser Management, but quite an odd thing happened. Both parties were prepared to suggest the exact same protocol to mitigate the problem. Thus, the commonly held concerns to put the patients first seemed a perfect motivation in terms of finding a workable fit to process a partnership relationship.
Question #2
The relationship between labor and management remains a delicate balance, although the agreement to serve patients’ needs ultimately represents a common core. Management should be less resistant to partnership initiatives, if such initiatives better serve patient well-being while remaining within a reasonable framework of handling budget concerns. Since Kochan et al. (2009) describe such a relationship as a “living thing” it is understandably expected that changes must need to respond to financial realities, and new legislative regulations in U.S. healthcare. Kaiser Permanente represents an accomplishment that relies upon improved patient care, employee satisfaction, and efficient managerial leadership from its executive branch. If there is any reason why management should be less resistant to partnership initiatives is in the case of its proposed standard adoption that severely hurts patient care, or employees’ ability to earn a decent wage.
Transitions normally cycle in the quest for best practices, especially in the world of healthcare and in the huge conglomerate that Kaiser Permanente’s Labor Management Partnership represents. In the report Kochan (2013) states that leadership transitions “have proven to be an Achilles Heel” in the case of “many labor management relationships,” and most of the challenge focuses on the new Affordable Care Act (ACA) (p. 2). When it comes to attempting to work together and solve a common roadblock to smooth and efficient solutions that rise in the coalition, management should perhaps be less resistant to partnership initiatives. Safety, health concerns, adherence to legislation, labor fairness, and patient care all correspond to a direct relationship to the quality of labor-management communications. Kochan (2013) would remind the reader that KP “was borne out of crisis,” and that the “partnership’s most significant initial achievements were to replace the escalating conflicts with a decade of labor peace during which the parties put in place new labor management processes and relationships” coalescing to meet mutual organizational healthcare delivery challenges and needs (p. 5). Essentially management has no legitimate, or realistic need to be wary of partnership initiatives which involve labor.
When management is less resistant to any type of partnership initiatives, the willingness to work together and solve problems as they arise places teamwork at a higher level. Employees and managers have mutually benefited from learning how to improve policy disagreements, problem-solve and implement their acquired skills in achieving “expanded training and development and opportunities for direct participation on a wide array of issues upgraded employees’ skills and abilities” (Kochan, 2013, p. 6). These are critical threads of cost-effective and efficiency behavior particularly within a health care organization.
Question #3
The question this section addresses is whether unions should be wary of partnerships. Unfortunately, it appears as though common sense would dictate that unions must be wary of partnerships. Generally, the reason is because although tough unions have existed in the past they are far rarer in today’s world. Traditionally unions represent the weaker components in a relationship, and in the modern era hold little of the prestige and power of the past. In other words, there shall always be limitations. For example, it must not be forgotten that the KP partnership began as a fight and the later negotiations of the years 2000 and 2005 proved that developments – good and bad are lurking in the gaps of change. The unions grew out of a disorganized group of approximately 7,300 in 1997, therefore the roots does not reside so far from the future branches spreading forth. Of course there are limitations.
Budget constraints alone represent a huge concern for patient affordability, worker compensation, and management coverage to find answers that lead ethically and implement protocol within the rubric of regulatory practices. In fact, Kochan (2013) clearly admonishes that “Building and maintaining the partnership is a costly endeavor,” partly due to “a labor-management trust fund established under the collective bargaining agreement and funded by employee and employer contributions” (p. 7). In 2005 the annual budget hovered at only $16 million, but skyrocketed seven years later in 2012 to $28 million dollar demand. These financial realities do not begin to bear on the full costs, according to Kochan’s report because it does not include every union representative’s input, leader-physicians, or what he called ‘front-line’ staff. In other words, the partnership itself costs money to run, excluding the mission to better balance quality health care practice, administration operational wisdom, and livable compensation to laborers. A codified objective did exist between 2005 and 2008, in which early-stage negotiations functioned between unit-based teams within the partnership arrangement.
The California local sector was placed into a trusteeship by the Service Employees International Union (SEIU) leading Sal Rosselli to resign from its local. Along with “a number of his local union colleagues” they resigned and began a new union called the National Union of Healthcare Workers (Kochan, 2013, p. 7). Amid shifting agreements, insolvencies of disagreements, emerged a network of teams. Coalition members numbered 3,458 teams by January 2012 and according to Kochan (2013) held fast a rating in which “40 percent of teams had reached” a high-level of performance (p. 8). The point these factors illustrate in terms of unions discretionary need to be wary of partnerships is that labor realities change within the rubric of differing economic challenges. Everyone endures a tough time in the unsettling global recession, and perhaps patients and workers (whose interests the unions represent) are most vulnerable to these kinds of unfolding situations. When it is suggested that unions should be wary of partnerships, it is not deemed so to believe that all management personnel harbor ill intentions, or are dishonest and cannot be trusted. The fact of the matter is that analysis and statistics support that the higher levels at which employees enjoy satisfaction, the “quality of care” measurement rise, demonstrating lowered mortality and infection rates, in addition to less incidents of “worker injury, an absenteeism” (Kochan, 2013, p. 8). The outcomes obtained from a Coalition interview implementation resulted in the quantitative measures that bear out the above facts. A handy chart entitled, “Growth in High Performing Teams” shown in Figure 2 of the report clearly indicates the various team divisions, as associated with greater or lesser degrees of performance growth.
Question #4
Why governments do not more pro-actively seek or promote partnerships entertains a plethora of reasonable and logical reasons. A simple answer renders that government does what government does. The smartest and most efficiently functioning government cannot possibly know everything there is to know about any single field. Perhaps this is a key reason why government relies heavily upon reports, annualized meeting data, and pays attention to outcomes in terms of how newly devised legislation affects the partnerships already in existence. For one thing there is no denying the complexity of union formation and execution of duties in attempting to operate within a cogently precise labor-management partnership without the help (or interference) of government. It was learned from the book that Kochan et al. (2009) stated that unions had divided employers into five groups, at one point systemwide, in an effort to straighten out better ways to handle the disputes and resolution agreements process. Imagine the government sticking its fingers into this pie, however as overseers of federal law setting rules to overhaul the new ACA, the serious balancing act has involved all stakeholders.
Another reason why governments do not readily become involved in active promotion of partnerships is that so much energy, and cost-analysis goes into legislative changes that healthcare organizations must respond to new frameworks. The internal stakeholders and framers of the labor management partnerships best understand the levels of effect any kind of new federal requirements, or budgetary re-arrangements will have on Kaiser Permanente as a health care enterprise. Empowerment for partnerships is crucial. Empowerment for the partnerships drive the ability for greater flexibility, insight, teamwork, and continued improvements in the system. In fact, one study from a premier medical university supports these claims. According to Kochan (2013) one “quantitative study carried out by colleagues at Johns Hopkins and Rutgers Universities found that primary care clinics that had high levels of participation,” in terms of autonomy and high-performance care “in which employees actually perceived having high levels of influence in decision making achieved higher levels of performance (measured as patient wait times) than” other units (p. 14). Government non-involvement to a degree seems to provide a framework of flexibility that Kaiser Permanente as a health care needs, to thrive and flourish at the highest levels of efficiency.
Question #5
Every analysis exchanges a tradeoff between strengths and weaknesses. Kochan is no different. Ironically, perhaps one of the flaws is that government should be more involved with partnerships of this kind, whereby the relationship between labor and management can benefit from suggestions or simply third-party rendering of data and statistics on improvements (or failings) in various areas. Government certainly has the resources to do so. Conducting qualitative and quantitative data gathering utilizing the latest technological tools could encourage the Kaiser Permanente Labor Management Partnership to see its internal weaknesses. Kochan’s main strength is in explaining categorizations of performance, worker satisfaction, historical union impact, and KP contract negotiations periods.
Conclusion
In conclusion, Kaiser Permanente Labor Management Partnership has helped thousands of patients, and given employees the opportunity to function in their livelihoods by becoming truly involved in outcomes. Liabilities and assets from the partnership shall continue to unfold, particularly with the new healthcare regulations peeking into the future.
References
Kochan, T.A. (2013). The Kaiser Permanente Labor Management Partnership: 2009-2013.
[Report]. London: Blackwell Publishing.
Kochan, T.A., Eaton, A.E., McKersie, R.B., & Adler, P. (2009). The Kaiser Permanente Labor
Management Partnership. [Book]. New York: Cornell University Press.
