“The Largest Room in the World is the Room for Improvement”

***writers note: this article was completed BEFORE the outcome of the 2020 election

Helmut Schmidt, the Chancellor of the Federal Republic of Germany from 1974-1982 is among many who have inspired listeners with the above well-known quote. The quote is an emotionally cohesive exhortation to people everywhere to recognize the commonality we all have when it comes to solving problems that are meaningful and necessary to all of us.

I first heard the quote in February of 2018 when I attended an international conference on healthcare improvement in Jonkoping, Sweden. Each year, the Qulturum (Center for Learning) of Jonkoping County sponsors a “Microsystem Festival”. In opening remarks at the Festival, Pernila Soderberg, RN and one of the many Improvement leaders in their health system opened her remarks with this quote. It is notable that this exhortation to Improvement helped launch a celebration of “micro-systems” or unit based teams, the frontline building block of Quality Improvement.

This notion of IMPROVEMENT sounds simple and non-controversial. But it is anything but that! For improvement to be systemic and continuous requires fundamental change in the way people work together!

In our extreme state of polarization as a society, we must look for the elements of cohesion, healing, trust, and solidarity. In my experience of more than 40 years in the labor movement and as a leader and practitoner in workplace innovation, conflict resolution, and frontline engagement, I have been convinced for a long time now that it is in the workplace where we can find the actions and antecedents to social healing.

Many agree.

For example, Paul Adler and Charles Heckscher write in their 2007 essay, “The Firm as a Collaborative Community: Reconstructing Trust in the Knowledge Economy” (Oxford University Press). “Collaborative community forms when people work together to create shared value.” And they go on: “The institutions of collaborative community are centered on defining the core purposes and regulating interactions so that the right people can contribute at the right time to advance the process of value-creation”. The authors argue for a new form of organization in the modern enterprise, one that creates the environment for the re-birth of trust.

When I had the privilege of leading the Coalition of Kaiser Permanente Unions from 2006-2013, I participated in a system wide, joint effort with frontline workers, frontline managers, and frontline physicians to create the foundation for WHOLE SYSTEMS IMPROVEMENT. For those who are not familiar with Kaiser Permanente, it is among the largest employers and health systems in the nation with more than 200,000 employees who serve 12 million patients and subscribers. It is close to 100% unionized with the best wages, benefits, and conditions in the industry. Working at Kaiser Permanente is considered the gold standard of employment in healthcare.

This concept of whole systems improvement was embedded in the original documents of the Labor Management Partnership of 1997: “Now is the time to unite around our common purposes and work together to most effectively deliver high quality health care and prevail in our new, highly competitive environment.”

When the partnership first came into being, that vision, to “unite around our common purposes”, was difficult to define and put into daily practice across such a huge organization spanning 10 states.

The goals were NOT to have projects and initiatives, but rather to create accountable organizational change that would produce system-wide improvement. As such, we needed to find highly innovative forms in collective bargaining and organization to achieve our goals!

The concept of Unit Based Teams (Microsystems) was bargained collectively and placed into the section of the union contract which commits all stakeholders to Performance Improvement, envisioned as the pathway to conintuous, accountaable, and measurable improvement.

Our friend and colleague, Professor Thomas Kochan of MIT produced a Report on the Labor Management Partnership (LMP) , 2009-2013, (published by IWER, Sloan School of Management, 2013). In that Report he cited important data from an internal report from the LMP called Culture Matters. That report showed clear correlations between high performing unit based teams and systems improvement in key measures, including improvement in patient satisfaction, inpatient mortality, central line blood infection, workplace safety, and attendance.

We learned from data in that report that systems improvement was being achieved through an analysis of hundreds of teams that were rated “high performing”, based on a collectively bargained rating system of unit based teams called the Path to Performance, The data indicated that these high performing teams scored higher on key employee engagement scores which in turn drove higher performance outcomes than lower rated teams on the Path to Performance.

Additionally, in 2013, the Office of Labor Management Partnership showed that Unit Based Teams produced savings to the organization of between $100-200 million in one year!

All parties made investments of time and expert support to learn consistent practices and tools focused on Plan, Do, Study, Act (PDSA) Rapid Improvement Cycles applied to strategic problem solving across the enterprise.

What has this experience taught us when it comes to organizational change in our workplaces?

Twenty two years ago, two of our former Deans here at ILR wrote a brief and trenchant article, “The Collective Bargaining System in the United States: The Legacy and the Lessons”. (from, Harry Katz and David Lipsky, Industrial Relations in the Dawn of the New Millennium, pp. 144-161, Ithaca, NY, ILR Press ). Through scholarship and practical experience they challenged all of us to “struggle to develop and then diffuse a new industrial relations system.”

Given the clear transformation of our economy and the waning influence of unions and thereby worker voice, much effort is devoted these days to understanding and recommending what new forms of workplace organization and industrial relations ought to look like. We have the “Clean Slate” proposals from the Harvard Law School designed to reform U.S. labor law and enhance worker voice in the workplace, including works councils and sectoral bargaining. We also have recent scholarship which tells us that a broad cross section of working people (4,000 people surveyed) are looking for new forms and meaning in what labor organizations ought to do and stand for in “What Forms of Representation Do American Workers Want? Implications for Theory, Policy, and Practice”, (Hertel-Fernandez, Kimball, Kochan, September 24, 2020, ILR Review). That research tells us that working people from a broad and diverse sample want to be part of an organization to “represent workers in a joint committee with top management to decide how the organization should operate”.

We must pay close attention to these strong recommendations to truly transform workplace and industrial relations to be able to meet the needs of our time, and for our children and grandchildren.

However, I believe there is a missing link in these conceptions of increased worker voice and influence. For too long, we have neglected the imperative to achieve continuous and systemic improvement in our material and spiritual (non-religious) lives as expressed in the oft quoted phrase about “room for improvement”. I suggest that time is short, and to wait for legal, regulatory, or other government sponsored change in labor relations and labor law is time we may not have!

Rather, I suggest that in the innumerable workplaces that we work and live in today, the dynamic of improvement can begin to change relationships and build trust. Let’s have discussion of purpose, and better yet, collective purpose.

Large unionized workplaces are a great place to start. The lessons of the labor management partnership at Kaiser Permanente prove this.

My direct experience includes hundreds of examples where teams of diverse workers, doctors and nurses and technicians, and social workers, and aides, and secretaries, and EVS workers, and transporters, and administrative staff overcame years of hierarchy, bureaucracy, and frustration by uniting around purpose and improvement. They did this through systems learning opportunities to use brainstorming, data that was understandable and friendly to the end-user, meeting regularly, making time for each other, and staying focused on their goals. Such sentiments were most often expressed in contrast to years of mistrust, lack of communication, and traditional relationships based on hierarchy and authority.

To be able to achieve continuous improvement such teams and their work must NOT be thought of as projects or initiatives, but rather actions of high performing and cohesive groups of people in workplaces who have a collective purpose. At Kaiser Permanente the work of all teams is guided by the Value Compass, a unifying strategy to work daily to improve quality, service, affordability, and best place to work, all designed to improve the experience of the patient! This work is done in more than 3500 teams which exist in every department in every workplace.

All teams are guided by the Value Compass which is also embedded in the collective bargaining agreement.

By focusing on the patient, teams at Kaiser Permanente build trust in one another for a higher calling than just their own narrow interests. To be able to envision a broader impact from the workplace on society, think of the patient as the community.

And if all workplaces could be organized to contribute to the well-being and improvement of the community, just think what is possible.

From the workplace to the community lies the path to healing, cohesion, trust, and the social solidarity we need to create a new, modern, and sustainable social contract.

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