Who Are the Partners in Kaiser Partnership?

Book Review: Healing Together: The Labor-Management Partnership at Kaiser Permanente, by Tom Kochan, Robert McKersie, Adrienne Eaton, and Paul Adler (Cornell ILR Press, 2009)

Most labor relations academics are unabashedly anti-union, reflecting the influence of business and the decline of organized labor. The authors of Healing Together are pro-union in the sense that they still see a place for unions in the modern economy, even if that place is to assist management. This case study of the Labor-Management Partnership at the Kaiser-Permanente health system, based in California, is both description and promotion.

With the implosion of the unionized auto industry and particularly the closing of two plants that were poster children for team concept and union-management cooperation—the California NUMMI plant and the Tennessee Saturn plant—the Kaiser health care partnership, more than 10 years old, is probably the most important one left standing.

The union side is represented by the Coalition of Kaiser Permanente Unions, 11 unions dominated by the Service Employees (SEIU). The California Nurses Association (CNA) has been conspicuously absent from the Coalition and in clear opposition to partnership.

The 1997 Partnership Agreement includes all the standard win-win-win language to describe the partnership’s purpose:

  • improve quality care for Kaiser communities
  • “market leading competitive performance”
  • expand KP into new markets “including designation as an employer of choice for all labor organizations in areas we serve”
  • provide KP employees with the “maximum possible employment and income security”

Despite the authors’ slant, Healing Together has some useful information for those trying to strengthen the union movement. But recent events, just unfolding when the book was written, have answered the question of who the partners in this partnership are. The partnership is not between management and Kaiser employees. It is a partnership between management and the leadership of the union, which “owns the contract,” against the members if necessary.

The events in California’s huge health care local are familiar to Labor Notes readers: When SEIU put the United Healthcare Workers-West (UHW) in trusteeship in January 2009, the former UHW leaders established a new union that had overwhelming support from the stewards, activists, and membership base at Kaiser. The National Union of Healthcare Workers (NUHW) quickly got petitions signed by super-majorities asking to certify the new union. The SEIU, forgetting all the arguments it had made for the Employee Free Choice Act, pressed the NLRB to delay elections, so that most Kaiser workers are still in UHW-SEIU.

During the NUHW founding convention in April 2009, I talked to a Kaiser steward who felt optimistic about the new union’s immediate prospects at Kaiser. She expected that Kaiser would not actively back the SEIU in its battle to keep members from switching to NUHW. She thought management would continue working with NUHW activists and stewards—because Kaiser would want to protect the partnership program.

As it turned out, she was wrong. Kaiser instead became a partner of the SEIU trustees in trying to drive “a stake through the heart” of NUHW. Popular elected stewards who refused to take SEIU loyalty oaths were notified by management that they had been replaced. NUHW activists were threatened and harassed by “joint” efforts of management and SEIU. (See also Steve Early, "SEIU Civil War Puts Labor-Management 'Partnership' In New Light," in Real World Labor: A Reader in Economics, Politics and Social Policy from Dollars & Sense, edited by Immanuel Ness, Amy Offner, and Chris Sturr, Economic Affairs Bureau (Boston), 2009, pp. 200-203. Ordering information at www.dollarsandsense.org.)

The Labor Management Partnership (LMP) program, a $16 million operation, quickly aligned with the SEIU appointees against the members. Under pressure from SEIU the executive director of the Coalition of Kaiser Permanente Unions (CKPU) sent a letter declaring that new unions had no place in the Coalition or in the partnership program, threatening that if Kaiser workers voted for NUHW they would bargain alone and lose participation in partnership activities. A long time LMP participant wrote to the coalition director:

I am very disturbed that you do not support our members' right to determine which union we want to represent us. You are threatening that if we choose NUHW through a federal legal process, exercising our rights, that you will not allow us to be part of CKPU or LMP.

Is not a union made up of it members and members voices? Is not unionism a democratic process where we as members have a right to take their union in the direction we feel is best for us and for those we serve? Does not LMP consist of union members (no matter which union) working together with management for the good of all?

As it turns out, the threats only seem to have made things clearer to the members. In the first votes held in Kaiser units, in mid-January, the members impressively turned out and overwhelmingly supported the NUHW, 1,652 to 257.

Who Knew? Any Clue?

So is there anything in Healing Together that could give us a clue that the partnership didn’t belong to the members but could be used against them?

Yes, plenty of clues, but first, disclosure. Like the book’s authors, I come to this question with a point of view. For years I worked with Labor Notes writing books, organizing workshops, and advising union activists on dealing with labor-management partnership schemes. The main message was, “Watch out—these programs will undermine union consciousness and therefore union strength at the workplace.”

At the same time, we recognized that these programs can be appealing—workers would supposedly get a voice in the way things ran. In addition, local unions often had no choice but to participate because they were bound under a national contract or forced by other circumstances. So part of our writing and training was to point out what a good participation program would look like—one that actually empowered the members as it claimed and therefore built union power.

We were always on the lookout for any model program we could use to serve as an example for activists and local unions struggling to survive. I always thought the Kaiser program had several factors that might make it such a model:



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1. A strong local union (then SEIU 250, later merged into UHW) which had an aggressive organizing agenda built around what unions could do for members. If your “partnership” results in concessions and a weak union, it hurts organizing efforts elsewhere.

2. The presence of a union within Kaiser (the California Nurses Association) that opposed the partnership agreement and by its criticisms would keep the participating unions on their toes.

3. The fact that Kaiser’s health plans and hospitals are “not-for-profit” and generally good. For my money (I am covered by Kaiser), its model of health care is one of the best in the country. Working with management “to improve service to the customer” might actually do just that.

So I have always been open to the notion that labor-management participation at Kaiser might be different from all the other disasters for unions in other industries. (In the auto industry such programs became the main mechanism to protect the UAW International leadership from the membership while the companies were dismantling the union, well before last year’s crash and bankruptcies.) Yet at Kaiser, despite some good things that were done, particularly in the area of response to technological change, there were plenty of clues to indicate that the program was not rooted in the needs of the members.


The most important clues were in the institutionalization of the partnership process. Even if unions disagree over partnership, or other policies, it should be possible to have coordinated bargaining and a bargaining council consisting of all the unions under a single employer. Instead, the union coalition at Kaiser was essentially defined by the partnership arrangement. Only those in the partnership were part of the Coalition of Kaiser Permanente Unions. Partnership became a further barrier to work between essential unions.

Further, the program found natural work groups unwieldy for involving workers, causing too many scheduling conflicts. Instead the partnership settled on a “representative” participation model. But the representatives were not elected but selected by the joint leadership.

Those who made the appointments to the partnership program had a vested interest in maintaining it, no matter what problems developed. Sixteen million dollars was the annual LMP budget. Suppose instead that the unions had bargained that money for lost time and training for stewards!

As in just about any labor-management participation program, this structure and operation undermined the union. From management’s vantage, that is the point. Members see the program as an alternative to their stewards for solving problems. The people who hold jobs in the structure become committed to preserving it even when it comes into conflict with union principles or strength. For unions it is dangerous turf.

The Healing Together authors praise the partnership’s alternative problem-solving procedures and refer in several places to grievances as indicative of bad union-company relationships. How did grievances get this reputation? They are the way for members to respond to problems short of demanding strong concerted action like a strike or slowdown or engaging in a dangerous individual act. They are a way—a union way—of starting to handle individual and group problems. Grievances indicate the system is working--that workers are not afraid to challenge management and that management is open to being challenged. There are no grievances in a police state.

Since problems always exist, if there are no grievances they are either being suppressed through social pressure or problems are being handled in some other way. Taking this vital function away from the union isolates the union from the workplace and leaves it as only a contract bargainer.

No Nurses?

At first it would seem that the absence of the California Nurses Association as a central character in the book is peculiar. After all, nurses are usually the vital link in the health care system. You can’t work on making a car ride smoothly without including the tires. While a small number of Kaiser nurses are members of other unions and are in the CPKU, in the main nurses are in the CNA. But the authors’ only mention of the CNA is to explain that the union opposed the partnership. If the partnership or the CKPU were truly interested in improving patient care, they would have to figure out some way to work with the CNA even without its formal participation in the partnership.

Healing Together makes it clear that improving patient care could not be a real priority of this program. It is management-driven. Key issues for the partnership included getting staff to insist on patient payment at time of service rather than billing, reducing absenteeism, and other productivity issues.

It is peculiar that the academics would not take this opportunity to compare alternative approaches to dealing with workplace issues. Here you have two competent, aggressive unions with different strategies. A comparison is both inviting and potentially valuable. But the authors of Healing Together are mainly interested in promoting and perfecting their participation model, not suggesting alternative union strategies.

There are some worthwhile points in the book. The discussion of technological change could be valuable for any unionist dealing with a similar set of problems. In planning for major technological change, who do you retrain; how do you do it? Do job security clauses really mean anything? What if people in the growing occupations (e.g., IT) are not interested in the union, as in this case? Similarly, the book touches on problems facing unions that are spread over different labor market areas, under regulations from several states, in companies with different procedures and traditions pieced together. On such uneven terrain do you try to raise everybody equally or do you try to level the field?

More of this from Healing Together would have been welcome.

NUHW now is fighting the huge resources of SEIU with an active, committed, and educated membership. Any contact with Kaiser workers will confirm what the recent elections demonstrated—an intense loyalty to their old union now carries over to NUHW despite the partnership’s efforts to threaten loyalists. What is now NUHW must have done something right while leaders and members were part of the partnership, because the activists survived even when management and SEIU used the partnership against the new union.

But we don’t find out how from this book.

Mike Parker is co-author with Jane Slaughter of Working Smart: A Union Guide to Participation Programs and Reengineering and other books on labor-management participation and lean production.