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Leading from the Edge

John AugustExecutive Director, Coalition of Kaiser Permanente Unions

Union Delegates ConferenceMay 3, 2013

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Our strength: Empowered frontline teams

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A model for the nation

Face of the Future

of Health Care

New York Times,

March 20, 2013

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Whats happening?

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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

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Social Security being cutit is not the problem!

The Administrations proposed

cuts translate to three months

of food for typical Social

Security recipients

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The real problem

Share of federal revenue by source

1950s

33%

< 5%

34%

9%

2012

Corporate taxes

Individual payroll taxes

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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 middle-wage 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.

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Retirement savings gap

Retirement savings

needed*$400,000

Avg.401K balance for 65-

year-olds, estimated by

financial services industry

$100,000 Avg. 401K balance for65-year-olds, estimated

by independent experts

$25,000

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U.S. health care spending unsustainable

We spend almost twice as much on health care asother countrieswith less favorable outcomes.

17.9%

9.5%

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Health care premiums stole your car

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Deficit is about health care

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How to afford health care?

Total Obesity-Related Direct Health Care Spending, U.S. (2008-2018)

The economics of health reform depend on keeping per capita

cost growth below 6% after 2014.

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

2008 2013 2018

(Millions)

ProjectedHolding Obesity Rates Cons tant

Source: Thorpe, 2009

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Many Factors Drive and Shape Health

Family History andGenetics

30%

Environmentaland Social

Factors

20%

Personal Behaviors40%

Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993

Health is d r iven by m ult ip le factors that are intr icately l inked of whic h medical care is

one com ponent. Total Heal th is a comprehensive solut ion th at addresses al l components

Medical Care

10%

Drivers of Health

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Falling union density

2013 = 11.3%

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The world will not wait

Worlds tallest building 1931-1974

Empire State Building, New York

(1,224 feet)

Worlds tallest building 2010

Burj Dubai, Dubai

(2,717 feet)

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What shall be done?

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Organizing the unorganized

Outrage at collapse of Bangladesh

garment factory, April 24, 2013New York City fast-food workers

on strike, April 4, 2013

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Fighting back

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What are we doing?

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Our Value Compass

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Bargaining as social dialogue

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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 changeincluded:

Conducting a wasted meal studyto learn how

much money was being lost to unused meals

($16,000 a year)

Improving communication with unit assistants

about patientseating patterns and dischargedata

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

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23 23

Quality:

Worker-led change gets more kids vaccinated

Pediatrics, South San Francisco

RESULTS:

Over nine months time, the

percentage of children ages 2

and younger who are current

on their immunizations rose:

WHAT THEY DID

Children get injections in the exam room,

rather than in injection clinic.

Physicians have two versions of the samevaccine to choose from instead of several.

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

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

days 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.

Obstetrics and Gynecology, Hawaii

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25

Best Workplace:

Advancing safety, engagement and satisfaction

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 andengagement, and helped increase patient

satisfaction scores

Met PSP goals for past four years.

EVS, Panorama City

Accepted claims for

injuries, 2008 - 2012

-88%

Staff

satisfaction:

98%

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The way forward

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Look to our roots

Memphis, 1968

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Our Legacy Statement