The late Henry Kaiser once said, "Problems are opportunities in work clothes." Were he to observe the stalemate in contract talks between the California Nurses Association union and Kaiser Permanente in Northern California, I suspect he'd tell us to put on our work clothes.
Unfortunately, union leaders stay away from the bargaining table, preferring to falsely claim Kaiser's patient-care standards are dropping, while contending that only their union stands between patients and a "money-mad management." Nothing could be further from the truth, which you would never know from the CNA's publicity war.
Sadly, while union leaders carry on this war and refuse to bargain over wages, benefits and working conditions in any productive way, they also keep themselves from the table where the rest of the healthcare team is working hard on sustaining as well as improving high-quality patient care and service.
As for bargaining issues, Kaiser's current contract with the union, based on independent surveys, offers the highest wages and benefits in healthcare, including an average hourly wage of $29.76-up to 40% higher than nurses working down the street in some Northern California markets.
Therefore, Kaiser is not offering an across-the-board wage increase as it has in the past. Instead, to help bring compensation in line with the marketplace, 60% of our 7,500 nurses would see a four-year pay freeze followed by 1% raises in each of the fifth and sixth years, as well as up to a 2% increase each year in performance pay based on patient satisfaction. The rest would see 2.5% annual reductions in base pay and up to a 2% increase each year in performance pay. This compensation package would be competitive in our marketplace.
That said, consider how CNA leaders respond-not at the table, but in their sound-bite war.
Union sound bite: "Kaiser is doing away with registered nurses because they are the last line of defense for patients."
Facts: There are more nurses per patient today than three years ago. Kaiser, because of the declining use of hospitals due to medical advances, has reduced its Northern California hospital nursing work force about 15%. However, the number of patients in our hospitals has decreased 19%. Thus, the ratio of nurses to patients is up. In addition, we also have increased home health nurses by 57% in the past three years.
Union sound bite: "We're at war with Kaiser*.*.*.*because of the phenomenal erosion of patient care."
Facts: When the Joint Commission on Accreditation of Healthcare Organizations accredited our hospitals last year, one in four received "accreditation with commendation"-compared with one in 10 nationwide.
When Newsweek magazine surveyed health plans last year, Kaiser in Northern California earned four stars-the highest rating-for quality and for service.
And when the Pacific Business Group on Health surveyed thousands of employees and retirees in California in 1995, Kaiser won the best customer-satisfaction marks.
This isn't to say we don't-or won't-have problems like any human organization. But to falsely claim a "phenomenal erosion of patient care" is grossly irresponsible.
So why the disconnect? One answer came in a recent report in the San Jose (Calif.) Mercury News.
"Hospitals are the railroads of healthcare," James Robinson, a University of California at Berkeley economist and professor of public health, told the newspaper for an article about the CNA's one-day strike against Kaiser in March. "Railroad workers fought for 100 years against declining employment in railroads as people shifted to driving cars and flying planes. . . . We can be sympathetic to people who are facing employment concerns, but to say this is a quality-of-care issue is a stretch of the imagination."
Like the railway unions, the CNA has decided to fight an all-out war against changes in healthcare that neither the union nor Kaiser can alter.
The CNA could, however, follow the more thoughtful course of the United Nurses Associations of California, an AFL-CIO union that represents about 5,000 Kaiser nurses in Southern California. The UNAC accepted a contract more than a year ago that is virtually the same as what is proposed in the north.
I will not say the Southern California nurses are happy with the contract. It's a difficult one. But it does represent a realistic approach to the myriad problems facing healthcare. While the UNAC dealt with marketplace realities around wages, benefits and working conditions in its contract, the AFL-CIO and Kaiser nationally have developed a labor partnership agreement that, having been approved by the local unions May 31, will create joint partnership committees of managers and union representatives.
These joint partnership committees will work on solving the larger issues that go beyond labor contracts. They will jointly review and discuss future Kaiser business plans that affect union members. Most important, these teams will work on the key business decisions that will preserve and improve our existing high quality as well as work together to upgrade services and affordability for our health plan enrollees. In short, our proposed national partnership with labor has everything to do with quality.
This partnership with organized labor is the next logical step in what we said publicly several years ago in opening bargaining on our labor contracts in California-that we will stand by our historic, 50-year partnership with labor even as we deal with harsh competitive realities.
Unfortunately, the CNA union rejects this idea. As it did when it broke with other unions over a healthcare ballot measure last year in California, it increasingly goes its separatist way. We, meanwhile, look forward to joining representatives of the rest of the union work force in California to get on with the work ahead.
Debley is Northern California media relations manager for the California division of Kaiser Permanente.