Leading from the Edge
John August
Executive Director, Coalition of Kaiser Permanente Unions
Union Delegates Conference
May 3, 2013
Our strength: Empowered frontline teams
A model for the nation
“Face of the Future
of Health Care”
New York Times,
March 20, 2013
What’s happening?
Cross-currents of change
• Seemingly insurmountable challenges
• Progressive resistance and fight-back
• Rising expectations, global competitors
• An earth to save ̶ our only one
• Search for joy, not misery
• Our responsibility to lead in a time of change
Social Security being cut…it is not the problem!
The Administration’s proposed
cuts translate to three months
of food for typical Social
Security recipients
The real problem
Share of federal revenue by source
Corporate taxes
Individual payroll taxes
34%
33%
< 5%
1950s
9%
2012
A low-wage economy
• 21 percent of jobs lost in the Great Recession were low-wage
jobs, but 58 percent of the jobs created during the “recovery”
are low-wage jobs.
• 60 percent of jobs lost during the Great Recession were middlewage jobs, but, only 22 percent of those created during the
recovery were better-paying jobs.
• 43 percent of all jobs created have been in the low-paying
industries of food service, retail and employment agencies.
• 31 states have introduced “wage suppression” bills ̶ legislation
to repeal wage standard and minimum wage laws.
Retirement savings gap
$400,000
Retirement savings
needed*
Avg.401K balance for 65year-olds, estimated by
financial services industry
$100,000
Avg. 401K balance for
65-year-olds, estimated
by independent experts
$25,000
U.S. health care spending unsustainable
We spend almost twice as much on health care as
other countries – with less favorable outcomes.
17.9%
9.5%
Health care premiums stole your car
Deficit is about health care
How to afford health care?
The economics of health reform depend on keeping per capita
cost growth below 6% after 2014.
Total Obesity-Related Direct Health Care Spending, U.S. (2008-2018)
Projected
Holding Obesity Rates Constant
$400,000
$350,000
(Millions)
$300,000
$250,000
$200,000
$150,000
$100,000
$50,000
$0
2008
2013
2018
Source: Thorpe, 2009
Confidential – For Internal Use Only
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Many Factors Drive and Shape Health
Health is driven by multiple factors that are intricately linked – of which medical care is
one component. Total Health is a comprehensive solution that addresses all components
Drivers of Health
Personal Behaviors
40%
Family History and
Genetics
30%
Environmental
and Social
Factors
20%
Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993
10%
Medical Care
Falling union density
2013 = 11.3%
The world will not wait
World’s tallest building 1931-1974
Empire State Building, New York
(1,224 feet)
World’s tallest building 2010
Burj Dubai, Dubai
(2,717 feet)
What shall be done?
Organizing the unorganized
New York City fast-food workers
on strike, April 4, 2013
Outrage at collapse of Bangladesh
garment factory, April 24, 2013
Fighting back
What are we doing?
Our Value Compass
Bargaining as social dialogue
Affordability:
UBT improves nutrition service, cuts waste
Food and Nutrition department, San Jose
WHAT THEY DID
This team identified ways to prevent costly food
waste, where unused formula, supplements and
food end up in the garbage. Small tests of change
included:
• Conducting a “wasted meal study” to learn how
much money was being lost to unused meals
($16,000 a year)
• Improving communication with unit assistants
about patients’ eating patterns and discharge
data
• Improved diagnosis of malnourished patients,
which contributed to a financial return of more
than $1 million, and better patient care.
RESULTS
Monthly food expenses cut by 10 percent
Quality:
Worker-led change gets more kids vaccinated
Pediatrics, South San Francisco
RESULTS:
WHAT THEY DID
• Children get injections in the exam room,
rather than in injection clinic.
• Physicians have two versions of the same
vaccine to choose from instead of several.
Over nine months’ time, the
percentage of children ages 2
and younger who are current
on their immunizations rose:
• Medical assistants and physicians huddle
daily to determine which incoming patients
need vaccines.
MAs have shots ready for those patients.
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Service:
Team takes the pain out of waiting
Obstetrics and Gynecology, Hawaii
WHAT THEY DID
Members of this team at the Honolulu Clinic
shortened the average wait time for injections by:
• Designating a “shot nurse,” whose main duty for
the day is to give patients injections.
• Using a whiteboard to communicate who is the
day’s shot nurse and who is the floor nurse
(who directs patients to the shot nurse and
helps with shots when needed).
• Using Lotus Notes Sametime instant messaging
to alert clinic nurses when a patient checks in.
Best Workplace:
Advancing safety, engagement and satisfaction
EVS, Panorama City
WHAT THEY DID
EVS workers are part of cross-functional
inpatient UBTs. Through daily huddles, root
cause analysis and ongoing tests of change they
have:
• Reduced achieved the lowest injury rate in
the region.
• Achieved staff satisfaction scores of 98% in
People Pulse.
• Reduced absenteeism, improved morale and
engagement, and helped increase patient
satisfaction scores
• Met PSP goals for past four years.
Accepted claims for
injuries, 2008 - 2012
Staff
satisfaction:
98%
-88%
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The way forward…
Look to our roots
Memphis, 1968
Our Legacy Statement