Fists pounding on tables, demands, showdowns, strikes. So went traditional collective bargaining: Each side fighting for a bigger slice of the same pie. Each side gunning for a narrowly drawn agreement on pay and working conditions, leaving mutual concerns about patient care, quality and affordability unaddressed.

But Kaiser Permanente and the Coalition of Kaiser Permanente Unions abandoned the traditional approach in 1997, when they founded the Labor Management Partnership.

Our negotiations feature committees, observers and flip charts of options. Since 2000, KP workers, managers and physicians have worked together to craft four National Agreements and one reopener amid relative labor peace. On March 30, some 150 representatives will begin to negotiate a fifth agreement. Assuming all goes according to schedule, the new contract for the 100,000 workers represented by 28 locals in the coalition will be ready to go into effect when the 2012 National Agreement expires Sept. 30.

In an age of growing health care costs and increased competition, the joint goal is to provide our health plan members and patients with better, faster, less expensive and more personal care and to maintain and improve the best health care jobs in the United States.

“Interest-based bargaining is not a utopia and not always a win-win. It’s taken Kaiser and the unions a lot of hard work to get where they are,” says Linda Gonzales, director of mediation services for the Federal Mediation and Conciliation Service, Southwest Region. “[But] to resolve difficult issues in partnership is a strength.”

Because of interest-based bargaining, Kaiser Permanente and the Coalition of KP Unions have been able to go well beyond wages and benefits—the subjects of traditional bargaining—in  negotiating four program-wide contracts. These National Agreements have developed industry-leading approaches to worker sick leave, safety and training and workforce development. They have created unit-based teams to improve patient care and service, set standards to hold teams and their sponsors accountable, and pioneered programs for the mutual growth of KP and the unions.  

Interest-based bargaining pays off in other ways as well.

“To understand one another’s interests, you have to engage in inquiry and listening, and you have to resist jumping to conclusions about the other party’s intentions,” says Harvard Business School Professor Amy Edmondson. “Doing this develops leaders who better understand how the organization works.”

“People in health care look to Kaiser Permanente as the showcase for working together,” says Gonzales, who helped facilitate bargaining for the first National Agreement in 2000.

The mediation service last year recognized a handful of cases of successful interest-based bargaining. Our Labor Management Partnership was one of them.

Each day, more than 3,500 unit-based teams use interest-based problem solving and consensus decision making to improve performance and resolve issues throughout Kaiser Permanente. Those same techniques guide negotiations for the National Agreement.

The interest-based process differs from traditional bargaining in several ways. The first major difference can be seen in the room, says Dawn Bading, vice president of human resources for the Georgia region.

“The way we physically sit is different,” she says. “In traditional bargaining, labor sits on one side and management sits on the other. With interest-based bargaining, we sit at a U-shaped table and we are interspersed together. Beside me may be a union rep and on the other side may be someone from management. This physically represents the interweaving of thoughts and ideas.”

This intermingling continues as the negotiations begin, says LaMont Stone, labor liaison for OPEIU Local 29 in Northern California.

“In regular bargaining, you start apart and try to come together,” says Stone, who has participated in bargaining the last two National Agreements. “Here, we start together and try to stay together.”

Part of the power of interest-based bargaining is that in the early stages, the parties aren’t staking out possible solutions.

Walter Allen, executive director and CFO of OPEIU Local 30, says that in traditional bargaining, sides may start off with extreme positions to better their chances of getting what they actually want in the negotiations. “I’ve heard some unbelievable proposals, such as having Groundhog Day off,” Allen says. “Because we don’t do proposals (positions)—we do interests—you don’t get that here. You have to say why this is an interest. How can you argue seriously for Groundhog Day off? No one wants to defend a stupid proposal. Interest-based bargaining eliminates a lot of nonsense.”

This step also helps each side see how much they have in common before moving on to develop options and reach consensus.

“At times it was tedious,” says Angela Young, a unit assistant at Roseville Medical Center. An SEIU-UHW member, Young was a 2010 and 2012 member of the Common Issues Committee and is headed to bargaining again in 2015. “But it keeps the conversation going, and got us where we needed to be. That’s a good thing.”

When I was asked to represent The Permanente Medical Group at 2012 bargaining, I leapt at the opportunity. My own experience with partnership at Fresno Medical Center showed me what great things could be accomplished with collective problem solving.

I sat on the subgroup that looked at how to improve partnership to enhance performance and Kaiser Permanente’s operational agility. I was amazed at seeing so many people with different backgrounds sharing their thoughts and shaping the outcomes. From the highest levels of Kaiser Permanente and union leadership to the front line, everybody was around the table, and they were all equal in this venue. Everyone was heard and engaged.

I personally learned a lot from the different perspectives voiced by all of the individuals representing their fields. I strongly believe that collective wisdom is better than individual wisdom, and that with collective wisdom you can achieve anything in life. Interest-based bargaining, which assembles voices from all levels and reaches of Kaiser Permanente, is a great example of collective wisdom.

Another thing that struck me—how much folks craved the physician perspective. When I spoke, all 25 to 30 people in that subgroup really listened. And there were issues where a physician perspective was critical. That was a strong message I brought back to physicians. In most unit-based teams at Fresno, there is physician involvement. The intention is to bring those perspectives together to enhance the care for our members and patients. But does that mean if I walk into a UBT meeting I’ll see a doctor? Maybe yes, maybe no.

I’ve worked at Kaiser Permanente for 34 years, and I saw the pre-partnership years. They were contentious ones. We’ve had relative peace with coalition unions since partnership. That’s not to say that working in partnership is perfect in every way. It can’t be done without trusting each other. And how do you develop trust? Through transparency. The whole bargaining process was about transparency; essentially, everybody could share everything. That doesn’t mean people didn’t disagree.

The interest-based, collective approach takes into account everyone’s perspectives to reach a better outcome, which is ultimately a common goal—superior care for our members and patients.

I just used interest-based problem solving (IBPS) while I was at a union convention in Philadelphia. We got five people to rent a car together and go sightseeing on our one day off. So we had to decide what to do in Philadelphia for 24 hours. We brainstormed, then identified the ideas we all supported. We went to Valley Forge, Amish country and the boardwalk in Atlantic City. It worked great.

My husband and I used interest-based problem solving to make a decision about a major purchase recently. I used IBPS to get to “yes.” IBPS is the easiest way to organize your mind. My mind automatically goes to it and that whole process. If a conversation gets confusing, you can go back to the structure provided by it.

Being at a round table with interest-based problem solving is the best way to move health care forward. What we do at the bargaining table with IBPS is great, but we need to do a better job bringing that back to the workplace. We can make it better by having more frontline managers at the bargaining table.

Frontline managers, especially the newer ones, need a sense of the history and commitment of our National Agreement. And frontline managers need more support. There are still problems with backfill, with allowing employees to be involved in LMP activities.

The way we do business at Kaiser Permanente is the Labor Management Partnership, so we need to have those interest-based discussions. I’ve been involved in 2000, 2005, 2010 and 2012 bargaining. I am in awe of the great work labor and management representatives do—and how we can come up with common goals in a nonadversarial manner. I hope we all see it as a value.

No one does it like we do.

Our negotiations for a new National Agreement will be one of the largest private-sector contract talks in the United States this year. No one else brings together such a large and diverse group of representatives from labor and management—plus physicians—to arrive at a single contract for so many union locals nationwide.

We’re so accustomed to this being our norm, it’s easy to forget how revolutionary our Labor Management Partnership is—and how democratic our interest-based methods are.

“At the table, everyone has an equal right to speak and explain their interest,” says Linda Gonzales of the Federal Mediation and Conciliation Service, which helps facilitate the negotiations. “There’s more open dialogue and sharing of information.”

The tone set by interest-based bargaining carries over to the work of unit-based teams. UBTs were one of the outcomes of 2005 bargaining. Today, they are the engine for performance improvement at Kaiser Permanente. They are also the structure giving frontline workers a voice in making decisions. The work UBTs do to improve care for KP members wouldn’t be happening if partnership weren’t in place, and if each successive national agreement didn’t commit everyone to finding innovative ways to address common interests.

It’s not always smooth sailing. But the interest-based model grounds everyone in shared values.

“There are some hard issues, and bargaining still has to take place,” says Joel Cutcher-Gershenfeld, a professor at the Institute of Labor and Industrial Relations at the University of Illinois. “At the end of the day, you have to find the right balance.”