Cover

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Title Page, Copyright

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Contents

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p. vii

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Acknowledgments

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pp. ix-xi

When leaders of the Kaiser Labor Management Partnership first approached us about studying their experiences, we had no idea the project would turn into an eight- year effort, much less this book. We are grateful to the initial leaders of the partnership and to their successors for giving us free reign to explore and document their experiences without conditions. Special thanks are due to the early partnership...

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1 To Fight or Talk?

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pp. 1-7

The union leaders came prepared for a fight on that cold December day in 1995. They represented a coalition of twenty- seven unions and 55,000 workers employed by health care giant Kaiser Permanente (KP), the nation’s leading not- for- profit health maintenance organization. Both sides faced enormous pressures—and an enormous choice. At the time, Kaiser was losing more than $250 million and was being advised by a management con sul tant to break itself up and to take steps to better match the cost structures of competing HMOs...

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2 Partnerships:Great Challenges, Greater Opportunities

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pp. 8-24

The issues that engaged Peter diCicco and David Lawrence in 1995 in Dallas were symptomatic—then and now—of a crossroad facing U.S. labor-management relations. To put it bluntly, the nation’s labor law is broken.1 Workers who want to join a union face enormous hurdles. Relations between labor and management have become increasingly adversarial, less innovative, and less responsive to what workers want...

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3 To Fight or Partner: Forming the Partnership

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pp. 25-49

Against such an uneven history of labor- management partnership success and with federal labor law increasingly working against organized labor, establishing a labor- management partnership between a coalition of twenty-seven unions and an organization as complex as 8.6 million- member Kaiser Permanente (KP) was no easy task. This was especially so because the choice to partner rather than to fight was made in an environment..

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4 Early Challenges, Early Wins—But More to Do

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pp. 50-64

The structure—and hopes—for the Kaiser Labor- Management Partnership (LMP) were now in place. Now the challenge was to convert promise into measurable progress. That challenge was complicated by the financial pressures on Kaiser, which lost more than $250 million in 1997 and again in 1998. As Kaiser began a pro cess of retrenchment, resources became scarce for implementation of the partnership. Further complicating the picture was the structure of Kaiser, which had a strong, ongoing...

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5 Slow Diffusion

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pp. 65-86

Given some early successes such as Baldwin Park, the partnership began to face perhaps inevitable growing pains. Despite strong support from top management as well as physician and union leaders, the partnership did not diffuse smoothly or widely throughout the decentralized Kaiser regions or operations over the first decade of its existence. Nor did the parties have great success in transforming the image and identity of the partnership from an effort to improve labor relations and...

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6 Negotiating in Partnership:The 2000 and 2005 National Negotiations

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pp. 87-122

A major question facing labor and management is the relationship between a partnership and their collective bargaining pro cesses. Do contract negotiations proceed as usual? Do partnership activities go into some sort of holding pattern? Do the parties go to the other extreme and find that formal contract renegotiations are no longer needed? In short, how do these two different processes co- exist and influence each other...

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7 The Union Coalition

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pp. 123-149

Ten years after its founding, the Kaiser union coalition was still together. It weathered countless internal debates over policy and structure; three rounds of bargaining in which internal negotiations were nearly as intense as negotiations across the table with Kaiser management; a break- up of the national federation (AFL- CIO) that left coalition member unions on both sides of the split; and a transition in leadership. If, as a large body of theory and...

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8 Leading in Partnership

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pp. 150-174

To make this learning laboratory, and thus the partnership itself, succeed would require not just any, but a special kind of leadership. This chapter examines what it takes to lead a partnership—and what leading in partnership at Kaiser Permanente (KP) suggests about the type of leadership needed in modern, decentralized, and networked organizations, particularly in a health care setting. The very phrase, “leading in partnership...

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9 Partnership and Health Connect

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pp. 175-190

George Halvorson saw an opportunity to lead the nation in electronic health records (EHR) technologies when he joined Kaiser Permanente (KP) as CEO in 2002. In Epidemic of Care, a book he co- authored with George J. Isham, Halvorson wrote, “Real improvement in the quality and consistency of care will require the use of automated medical records that give doctors and patients full information about care and care systems...

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10 Partnerships on the Front Lines

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pp. 191-202

If strong and creative leadership was essential to the success of the partnership, so too was the involvement of front- line workers. That engagement was especially important in achieving the first two goals in the list of partnership objectives: to improve the quality of health care for Kaiser members and communities; and to help Kaiser achieve and maintain market- leading, competitive performance. Such goals reflected the partnership’s....

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11 Scorecard

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pp. 203-226

From the start, partnership leaders have sought to build measurement and evaluation into the effort. Indeed, one of the first committees formed in 1997 was the metrics committee; in 2008, resources continued to be dedicated to substantive, quantitative evaluation of the partnership.1 In this chapter we present the best data available within and across regions to assess progress to date in some of the major indicators related to goals established in the 1997 partnership agreement. None of these...

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12 Partnerships: The Future

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pp. 227-240

As we write this the United States once again appears to be on the brink of trying to address the crises in both labor relations and health care that we used to motivate this study in chapter 2. Thus, it is fitting to use this final chapter to first summarize what we have learned from our study of the largest and most complex labor- management partnership in U.S. history and then to draw out implications for the coming debates...

Notes

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pp. 241-248

Index

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pp. 249-258