Saving for Retirement: Advice for Young (and Not-So-Young) Workers

The US Department of Labor blog recently included a post entitled “Saving for Retirement: Advice for Young Workers.” The piece illustrates how investing earlier in your career pays off in a big way. 

In their “Top 10 Things Everyone Should Know about Saving for Retirement,” lifehacker.com describes the payoff of long-term investing a little more boldly: “Compounding interest is so powerful it’s almost magical.” Their Top Ten list includes a number of tips, tools, and useful resources.

Among other things, Lifehacker advises readers not to miss out on an employer’s matching contribution. That advice becomes even more valuable for SHARE members next year, when UMass Memorial doubles its match, as described in the Pension Reform section on page 3 of the most recent SHARE-UMMHC Contract Agreement.

Union-Management Partnership: the Kaiser Permanente Approach

SHARE reps at Memorial talking with KP leaders

Earlier this month, Walter Allen, a representative of the Coalition of Kaiser Permanente Unions, asked SHARE leaders to imagine a meeting of hospital employees . . . and then to imagine the roles blurred so you couldn't pick out who among them was a manager. At Kaiser Permanente, Walter explained, their Labor Management Partnership (LMP) is creating this kind of culture. Employees and managers in their hospital network train up together to work side-by-side in partnership, to handle operations and make decisions at every level and throughout the entire system.

A UNIQUE MODEL of UNIONISM

SHARE invited KP representatives from Kaiser Permanente’s Labor Management Partnership to come speak with our own EBoard and Reps (as well UMass Memorial's executive leaders and members of the hospital's Labor Management department), because their organization can claim one of the largest and longest-running Labor-Management partnerships in the country. (The Union Coalition itself consists of roughly 110,00 members.) Because that partnership has had made measurable improvements on the care-giving, culture, morale, quality, and profitability of their hospitals, we believe we have much to learn from their experience. Walter, along with a management counterpart from the LMP, Marie Monrad, gave us a lot to chew on.

This visit was part of a SHARE effort to understand what’s working out there, in the broader worlds of healthcare and labor, as we prepare for our upcoming contract negotiations. We want to change how it feels to come to work every day. We know that we need to replace the “command-and-control, shame-and-blame” culture that exists in so many departments. That change is essential for the long-term health of SHARE members, of our SHARE union, and our hospital. We know that those improvements will translate into a better environment for our patients, too. Walter and Marie came to help us think about whether and how deeper Labor-Management partnership could work for us toward those goals in our hospital.

Walter Allen and Marie Monrad from Kaiser Permanente with Nancy Bickford and Bobbi-Jo Lewis of the SHARE EBoard

UNIT-BASED TEAMS

A key feature of Kaiser Permanente’s approach to partnership is the Unit-Based Team, or UBT. They define the UBT as “a group of frontline employees, managers, physicians and dentists whose work brings them together naturally and who collaborate with one another to improve member and patient care. They are accountable for the performance of their unit and determine the methods and metrics of their performance improvement projects."

One thing that appealed to many SHARE leaders about the UBT model is that the teams required to hold certain principles in balance as they make decisions. So, when UBT's decide the best, most affordable quality and service, they continually balance those choices with their own interest in making Kaiser Permanente the kind of place where they want to work.

Marie Monrad (Vice President for Strategy and Operations Office of Labor Management Partnership, Kaiser Permanente), Walter Allen (Executive Director/CFO Local 30 & International Vice President Office & Professional Employees International Union, Coalition of Kaiser Permanente Unions), and Janet Wilder (SHARE Organizer)

THE ONLY CONSTANT IS CHANGE

Hospital system leaders at UMass Memorial are also researching a variety of options with the intention of transforming our hospital. Many SHARE members are already affected in their day-to-day work by the coming move to replace our current Information Technology system to EPIC.  And you may also remember that SHARE leaders have accompanied UMMHC leaders on visits to a Thedacare Hospital in Wisconsin, and have sat in sessions together at the Institute for Healthcare Improvement conferences, the largest gathering of its kind.

If this talk about transformation provokes in you some serious questions--about both your union and your employer--that’s good. Many SHARE members can remember a variety of “flavor-of-the-month” consultants brought in by previous hospital administrations to teach employees some method of improvement. Some of these efforts were better, some worse, and none of them fit deeply enough with our culture to last for long. Any solution that works for UMass Memorial is going to have to be home-grown, and everyone here must be involved.

DOING IT OURSELVES

The management-side representative from Kaiser Permanente, Marie, had only good things to say about their unions’ participation. While in Worcester, she made the case to UMass Memorial leaders that partnership was far more productive than the intense labor management fighting and adversarialism that had driven their hospital system to find this new approach in the first place.

SHARE believes that an employer needs a strong partner in order for partnership to be successful. A critical component to any employee engagement strategy is that the front-line workers need to be safe to participate.  A good employer can and should respect employees, but any employer’s goodwill and benevolence has its limits. Employees require their own, independent source of power.

Over the years, SHARE has developed an understanding of the real work needed to engage members in decision-making. Walter and Marie were insistent that the deep commitment to partnership at Kaiser Permanente often requires extreme effort, too. SHARE is going to have a lot of work to do if our next negotiations is going to maintain the kinds of raises and benefits that we’ve all come to expect, and, too, develop new structures that will change how it feels to come to work every day. There's much to figure out. We intend to do this right. And we’re going to do this together.

If you'd like to learn more about Kaiser Permanente and details about their Labor Management Partnership, you can ask your SHARE organizer or local rep what we've discussed, or contact the SHARE office. There are also a number of resources with information on the subject:

• Healing Together: The Labor Management Partnership at Kaiser Permanente is a book written by a group of academics who studied the partnership.
• The Labor Management Partnership itself has a robust website. Among other things, it includes: 
• Kaiser Permanente's definition of partnership
• The unique history of the partnership
• A series of videos like the one above in which frontline employees describe their experience with Partnership
• Information about Unit Based Teams
• Their unions' current and complete national contract agreement
• The Coalition of Unions maintains its own website. In addition to summaries of the contract agreement, this site includes:
• A history of the Coalition
• A full list of the participating unions
• A handout summarizing how partnership is designed to keep problem-solving local
• And, of course, more information about member hospitals and health insurance plans can be found in this brief snapshot of the organization and throughout the main website for Kaiser Permenente

Solving Problems between Departments: Pediatric Administration, Pediatric Scheduling, and Referral Management

When a department first puts an idea board up and begins to hold weekly improvement huddles, they are often encouraged to focus first on the problems that are entirely within their “span of control”: those things that the department can fix quickly and cheaply without another department needing to get involved.  But we all know that many of the biggest, most frustrating barriers that caregivers here at UMass Memorial face are between and across departments.  These problems can be very hard to fully understand and fix, but like any other problem, the people who are best placed to fix those problems are the ones at the frontline, doing and experiencing the work.

The Background to the Story

SHARE Rep Maria Wentworth and the idea board she helped start

SHARE has been working intensively over the last several months to bring all the idea boards in Patient Access Services at the Worcester Business Center up to 5 star status, including the pediatrics schedulers and referral management.  As it turns out, SHARE has also begun coaching a newly re-launched idea board with the Pediatrics admins at the university campus (championed by SHARE rep Maria Wentworth, among others).  At the huddles, SHARE Organizer Will Erickson heard Pedi admins voicing concerns about both the process for scheduling pediatric appointments and patients showing up for appointments without a completed referral. Will offered to facilitate an idea board visit, bringing one of the admins over to the WBC to attend the huddles there.  The two departments at the WBC embraced the idea (with the schedulers even agreeing to change their huddle time to make it more convenient for their guest to attend). 

Visiting another Department's Idea Board Huddle

 A little over a week later Jess Kowaleski, the lead for the admins, began her day at the WBC, a building she hadn’t previously visited.  First came the schedulers’ huddle, where she heard about how difficult it can be to schedule certain appointments, and answered questions from staff about the best way to escalate scheduling issues.  It was their best attended huddle ever, and several new ideas resulted from their conversation.  Later, after attending the PAS management huddle, getting a tour of the ten or so idea boards on the 5^th floor of the WBC, and checking out the IS visual management system on the 4^th floor, Jess attended the referral management huddle.  At that huddle Jess heard about many of the problems the staff there face, as well as things the Pedi admins can do to make it easier for a referral to be completed (such as sending a task rather than an email).  Jess even hung around afterward to observe SHARE member Jackie McPhee complete a few referrals and better understand how difficult the current process is. 

Finding Solutions -- Much Easier when You Understand Each Other's Work

When you don’t fully understand another department’s part of a process and are frustrated by that process’ unreliability or difficulty, it is sometimes easy to blame the staff in the other department.  This idea board visit resulted in a lot of new great ideas and made impossible fixes suddenly seem possible, but it also strengthened the respect these teams felt for one another’s work: a critical foundation for future improvements. 

Could this Work for Your Department?

If your  department has been coming up with fewer ideas lately, don’t be afraid to push the scope a little.  Try asking your coworkers what ideas they wish were on other departments’ idea boards; what could other departments do or change that would make it easier for you to do your job well?  A next step might be to arrange a visit with that department where you ask what your team could be doing to make that department’s job easier.  If you’re interested in thinking more about how to do this, contact will.erickson@theshareunion.org.

2016 Central Massachusetts AFL/CIO College Scholarship

The SHARE office recently received the following notice in the mail from Joe Carlson, the President of the Central Massachusetts AFL/CIO, about a really great scholarship opportunity for our members. The lottery for these scholarships will be open to any SHARE members, as well as children and grandchildren of our members, who will graduate from high school this year and attend college next year. The details are posted below. Please note that applications should NOT be sent to the SHARE office. If you would like a copy of the nomination form, please click here.

***

To: All Affiliated Locals of the Central Mass AFL/CIO,

We are pleased to announce that we will be awarding six $1,000.00 scholarships as well as a number of  $500 Platinum sponsored scholarships.

The scholarship recipients will be drawn by lottery at the May community services committee meeting and the winners will be announced at the Annual Scholarship Golf Tournament on Friday, June 3, 2016.

The scholarships will be presented at the Labor Day breakfast September 5 2016

To be eligible, the student must be a 2016 graduating high school senior and going on to college, and a child, grandchild, or member whose local is affiliated with the Central Ma. AFL/CIO. Union members must live or work in the jurisdiction of the Central Ma. AFL/CIO.

All names must be submitted by April 29, 2016 and returned to:

Paul Soucy

AFL/CIO Labor Community Services

Central Ma. AFL-CIO

400 Washington St

Auburn, Ma. 01501

Fraternally Yours,
Joseph P. Carlson, President
Central Massachusetts AFL/CIO

One Kaiser Permanente Unit-Based Team, and $47,000 Worth of IUDs

The hospital workers from Kaiser Permanente that I met at IHI all seemed so proud of the work their unit-based teams are doing.

A good example are the three co-leads of a unit-based team from the OB/Gyn clinic of Kaiser Permanente Los Angeles Medical Center: Richardson, the manager; Brittanye an LVN (Licensed Vocational Nurse, like our LPNs); and Marcia, a Nurse Practitioner. Brittanye and Marcia are both union leaders, from 2 different unions.

How Unit-Based Teams Change the Day-to-Day Experience at Work at Kaiser

When I asked how the unit-based team changes work for her, Brittanye told me, “You have more input. It makes us feel better because our voice is heard. When we are asked, we feel we are going to be listened to…. It’s more collaborative, not management saying ‘this is how it’s going to be.’ We can make it better and get the job done.”

Richardson, the clinic manager, said their unit-based team collapsed the first time they tried to get it going, but now it's thriving. “Finally we have a team where we all listen to each other. We aren’t just talking at each other… We respect each other. I want our department to shine. I have pride in my department, and I trust my employees. I have pride in what we work on together. I listen to what they say. It fills me with joy to see them thinking outside the box, and to see how much they care about the patients.”

Harvesting Old IUDs to Improve Work and Patient Care

One of this unit-based teams projects was setting up a process to return unneeded IUDs, which are worth about $500 each when returned to the company. Creating a new, and smooth, process to make sure the IUDs didn’t get trashed involved the front desk, the Medical Assistants, the physicians, and the LVNs.  As Richardson said, “It wouldn’t be successful if we didn’t have the engagement of everyone.”

Over 11 months, the OB/Gyn clinic saved $47,000 by returning IUDs. Brittanye said they were able to buy 5 new ultrasound probes with the money they saved last year. “That increases access for our patients, and they have to wait less. The staff is happier and it’s not as stressful.”

Why Kaiser and the Unions Created Unit-Based Teams

The coalition of unions at Kaiser and Kaiser Permanente management negotiated to put in their contract a system of unit-based teams in every department. Unit-based teams tap into the knowledge and experience of front-line staff, managers and physicians. According to the Kaiser Permanente Labor Management Partnership website, “These teams are transforming Kaiser Permanente by changing the roles of union members and managers and creating an environment in which all employees are encouraged to think critically about problem solving and work innovations.”

SHARE and UMass Memorial senior management have invited a union and a management representative of the Kaiser Permanent Labor Management Partnership to visit UMass Memorial, to explain how their unit-based teams work. 

(The first 2 pictures show the OB/Gyn Unit-Based Team at a celebration of unit-based teams' work. The 3rd picture shows the three co-leads that I met at IHI -- Brittanye, Richardson, and Marcia.  -- Janet Wilder)

Looking at How Other Hospital Unions Are Making Work Better

One main focus of the upcoming contract negotiations for SHARE will be improving the day-to-day experience for SHARE members. To prepare, SHARE is looking at what other hospitals and unions are doing.

The annual IHI (Institute for Healthcare Improvement) conference is a great place to meet people doing innovative work. IHI is a world leader in the effort to improve healthcare, and to make good care available to everyone. The conference brings together healthcare leaders, front-line employees, nurses, doctors, medical students, administrators, and a few of us from organized labor. It was inspiring to be with over five thousand people from all over the world who are trying to make their hospitals better.

Highlights from other unions:

• UNITE HERE, a union that represents hotel workers in Los Angeles, is running classes for their members (voluntary, of course) in self-management of chronic disease. Many members are feeling healthier, and they are keeping the costs of their health insurance down. (For more info, see link to video, link to report with health outcomes data.)
• CIR (the Committee of Interns and Residents, a union of doctors), teaches process improvement to new doctors, who are motivated to gain those skills and experiences to use in their careers. You can read about them here, here and here.
• I got to learn a lot more about the Labor Management Partnership at Kaiser Permanente. The best part was meeting the union & manager co-leaders of unit-based teams in their departments. Kaiser rewards the 30 best unit-based teams every year by sending the co-lead to the IHI conference.
•  I went to a workshop from Kaiser called "Workers and Patients: A Single Culture of Safety" where they said that the best prevention for injuries is to have a good team, where workers feel free to speak up when they see something that could be improved.

The Labor Management Partnership at Kaiser Permanente is really changing the role of frontline staff at their hospitals, and we want to learn a lot more about how they are doing it. This week, we are hosting a series of meetings with a union and a management leader from Kaiser Permanente -- more on that soon.

Pictured: Maggie Ridings, LPN (right) and Jane Baxter, Nurse Manager. Maggie and Jane are co-leads of a unit-based team in the OB/Gyn department and clinic in Alpharetta, Georgia. One of their team's projects was to develop a system to help their patients be sure to pick the right hospital for their delivery, saving their patients money and helping Kaiser Permanente to keep their healthcare affordable. In another project, they built a garden to encourage healthy living for patients and staff. 

Process Improvement Spotlight: Mapping Out New Solutions in Insurance Verfication

GROWING and GROWING HEADACHES

Even routine work can get confusing quickly around here. As our hospital grows and technology advances, new complexity arises in the day-to-day. Marion Galeckas, an Insurance Verifier in Patient Access Services, has been making sense of that change throughout her twenty-two years working at UMass Memorial. She works in the Insurance Verification Department specializing in auto liability encounters, where the problems are naturally complex.

Not long ago, in the Idea Board huddle in this area, the staff recognized that they could solve some problems by changing how they communicate about them. I talked with Marion a little bit about their process. It’s a model worth sharing.

MOTOR VEHICLE ACCIDENTS: A FAMILIAR MUDDLE?

Marion is part of the team that makes sure a patient’s hospital bills get sent to--and paid by--the correct insurance plan, whether that’s the patient’s health-insurance or auto-insurance company. Marion spends a lot of time investigating accidents. She speaks with local police departments. She collects a lot of details about automobiles and their owners. She’s been at this for a while. She’s sharp. She’s learned a lot. She’s a professional, and treats her work with professional care. And still, she was frustrated.

The trouble was, the folks in Insurance Verification weren’t the only ones collecting this information. “Sometimes I didn’t know how far to take it,” Marion explained, not knowing the point where an employee in another financial department might pick up the work. In the end, the investigatory work was sometimes even being done in triplicate. And still, sometimes, something could somehow get dropped, leaving no-one in the hospital holding a particular piece of important information.

FIXING THE PROBLEMS, FACE-TO-FACE

Marion was frustrated with what felt like a very uncertain and wasteful process, so she put an idea on her department's idea board to pull together all the different people involved. They would do a deep-dive into the process. This idea led the groups involved, including Billing and Care Coordination departments, to come together with for two intense, focused sessions. They mapped the workflow, who should do each piece of it, and how they would communicate about it. The result is a system that’s working much more smoothly. Multiple departments now dedicate a SharePoint site to manage each particular case. And the SHARE members who participated know that if glitches arise in their new process, they have a way to call together another meeting with other front-line employees to make corrections . . . although their new process is working well after the first few months, and they haven’t had to do so.

Marion says that she’s now more regularly satisfied with her work, knowing that she’s handling her part of the process from a clear starting point to a clear finish, and can better review a complete case for accuracy in the end.

Beyond that, it’s in describing the mapping events that Marion seems to me the most enthusiastic. Before the meetings, Marion had been speaking with many of the other participants over the phone, sometimes for years. And yet, this was the first time she’d ever seen many of them face-to-face, and understood the frustrations from their perspectives. “It was really good to have the time to do that,” she said. “We even shared some laughs.”

These personal interactions reminded Marion of the regular rounding that UMass Memorial employees once did. She enjoyed shadowing the work that others were doing, and learned by comparing experiences. She’s excited to see more of this kind of sharing again.

WHAT’S NEXT?

This process map is making big differences in the way the work gets done in Insurance Verification. And it’s only one of many conversations that together can transform our hospital. As we continue to build our network of information among members and across campuses, please let us know if you have an opportunity for improvement in your area, and stay tuned for more here on the SHARE blog.

SHARE Reps Learn to Use Lean to Improve Their Jobs

One morning in early March, over twenty SHARE leaders from all over UMMHC came together for a special, customized “White Belt” training. We even welcomed a few SHARE colleagues from UMMS who work in related jobs. Our hospital has adopted a "lean methodology," and our union wants to understand that, to know how we can make it work for us. So far, SHARE members’ experience of lean has been uneven: many SHARE members feel that their idea boards are helping make their jobs better, while some have not noticed any change.  Others wonder how to use these tools more effectively.

We began by talking about the purpose of process improvement.  A “good process” is one in which doing a great job is relatively straightforward; in a good process, it is difficult to make a mistake. A “bad process” is unnecessarily complicated, one in which it can be frighteningly easy to make a mistake, leading to high levels of stress and burnout (not to mention worse outcomes).  If you have to struggle against the system to make the right thing happen, leaving you exhausted and frustrated, you’ve got a process that needs improving.  SHARE reps’ stories of processes in need of improvement were hilarious and horrifying, sometimes at the same time.

When some organizations say “lean,” what they mean is “do more with less.” However, SHARE reps learned to substitute an idea of flow, since the point of process improvement is to keep things working smoothly, to remove barriers that get in the way, wasting SHARE members’ time.  Reps learned more about idea board best-practices; many left with ideas about how to improve their department’s board.

One highlight of the morning was a visit from Eric Dickson, CEO of UMMHC, who encouraged the SHARE Reps to "ask what is the problem we are trying to solve?". When a manager or supervisor proposes a process change that an employee is not sure will work, or doesn't understand, Dr. Dickson suggested, rather than just accepting it but being frustrated, or refusing to change, they should ask the manager to clarify the purpose of the change. Ask why. Work to agree about the definition of the problem. He pointed out that when we're on the same page about the problem to be solved, we're more likely to come to consensus about how to solve it.

At the end of the training, the SHARE reps wanted to know more about the flow and problem-solving tools involved in lean. The next step, a “yellow belt” training, is in the works!

All SHARE members can sign up for lean process improvement training (many hundreds have already attended).  You can sign up on Ournet.