The dialogue in this blog is interesting and seems to be representative of the continuum of dialogue that is taking place across KP. For me, the continuum of postings runs from polarized to collaborative. As an instructor for the Issue Resolution, Consensus Decision Making, and Interest Based Problem solving LMP modules the contrast in approaches is stark.

Let’s examine some of the dialogue in this particular blog. On December 12/10 Tony presents his view of a successful UBT at work. He describes a classic interest based problem solving approach in which the members of the effected unit, the stakeholders, came together to problem solve. Lot’s of uninformed interpretation on my part here but if I had to guess at what the problem statement might have looked like it might have read something like… “how can we work together to reduce our use of resources while still providing excellent service and causing the least amount of disruption to our labor partners, management and members?” And from the sound of the outcome as Tony described it they accomplished their mission. This is indeed LMP in action. Congratulations! From my interpretation of both the national agreement and the UHW Collective Bargaining Agreement this is how the LMP is intended to work.

Now this does not necessarily imply that there was no pain or discomfort involved in the dialogue and decisions that were made for union members and management. But what makes the UBT concept hum is the willingness of all partners to sit down and openly engage in interest based problem solving. When one “side” takes a rigid position on an issue without considering the larger interests of all stakeholders the collaboration ends. In fact, in the end it is probably not really in the best interest of the individuals or “side” that is taking a rigid position in most instances.

The response to Tony’s entry sited above by OPEIUVoice on 12/11 appears to be a classic example of positional bargaining. The entry implies that any loss of union positions for any reason is unacceptable. Given the current environment in the US and comparing the cost and quality of care received by the majority of US residents on most measures it seems evident that we must figure out efficiencies somewhere. Since staffing is by far the greatest expense in virtually any healthcare operation, once you make absolute staffing numbers a sacred cow the game is over.

The objective in interest based bargaining is to reach an agreement whereby each party gets all of their interests met. It is a legitimate interest for a union to maintain its security through membership growth. In Tony’s example it appears on the surface that the union's interests were not met because there was a net loss of positions in the department. But if we take a longer view supporting efficiencies throughout the organization will result in smaller rate increases for our members and keep KP in the position of offering great quality at an affordable price. Few other health plans in the country can offer the quality of KP and if we control costs we will continue to increase market share as the economy recovers. So in the long run supporting efficiency now is in the best interest of our union partners as well as all of the employees. More members translate to more jobs. This is a classic win/win solution.

Unfortunately it seems that the partnership can suffer when either “side” moves away from interest based problem solving to positional maneuvering. I’d like to close with an appeal to all to use the fantastic tools that the leadership of both labor and management embraced in 1997. If we do so relationships will sustain the least damage, the decisions will be the best possible and KP’s position under the new economic and health care realities that are about to emerge will be stronger than ever.

When I was a steward and labor partner, it was very clear in all our union discussions and training sessions that "co-managing" means inappropriate behavior by a steward or labor partner that consists of acting like a "straw boss" or just another manager, taking management's side, rather than representing the workers' interests (acting like a little manager).  And that's what the contract sentence about avoiding "co-management" means -- although it's not the greatest word choice, in my opinion.  (It seems to me that labor included that sentence in the draft of the National Agreement, using the above specific definition of "co-management," and was not aware that the word might be open to different interpretations.) 

We at the union were clear, in our discussions of the LMP, that being labor partners means sharing equally the responsibility of running the business.  That's what being a partner means. 

If management is defining "co-management" differently, to mean sharing equally as partners, and trying to claim that the National Agreement forbids that, then there has clearly never been a meeting of the minds about what that sentence in the National Agreement means. There really needs to be a very serious review of this.  

_{Interesting points, Barb.}

From a local perspective, the real challenge is maintaining capacity (for patient visits) while allowing employees at the 'work unit level' time to participate in UBTs. Its interesting- physicians all the time get 'pulled' for administrative tasks, and their clinical FTE is accordingly reduced, and, if necessary, additional resources are brought in to care for the members. At the work unit level, however, backfill is funded BY THE DEPARTMENT- and because that impacts the economic 'bottom line', even managers that totally embrace the partnership have difficulty in regularly getting employees free to participate. This places an additional burden on the folks left 'back in the office' to do the work with one less body. The language of the National Agreement suggests backfill be calculated "before the fact", based on a 0.12 replacement factor. Unfortunately, the economic reality is that we simply do not have the resources, given our present economic challenges, to do so. That being said, in the departments where UBTs are up and running, things are getting better!

The sites I support have had all LMP activities/mtgs on 'hold' since Sept. '09.  I understand the environment is very different at these sites; however, I believe what I've experienced in my position as an LMP Coord. over the last 3 yrs. enforces the need for LMP to continue.  I also understand there are priorities (pt first). 

I am usually in a position to see both sides of the fence and am to remain a neutral resource for both management & labor.  I am not hearing anything about any talks to get LMP moving forward again or anything about it. 

When employee morale in the workplace is down in this environment it affects individuals' demeanor.  When I say 'employee', I am including the front line managers in this current situation as they are also affected by this.  It's more than their demeanor and comes down to a non-working behavior re-surfacing.  This is just my point of view from the fence though. 

The duration of this 'hold' causes me to ask:  Where do LMP activities rank/place in the long list of priorities?

Having participated from both sides of the table (L and M), I must observe that the partnership in my area is on life-support or should be.

Psychiatry has long suffered from the illusion that we are already past masters at getting along and communicating. Norcross et al have done a good job of documenting how imperfect we are at judging our treatment realtionships, and the same caveat may apply to our judgments of our workplace relations.

Managers can be very nice, very diplomatic, and very wise in their judgments about what we ought to do next - and still be top-down leaders. The most common structure supporting this way of operating is the management meeting with an invited labor representative. The representative is assumed to be in close contact with his peers but no time is actually committed to that function. Another artifact is the management meeting which is devoted to making a strategy to prevent "undue" labor influence, rationalized and justified by that one sentence in our LMP manuals that says LMP is not co-management. Now a third structural impediment is the takeover of UHW by SEIU, which prefers to operate behind the scenes leader-to-leader without keeping the worker in the loop. Kaiser is apparently powerless to insist on participation by workers because that could be construed as interference in labor business.

So, yes, we need help if the patient is not going to be allowed to die.