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DECEMBER 2005 JUNE 2006
FRONTLINE NEWS FOR KP WORKERS,
MANAGERS AND PHYSICIANS
In This Issue:
Billing Turnaround
Many Hands, One Voice
Got iPod?
And more...
Does this
agreement
have muscle?

Just the Facts
About Hank
What: An award-winning journal
dedicated to telling our stories,
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 workers,
managers, physicians, and
dentists involved in the Labor
Management Partnership
across KP.
Where: At KP’s 400-plus workplaces.
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.
Hank Wins Prestigious
International Gold Quill Award
Hank has added “award-winning” to
its description, as the International
Association of Business
Communicators has honored Hank
with its annual Gold Quill award of
excellence.
Hank, the magazine of the Labor
Management Partnership at KP,
received one of only five highest
honors in the Publications category
of the Gold Quill awards from IABC,
a global network serving more than
13,500 members in 67 countries and
10,000 organizations. Only 56 Gold
Quills were awarded out of 1,175
entries submitted worldwide.
Hank was one of two Gold Quills
that KP won this year. KP won a
second Gold Quill for its 2004 annual
report, “Health is Not Our
Industry, It’s Our Cause,” which was
released in spring 2005.
Entries are judged by stringent criteria
that consider strategic alignment
and tangible outcomes as key measures
of excellence. Winning entries
went through two rigorous rounds of
judging by a team of top senior
communicators globally. The final
selection was made by the Blue
Ribbon Gold Quill judging panel that
included 30 communication experts
from the Philippines, Canada,
Switzerland, United States, Slovenia
and Mexico. Hank was recognized
for demonstrating “world-class standards
in strategic communication.”
“Hank tells it like it is,” added Mike
Dowling, OLMP communications
practice leader. “This award is a tribute
to our outstanding LMP communications
staff, and to all the people in
KP who contribute their diverse stories
and opinions.”
Hank Survey Says:
10 of You are
Winners!
Thank you to the
2,500-plus readers
who responded to
the Hank/Program
Offices
Communications
and External
Relations survey in
the March 2006 edition
of Hank. We
will present the survey
results in our
next edition.
Ten of you, drawn
at random, have won our survey
enticement prizes: Five iPod Nanos,
and five $100 Amazon.com gift
cards. Congratulations!
And the winners are:
Winners of an iPod Nano: Elliott
Gonzalez, Zion (SCAL); Alonna
Montgomery, Stockton (NCAL);
Lena Yee, Santa Clara (NCAL); Chi
D. Tu, Dental Lab (Northwest),
Cheryl Shemanski, Zion (SCAL).
Winners of a $100 Amazon.com gift
card: Brenda Perdue, South Bay
(SCAL); Loa Prophet, South
Sacramento (NCAL); Alex
Hernandez, Redwood City (NCAL);
Pat Hernandez (NCAL), and Tracy
Guess, Roseville (NCAL).
Winner of the 2006 IABC Gold
Quill for international excellence
in communications.
KP Wins AFL-CIO’s Labor Management Award
Published by Kaiser Permanente
& Coalition of Kaiser
Permanente Unions, AFL-CIO
Communications Directors
Maureen Anderson and
Michael Dowling
Staff
Patty Allison, Janet Coffman,
Paul Cohen, Jennifer Gladwell,
Vince Golla, Kyra Kitlowski,
Julie Light, Chris Ponsano,
Neal Sacharow, Gwen E. Scott
Graphic Design: Design Action Collective
Cover Photo: Scott Braley
Kaiser Permanente has been
named a co-winner of this year’s
prestigious Labor-Management
Award from the AFL-CIO.
The award, given by the AFL-CIO’s
Union Label & Service Trades
department, recognizes employers
who demonstrate commitment to
collective bargaining and to producing
competitive, quality union-made
products 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 an
exhibit booth at the show, which
highlighted union-made products,
services, and jobs. Past shows have
drawn more than 200,000 attendees
interested in learning more about
union companies and products.
AFL-CIO affiliated national or international
unions nominate employers
for the annual Labor-Management
Award. KP was nominated by not
one but three Coalition unions:
■ Michael Goodwin, president,
Office and Professional Employees
International Union.
■ Gerald McEntee, president,
American Federation of State,
County and Municipal Employees.
■ Edward J. McElroy, president,
American Federation of Teachers.
In addition to an exhibit booth, KP
had a health screening booth at the
show that was staffed by registered
nurses from OPEIU and the Ohio
Nurses Association.
Contents
3
No Pain, No Gain
So Far, National Agreement
Work is Real—Yet Not Real
Quick.
6
Catch Me if You Can
A Steward Reflects on
Her Busy Day.
8
Many Hands, One Voice
Spirited Delegates’ Conference
Highlights Organizing,
10
Leadership.
Lemonade Out of Lemons
A Partnership Response to
Big Trouble.
2 | HANK JUNE 2006

No Pain, No Gain
So Far, National Agreement Work is Real—Yet Not Real Quick
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 really
doing it differently this time.
“It” is implementing the 2005
National Agreement for the 130,000-
plus employees, managers, and
physicians covered by the Labor
Management Partnership. The several
hundred employees toiling to make
the National Agreement real have
hundreds of challenges ahead. Near
the top of the list: Convincing folks
at the front line that it is happening.
After all, cynics need only point to
one thing: As of July 1, 15 percent of
the time covered by the five-year
National Agreement will have passed.
While the two things that 86,000
employees probably find most tangible—improved
wages and benefits—
are already in force, and while some
key elements (such as the attendance
program in Southern California) have
been launched, many things in the
National Agreement exist only on the
paper it’s printed upon.
“I think some of the cynicism at the
front line has existed since (the
Partnership) began,” said Will
Clayton, administrative vice president
for SEIU United Healthcare Workers-
West. “People say, ‘I just want to see
something, to feel something.’ We
just have to show the workers that
we are on the road (to implementation)
and we are moving forward.
“We’re further along than we were
in 2000—because we never did anything
like this then,” he adds. “Am I
satisfied with where we are? Of
course not. But I think that it is
progress.”
JUNE 2006 HANK | 3

Converting Agreement
to Action
The trick of course is showing people
what “this” is: The enormous,
programwide effort that 250 employees,
managers, physicians, and Union
Coalition staff kicked off in March to
convert agreement—not just implementing
a plan, but establishing the
Partnership as KP’s operating strategy—to
action in the coming months
and years.
How enormous? When
those 250 people left
San Francisco after
a three-day working
session
March 21-23,
they left behind
16 draft work
plans that
addressed 146
deliverables
spelled out in the
National Agreement
that must be planned
and executed. These are
real projects, planned by real people,
who—because they also have
their day jobs to do—are really busy.
Those Implementation Action Team
members identified many of the
complex issues that will be
addressed across KP to effectively
implement the National Agreement
— for instance, the launch of unitbased
teams, a key building block
for the Partnership. The teams will
also address the roll-out of the new
Attendance program, the details of
two workforce development trusts,
PHOTO: SCOTT BRAILEY
“I’m very
comfortable that
we will achieve
what we need to
achieve—there’s no
reason to think we
wouldn’t.”
the logistics of budgeting and backfill,
performance improvement, and
a host of other issues.
As the Action Teams develop
detailed work plans, KP and Union
Coalition leaders have mapped out a
plan for what gets done when, taking
into account regional priorities.
Based on factors such as whether an
initiative is critical to the work of
other Action Teams, or whether an
initiative has specific deadlines
imposed by the
National Agreement,
or an initiative’s
measurable
return on investment,
the work
of some teams
may get a jump
start.
That all sounds
interesting, and
promising…and
yet so bureaucratic.
Why is this different
than the unevenly implemented
2000 National Agreement?
Bulging Biceps Ahead
Many union and management leaders
acknowledge that the 2000
National Agreement wasn’t fully
implemented. What’s different this
time, they say, is that this agreement
has “muscle”—in the form of the
Kaiser Foundation Health
Plan/Hospitals’ Boards of
Directors—and that muscle has
already put a mighty grip on the
management, Union Coalition, and
medical group executives who have
to report their progress at every
board meeting.
Here’s how it works:
■ The Implementation Action
Teams—frontline workers and
managers, many of whom were
involved in National Bargaining—
were responsible for coming up
with detailed work plans and presenting
them to their leaders by
June 1. Those plans must include
timelines, benchmarks, and metrics.
■ A project management office coordinates
the effort and maintains a
painstakingly detailed “dashboard”
showing which initiatives are on
track, and which are falling
behind. A “green” project is on
track. A “red” project is not—and
stands out like a sore thumb.
■ The LMP Strategy Group—a team
of the top 30 union, management,
and physician leaders across KP—
will review and approve those
work plans in July. Five strategy
group members comprise the
Common Issues Action Team,
which directly oversees implementation
and reports to the
Strategy Group and the KFHP/H
directors.
That gives this implementation the
“muscle” that the 2000 effort never
had. Others prefer to refer to the
process with the A-word:
Accountability.
“I heard the A-word many times
(during National Bargaining),”
Clayton says.
Implementation progress is measured in a
“dashboard”—green is good, yellow warns
of issues, red gets prompt attention.
I see this implementation process as
a big, big part of the A-word. The
Action Teams, the Action Plans, the
dashboard—all of those will all help
with accountability.”
By muscle, or accountability, or by
any other name, the Implementation
Action Teams who met in March
expressed eagerness to finally do
some hands-on work, but also an
overwhelming sense of how much
of a workout they have in store.
Failure Is Not An Option
“We have a heck of a lot of work to
do. I feel a little bit of anxiety; there
are some pretty aggressive timelines
we have to follow,” said Kathy
Petersen, Northern California labor
liaison and the Union Coalition colead
for the Staffing, Budgeting and
Backfill Team. “But it’s not an
option to not get it done.”
There’s certainly the commitment to
get it done, says Catherine Futch,
regional compliance officer in
Georgia and a member of the Scope
of Practice team. “It’s early to say
after just one meeting but there’s a lot
of energy in our team and across all
the teams as a whole, and I expect
that to carry over,” she says. “I’m very
comfortable that we will achieve what
we need to achieve—there’s no reason
to think we wouldn’t.”
The trick, notes Cesar Villalpando,
management co-lead of the staffing
team and executive director of Care
Management in Southern California,
is to get it done within an organization
of KP’s size and complexity.
“There’s a tremendous level of complexity
to our organization and we
need to be thoughtful and practical
in our work to get through the many
layers and layers of the tens of thou-
Rose Cohan facilitates the Joint Marketing
team's work at the March 21-23 Action
Team launch.
4 | HANK JUNE 2006

This just in:
The 2005
National
Agreement
is available
to download
from
the LMP
website!
The PDF, which includes both the
full text of the agreement and all
associated exhibits, can be downloaded
in seconds by web users with
high-speed connections. Dial-up
users can download the document
in less than one minute
Point your browser at
http://www.lmpartnership.org/
today to download the National
Agreement.
Several tools and documents are in
the works that can help you understand
the 2005 National Agreement.
Check www.lmpartnership.org
frequently for updates. We’ll highlight
the latest news in Hank, also.
sands of people without losing the
intent,” he said.
One troublesome byproduct of all
that work, though, is that frontline
employees and managers hear
there’s work going on—but they
don’t see it happening.
Outgoing Union Coalition Executive
Director Peter diCicco addressed just
that impatience when he addressed
the Implementation Action Teams in
March.
“If there is anything we’ve learned in
all the experience we’ve had, both in
the Partnership and otherwise, it’s to
take the time to do the fundamental
work upfront,” he said. “If we do that
right, not only do we do it better, but
we have better outcomes and we do
it faster in the end.”
Frontline employees and managers
involved in National Bargaining last
year apparently are aware of the
great challenge—both to implement
the National Agreement and to
assure colleagues that it’s happening.
An impromptu email survey of all
Bargaining Task Group and Common
Issues Committee members from
National Bargaining 2005 illustrated
this pretty clearly. About 20 percent
of the 350-plus BTG and CIC members
responded, among them frontline
workers and managers, and
Permanente Medical Group employees.
Among the results:
■ 46 percent thought we’d be farther
along in implementing the
National Agreement than we are
today; 41 percent said we’d be
exactly where we are, and only 3
percent thought we’re farther
along than they expected at the
end of National Bargaining.
■ 19 percent said that KP and the
Union Coalition “absolutely” will
fully implement the National
Agreement, while 49 percent said
“probably,” almost 29 percent said
“probably not,” and only 3 percent
said “absolutely not.”
■ 52.8 percent said that their
coworkers were very or somewhat
optimistic about implementation;
41.3 percent said their coworkers
were very or slightly pessimistic.
■ When asked to guess what percentage
of the National Agreement
KP and the Union Coalition will
have implemented by 2010, the
average result was 66.3 percent, or
just less than two-thirds.
■ When asked what factors posed
the greatest risk to fully implementing
the National Agreement,
the most frequent answers were
“inability to release enough
union/Coalition staff for just implementation
activities” (40 percent),
followed by “insufficient union
capacity” (31.7 percent), followed
by “inability to convince managers
to champion the National
Agreement” and “uneven implementation
of National Agreement
by regions” (both 28.3 percent).
KP’s senior leaders leave little doubt
that they’re serious. “If anyone questions
whether Kaiser Permanente is
committed to the full implementation
of the National Agreement, let me put
that to rest,” said Bernard Tyson, who
in January became KP’s senior vice
president for health plan and hospital
operations. “We are fully committed
to it. That is not a question.”
“Truly This Is Showtime”
Lon O’Neil, senior vice president for
human resources at KP, ended the
Implementation Launch with a frank
discussion of how the 2000 National
Agreement wasn’t fully implemented,
and how this time around will
be different.
“In essence, the last seven years
were all about getting ready for
‘now,’” he said. “Perhaps we overpromised
and underdelivered in
2000. We didn’t know what we
VOXPOP
“Build and have a
really good relationship
with your
shop stewards and
business reps.
We’ve been working
closely together
with some of the issues that we
don’t have clarity around regarding
the National Agreement. Also, provide
official communications, in a
timely manner, to just let us know
that issues are being worked on,
and that dialogues are happening.”
Susan Millar
Director, Radiology Services
Oakland Medical Center
“Understand it. If
they don’t understand
they need to
ask questions. Ask
your manager, ask
your union steward.”
Shaifali Ray
Service Unit Manager,
Imaging Services
South San Francisco Medical Center
Hank gets an earful from the
people of Kaiser Permanente…
What’s the one thing that you think
anyone could do, this month, to help
implement the National Agreement?
“As a union member
and a steward
I’m trying to help
educate others
about the agreement.
Because the
medical records
department was hit the hardest
with KP HealthConnect, a lot of
members were nervous about losing
their jobs. We need to work
hard to help them understand how
the agreement protects them.”
Richard Cruz
File clerk and SEIU-UHW West steward
South San Francisco Medical Center
“Get the word out
and promote this
agreement! This is
the best agreement
in the world
and people should
know about it. I
think departments should have an
open forum for their employees
and allow people to ask questions
and get answers.”
Aimeon Holsome
Store Keeper 2, Materials Management,
and chief shop steward, SEIU-UHW West
South San Francisco Medical Center
That’s what others say; let us know what you think. E-mail
Hank at: hank@kp.org. Or fax your comments to 510-267-2154.
needed to know to win. Now, truly
this is showtime.
“We (KP management) are committed
to the National Agreement and
we entered into it honorably, openly,
and with every intent to make
this work,” he added. “Great organizations
learn how to learn, and learn
how to change. We are going to
change and evolve and win. But the
only way we’ll do it is through the
full implementation of this agreement.”
For John Kolodny, a labor leader for
clinical operations in Ohio and a
member of the Performance
Improvement BTG last year, it’s a
matter of applying the “90-10 rule”
and keeping people focused.
“The 10 percent are the hardest to
change. The (other) 90 percent realize
it’s a culture change, and it takes
years to change a culture,” Kolodny
says.
This implementation plan is a huge
step forward, he adds. “I really like
the structure of what they did. Two
responsible people—one labor, one
management. You don’t have to try
to figure out who in the world is
responsible for making it happen.
And you also know who to reach
out to in the regions.”
Pressed to characterize his thoughts
about implementation as either optimistic
or pessimistic, Kolodny says,
“If there is no word in between… I
would say ‘optimistic’.”
JUNE 2006 HANK | 5

C
AT
C
H
Me If Yo
A Steward Reflects on Her
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-onone
sessions with members. She takes her
pager home with her—and keeps it on.
Who’s to say when a shop steward’s
day begins—or ends?
“When I look at my calendar, it just
overwhelms me,” she says with a
laugh.
Minasian’s passion for helping her
co-workers is obvious. Her strong
belief in the Labor Management
Partnership and commitment to her
role as union advocate are equally
evident. She says it comes from a
lifelong desire to stick up for the
underdog.
“When I was growing up, when kids
at school were being picked on I
would always stand up for them,”
she says. “It wasn’t fair for someone
bigger to attack someone smaller. If
they didn’t have a voice I would try
to be their voice for them.”
Later in life, working for different
employers before coming to Kaiser
Permanente, she always spoke her
mind. “If you don’t speak up [about
an injustice], nobody is going to
know,” she explains.
When she walks the halls of the
hospital she could be mistaken for
the mayor of the medical center
rather than a working phlebotomist,
as she’s known to just about everyone
from hospital administrators to
EVS workers, many of whom seek
her advice.
Her colleague and co-chair of the
Woodland Hills stewards’ council,
Kathy Gayle, says the two are
“joined at the hip.”
“She’s one of those people who are
extremely articulate, fair, and able to
pull the layers of the onion apart to
get the heart of the matter,” says
Gayle, an LVN in the pediatric
department. “She gets to the root
causes [of an issue] more than most.”
6 | HANK MAY 2006

u Can
Busy Days
photos by Robert Gumpert
Gayle says Minasian is not just a comrade
in arms but also a friend. “She
holds a confidence and is funny as all
outdoors. She makes me laugh.”
A Union Partner Respected
by Management
Minasian is equally respected by her
management partners. “She’s an
incredible gift to the medical center
as far as her Partnership approach,”
note Cathy Casas, who “tri-chairs”
the Comprehensive Workplace
Safety Management Program steering
committee with Minasian and another
labor partner. They also work
together on the Comprehensive
Performance Improvement Project
(CPIP) and other LMP efforts.
Of course, the two have at times
found themselves on opposite sides
of an issue. But Casas says her labor
partner never makes it personal and
often is able to see an issue from
different perspectives. She says the
two have a pact to “agree to disagree”
and not assume that one is
right and the other wrong. At the
same time Minasian is known as a
staunch advocate for the interests of
her fellow union members.
Despite the high praise from her
partners in both the union and management,
there aren’t many who
would trade places with Minasian
because of the heavy load she carries.
She advises newer stewards,
and admits that there is a shortage
of stewards at Woodland Hills, like
most places.
A Mentor to Her Peers
A typical day for Minasian is all
about people. Recently, despite
punching through her voicemail first
thing in the day, by lunchtime she
had a dozen messages waiting. A
few were logistical: a film crew was
coming to the hospital looking for
frontline workers to interview about
attendance; a colleague wanted to
know if a meeting was still on. But
the rest involved counseling coworkers.
For example, she was scheduled to
represent a union member in an
issue resolution. And a young colleague
in the lab was concerned
about a dispute with a co-worker
that had escalated to the department
manager. Minasian met in person
with her colleague and counseled
the lab employee to try to work out
the conflict directly with the coworker.
She drew on her knowledge
of the National Agreement and local
contract, labor law, issue resolution
skills, and a host of other
Partnership tools, but she says the
tools she reaches for most are her
compassion and her good sense
about people. If the manager were
to get further involved, Minasian
told her co-worker, “Don’t hesitate
to call me, I can go into the meeting
with you.” The young lab worker
was clearly reassured.
Do Stewards Have a Life?
Minasian insists that she is not all
work and no play. But she also sees
herself as a victim of her own competence.
“The motto here is ‘the
more you do, the more you get
asked to do,’” she says. But she
makes sure that she takes vacations
and makes time for friends and family.
Her load at home is easier now
that her 20-year old son is grown,
though he’s still living at home while
attending college. Minasian has been
a single mother since her son was
three. She says he doesn’t say much
about her steward work, but she
knows he notices her accomplishments.
“He’s impressed by what I’ve
done, what I’ve achieved.”
Despite the challenges, Minasian
says she cannot imagine life any differently.
“I can’t see myself not educating
[people] or not involved in
helping 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.
MAY 2006 HANK | 7

Many Hands,
One Voice
Spirited Delegates’ Conference Highlights Organizing, Leadership
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.
It was the start of a Union Coalition
delegates’ conference unlike any
other.
Held March 31 to April 2 in Los
Angeles, the annual conference
drew 600 delegates, staff, and visitors
who learned about everything
from implementing the National
Agreement to the fundamentals of
organizing at the front line.
It was a different kind of conference
for the Coalition of Kaiser
Permanente Unions. It anticipated a
future without diCicco, who had led
the coalition since its formation in
1996 as 30 unions learned to work in
collaboration, the basis of the conference’s
“Many Hands, One Voice”
theme. It was bigger, with 200 more
delegates than normally attend the
annual conference. It featured
keynote speakers and workshops
about leadership, workplace mobilization,
and union priorities such as
unit-based teams, staffing, workforce
development, and attendance.
And it launched an ongoing coalition
campaign with clear objectives:
■ Expand union capacity.
■ Identify what a successful implementation
looks like for union
members.
■ Mobilize the 86,000 members of
the coalition to implement the
National Agreement, something
union delegates, through a preconference
questionnaire, said
they feared could be undermined
by barriers ranging from management
inattention to inadequate
staffing to “frontline workers not
understanding how the National
Agreement affected them” and
“labor not being a team player.”
The conference also introduced
new leadership on both sides of
the Partnership. Delegates heard
from Bernard Tyson, the newly
appointed senior vice president of
health plan and hospital operations
and LMP executive sponsor, who
gave a ringing address to delegates
who had grown comfortable with
Leslie Margolin, whose long-time
commitment to the LMP was constant
and obvious. The conference
also heralded the arrival of new
Union Coalition Executive Director
John August, a former line worker,
steward, and local union president
who went on to serve as a harddriving
health care organizer and
leader for several international
unions.
Winning Solidarity
August pledged to assume his
duties, if not at warp speed, then
quickly. “The way I plan to learn is
to learn from you,” he said during
his keynote speech. “I’m not going
to start slow; we’ve got to hit the
ground running and make things
work.”
As on other occasions, August complimented
union leaders for their
long-standing coalition and noted
that they seem to defy nationwide
trends that have employers’ winning
pay and benefit concessions to
improve market positions. “While
Kaiser Permanente is engaging in
Partnership, the rest of the country
is going in the exact opposite direction,”
he said, followed by the more
ominous “Consequently, we are not
only leaders, we are a target.”
August spent the conference learning
from delegates as he talked oneon-one
with them, joined them at
meals, on the dance floor, and at a
celebration for diCicco. He also led
a well-attended workshop on organizing
that emphasized the basics of
mapping worksites, assessing union
commitment, and collaborating to
solve problems.
8 | HANK JUNE 2006

PHOTO: ROBERT GUMPERT
“Pick something winnable,” he
advised during the workshop.
“People think they have to take on
huge battles. Small victories are
important. Sometimes you win solidarity
one person at a time.”
Breathing Partnership
diCicco deservedly basked in tributes
and picture-taking as he
entered semi-retirement. He intends
to continue to advise the Union
Coalition and Kaiser Permanente.
“Peter breathes, eats, sleeps the
Partnership,” said Jaki Bradley, a
member of the UFCW Local 400 and
a nurse practitioner at the North
Capital Medical Center in
Washington, D.C.
“He gave us all a great sense of
hope and confidence about the
Partnership,” said Marti Batchelder, a
psychiatric social worker at the Point
Loma (Southern California) Medical
Clinic, and vice president of SEIU
Southern California Mental Health
Providers Local 535.
But before the roasts and toasts
began, diCicco sounded fire and
brimstone on the first day of the
conference as he discussed accountability.
“One of the big differences
between 2000 and 2005 is our
approach to implementation,” he
said. “To make sure people are
engaged on the work level in implementation,
we must hold management
accountable. Believe me,
they’ll hold us accountable.
Management must adequately budget,
must adequately communicate
the importance of the agreement,
and must support it as a business
strategy if it is to succeed.
“That’s why we need to mobilize,”
he said. “We need to exert pressure
from the bottom up to match the
pressure that’s coming from the top
down. Acting together and speaking
with one voice need to be more
than just words.”
All Roads Lead to Unit-
Based Teams
More than 70 delegates attended the
workshop on unit-based teams, what
workshop co-leader and Union
Coalition National Coordinator Steve
Francy likes to call “the mechanism
of a democratic workplace.” Unitbased
teams are the ultimate vision
of the Partnership, promising to support
increased participation and
transform the traditional roles of
stewards and supervisors so they act
more like frontline leaders, coaching
and mentoring their colleagues as the
team tackles workplace issues. All
roads lead to the unit-based team.
The National Agreement requires the
teams to be established in every
department by 2010, so Francy and
his colleagues used the workshop to
solicit advice about the teams.
Participants suggested standards to
help create a common employment
experience among the regions and
noted that staffing and backfill were
the major barriers to unit-based
teams, a reality borne out by the
Northwest’s experiments with teams.
Backfill is a huge problem in the
Northwest, says Kate Pingo, a coalition
partnership representative originally
from SEIU Local 49. Union
members face additional requirements
to complete six courses of
training, including Partnership
Orientation, Interest-Based Problem
Solving, and Maps I and II before
they can participate. There’s no
streamlining for them.
But they have learned a valuable
lesson. Originally their unit-based
teams were based on a representa-
CONTINUED ON PAGE 11
PHOTO: ROBERT GUMPERT
Bernard Tyson, left, and John August, center, chat with Peter diCicco.
NEW LEADERS FOR LMP
Tyson, August Take
the Reins
Two executives, one a Kaiser Permanente veteran and one a longtime
national union organizer, have taken over executive sponsorship for the
Labor Management Partnership as National Agreement implementation
moves to the front burner.
On the Kaiser Permanente side, Bernard J. Tyson has taken over as senior
vice president of health plan and hospital operations. In late January
Tyson succeeded Leslie A. Margolin, who resigned from KP after leading
Common Issues Bargaining 2005 and other key initiatives.
For the Coalition of Kaiser Permanente Unions, 30-year organizing veteran
John August took over as executive director as of April 10. He succeeds
Peter diCicco, the founding executive director of the Union
Coalition when it was created in 1996.
These two appointments are critical because, as union and management
executive sponsors of the LMP, August and Tyson will work closely
together to lead the implementation of the National Agreement and all
other high-level LMP initiatives. August and Tyson also both serve on
the Common Issues Action Team, which must report periodically to the
Kaiser Foundation Health Plan/Hospitals’ Boards of Directors and the
Union Steering Committee regarding the National Agreement.
Tyson is well versed in both the LMP and KP operations, as he has held
several nationwide executive posts in the organization. Most recently he
was senior vice president for brand strategy and management; the
“Thrive” image advertising campaign was launched under Tyson’s leadership.
He started in KP in 1985.
August comes to the Coalition from a 30-year career in union management
and organizing. As diCicco said in his note introducing August,
“From coast to coast and many points in between, [August] has organized
and represented social workers, bus drivers, airline mechanics and
flight attendants, school employees, printers, and virtually every type of
worker in hospitals as well as nursing homes and home care.”
Most recently, August served as deputy director of the SEIU’s Health
Systems division. August started April 10; however, his unofficial coming-out
party came March 31-April 2 at the Union Delegates Conference
in Los Angeles (see story, this edition, page 8)
JUNE 2006 HANK | 9

FIELD NOTES
LEMONADE OUT
OF LEMONS
A Partnership Response to Big Trouble
In May 2005 alarm bells rang in executive suites
across Kaiser Permanente.
An audit of KP’s fee-for-service
billings to Workers’ Compensation
and government payers had
revealed serious problems in billing
systems in California and elsewhere.
Chairman and CEO George
Halvorson ordered the systems shut
down until the problems were corrected.
That meant turning off the
tap in California on about $114 million
in 2005 billings. Few people
predicted a happy ending.
“People were shocked by the auditors’
report,” recalls Robert
Hochberger, LMP National
Coordinator and then the regional
LMP co-lead for Southern California.
“It had huge implications, in terms
of financial impact on the company
and for the hundreds of people
working in those [billing] jobs.”
“We didn’t know what to expect, or
how we would approach a solution,”
says Patti Harvey, RN, director
of risk management and patient
safety. “There was a sense of foreboding
about what it would mean
for us and our positions.”
Heads rolled. Right?
Wrong.
What happened instead was a Labor
Management Partnership initiative to
fix the problem and retrain hundreds
of employees and managers. Since
January, Southern California has
begun to gradually resume its nongovernmental
billings. And, rather
than shipping off jobs to an outside
service, KP has retrained frontline
staffers and created new employment
opportunities in the region.
“There was no finger-pointing or
blaming or punishment,” says Kathy
Weiner, senior project manager in
Southern California. “Labor and
management shared an interest in
fixing the problem, and dealt with it
in a cooperative way.”
As a result of this joint problem
solving, the Southern California
region has
■
Developed a skilled force of
billers and coders
■
Created a new
career path for
employees and a pipeline for
hard-to-fill positions
■ Introduced new systems that allow
KP to submit bills in compliance
with all regulations.
In Northern California and the
Northwest., which had similar billing
issues, union and management leaders
are likewise digging in to solve
the problem together.
Follow the Dollar
As part of Kaiser Permanente”s
Compliance program, KP hired
accounting firm
PriceWaterhouseCoopers to audit
billing systems in Northern and
Southern California, and other
regions.
At issue was KP’s billing procedure
for services to nonmembers or to
members covered by third parties,
such as Workers’ Compensation
insurers. Most health care providers
use certified medical coders—often
from outside companies—who
review every medical procedure performed
and assign the correct code
from several thousand choices for
inpatient and outpatient services.
The industry standard is then for
employees in a separate department
to generate the bill. However, with
fee-for-service business representing
a very small percentage of KP’s total
revenue, most regions had not
invested heavily in these systems. As
a result, billing agents in California
did double duty as coders—a potential
conflict of interest in the view of
the auditors.
The solution—to separate the billing
and the coding functions—was obvious,
yet far from simple. It involved
creating a new job classification,
providing specialized training, and
devising a clear process for allowing
employees to apply for the higherskilled,
higher-paying coding jobs.
Making It Work
Even before the suspension of billing,
Southern California Chief Operating
Officer Greg Adams suggested that a
regionwide senior group of union
and management leaders join to hammer
out a solution.
“It was clear to me from the beginning
that the issue had significant
implications for the organization and
for our employees,” Adams says.
“We needed to move to correct the
problem with determination, speed,
and alignment. I never secondguessed
the Partnership as the way
to tackle the issue.”
Union Coalition leaders also pushed
for a broad-based group, including
frontline workers and supervisors, to
work the problem. Ultimately a
Billing Steering Committee formed,
with more than 40 managers and
staff, including members of SEIU
United Healthcare Workers-West,
OPEIU Local 30, and United
Steelworkers Local 7600.
10 | HANK JUNE 2006

“We had senior institutional labor
leaders involved in the work from
the beginning,” Adams says.
“Expanding the work group to
include frontline workers and
supervisors was ultimately the key
to our success. They had the
opportunity to understand the
problem and to engage with senior
management and senior labor leaders
as thought partners in identifying
solutions.”
“The crisis forced both sides to sit
down together and figure out how
to get things up and running
again,” Hochberger adds. “Union
members themselves understood
the need to separate billing from
coding, and agreed that the coders
should be certified [by an outside
agency]. What had to be worked
out was the best way to provide
opportunities for training, how to
build the infrastructure, make the
necessary system fixes—everything.”
The steering committee agreed on
a comprehensive, 23-day training
program for coders: 10 days of
coding basics, 5 days of skills
evaluation, and 8 days of preparation
for the certification exam. The
cost of the training—including
release time, program development,
and delivery—exceeded
$500,000. That investment has
paid off. To date, 117 of 135
employees have been certified by
the American Association of
Professional Coders. That’s a pass
rate of 87 percent, far surpassing
the national average of 65 percent
for the AAPC exam.
“Our pass rate shows that we have
excellent people,” says Bertha
Aviles, regional director of Patient
Business Services. “Frontline staff
and managers from across the
region came together in partnership,
were very committed, and
were able to raise the level of performance
of the organization.”
It was an emotional experience
for employees who took the
exam. “The training was very
intense, but it was first-class,” says
Dannielle Estrada, a cancer registrar
and UHW steward at Baldwin
Park Medical Center. Her job was
being eliminated due to a reorganization
of the Southern California
cancer registry, and though she
was assured of a comparable position,
thanks to the Employment
and Income Security Agreement,
she was not happy about the
change. However, medical coding—something
she’d studied
before joining KP nine years
ago—was appealing. “It’s important
work, and an opportunity for
a new start,” she says. “Training
and promoting from within was
the right way to go.”
Building New Skills
As certified coders began their
work, the region faced another
hurdle: digging out from an enormous
backlog of bills. By
November 2005, with most of the
billing system still paused, nearly
17,000 bills were waiting to be
issued to customers. State Workers
Comp insurers demanded that KP
significantly reduce that number—
fast. The steering committee set a
target to cut the backlog by more
than half—to 7,500 bills—within 30
days. At the time it took more than
60 days, on average, to turn
around a bill.
Union and management leaders
agreed on a way out of the
morass that included voluntary
overtime, borrowed staffing from
regional medical centers, and temporary
outsourcing. “No one was
really sure it was doable,” says
Hochberger. But within 30 days
they beat the target, cutting the
backlog to less than 4,000 bills.
As a quality control measure, the
Southern California region is using
an outside consulting firm to
review the accuracy of State
Workers Compensation bills.
So far, the story is a win-win—and
is having an impact beyond the
billing and coding departments.
For instance, the initiative will
become “a platform for launching
unit-based teams in local service
areas, to help set directions and
priorities and resolve other workflow
and workplace issues,” says
Aviles.
“We see what’s possible when KP
and the unions work together,”
says Dannielle Estrada, who admits
to being skeptical about the
Partnership in the past. “We could
have these kinds of successes more
often, but both sides have to
believe it’s possible, and be willing
to work at it.”
ONE VOICE
CONTINUED FROM PAGE 9
tional model, but they discovered it
was more of the same with only a
few staff participating. Only when
they used a democratic model did
they fully engage frontline workers
and supervisors.
“If you keep it [the unit-based team
structure] in the representational
model, nothing changes,” says
Pingo. “As long as people have a
voice in how they do their work,
they feel they are part of the
Partnership. People all want to be
involved or they cannot see or feel
or understand our Partnership.”
Or resolve attendance problems.
While Francy and Pingo discussed
unit-based teams, Walter Allen, executive
director of OPEIU Local 30,
and Ralph Cornejo, SEIU UHW-West
Kaiser Permanente staff director,
stressed accountability in one of two
workshops on attendance.
Making Attendance Work
The average KP worker takes off
more time than workers employed
by other health care providers,
reported Allen. And the average
KP worker carries only nine days
in a sick bank, a number small
enough to be only incidentally
helpful in the face of a serious
illness or accident.
Cornejo provoked a discussion about
why people call in sick—short staffing,
illness, burnout, poor scheduling, poor
management, unsafe working conditions,
a second job, entitlement—
before examining how to turn the
tables. Participants mentioned the
need for backfill, and the importance
of educating workers about how calling
in sick affects the entire staff.
Changing the work environment, providing
incentives, and applying discipline
were mentioned as solutions.
“We’re on a team. If you don’t like
the team, if you’re out sick chronically—don’t
bring down the rest of the
team,” said one of the participants.
Then they discussed attendance language
in the National Agreement: flexible
personal days for most unions,
front loading of sick days at the beginning
of the year instead of accrual
over the course of the year, and the
ability to cash out unused sick days at
50 percent of their value once a worker
has banked 10 days of sick leave.
The final provision, said Allen and
Cornejo, means that workers can add
to their take-home pay at the end of
the year by using sick leave wisely.
“At the end of the day, it all boils
down to accountability,” Cornejo
said. “We will change the culture.
We won’t change it overnight,
but we can make progress, incrementally.”
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