Statement to Kaiser Permanente Administration and IBHS Professionals

April 22nd, 2014

To Kaiser Permanente Administration and IBHS Professionals,

Over the last three years many of us have grown familiar with the distorted communications coming out of the office of Kaiser’s senior HR management, their report of the bargaining process related to the labor issues at OAK/RCH is once again predictably simplistic and flawed.

To say that “we believe the differences should be resolved at the bargaining table” is the height of hypocrisy for a Kaiser team relentlessly obstructionist, inflexible and unwilling to collaborate on any NUHW proposal of importance to us for several years of bargaining. Administration reports that “the strike is being called over practices to improve access to outpatient and emergency mental-health services”. The strike was called precisely because the familiar drive for “access is everything” will only be achieved at the unacceptable expense of care quality, return appointment access and clinician well-being.

Regarding staffing: your letter indicates that staffing has increased since 2012 but makes no mention whatsoever about the corresponding increase in patient work load number or new patient intake demand. Due to this reality, the Adult service has experienced very real challenges in retention and the numbers, “52 to 62 since 2012,” are not representative of new staff but largely document replacement staff. In fact according to numbers provided by Kaiser to NUHW, staffing in Oakland has actually gone down in spite of a nearly 26% increase in demand over the last five years. We know this because our clinic screeners keep records of requests for services and they have been drowning trying to keep up with new service requests. God help them should one of them dare to take a planned vacation, only to return to a sea of members waiting for return calls due to no planned backfill for these workers.

Regarding Scheduling: The “block intake system” (or “Clusters” ) is a system which has been tried and failed in other facilities. In the Redwood City clinic it was largely seen as responsible for a spike in suicides at the facility; – six, to be specific. We know that it front-loads the system in favor of initial access over returns. This allows more patients to be seen initially but erodes capacity for those members to actually receive follow up treatment. This phenomenon is well known to our members and clinicians who dub it, “rapid access to no care.” It is also the core of the charges made by the DMHC related to poor access to quality mental healthcare. To make matters worse, the system requires patients to carve out two hours for their initial appointment. What other service (perhaps other than the DMV) requires a customer to wait for two hours; especially an emotionally compromised individual?  Finally, the system is designed to overbook into provider’s charting and phone time. In effect, this forces clinicians to perform essential and mandated work on their own time and is seen as yet another artifact of a pattern of inadequate staffing. After nearly eleven months of bargaining and at least three very creative alternative proposals tendered by labor, the management team chose to implement their ill-conceived program.

Regarding PTO Policy: What is left out of this very sanitized version of the facts is that this management team created a system which very effectively front loads new intakes, requires staff to make up intakes missed for absences AND allows management to additionally increase the number of intakes without cap during holidays and summer months. This organization actually has no policy as to what is too much. Apparently the prevailing belief by Kaiser is that the very delicate business of helping people has no real upper limit. Even automobiles and manufacturing plants have their tolerance limits. Staff have responded by suggesting that if an intake policy is in place then they should NOT be expected to also make up work for taking earned vacation or, be expected to see ever more new members without regard to the follow up resources to treat those members.

Are you hearing a theme here? What is happening at Oakland on a micro level merely reflects what is going on in the macro system as a whole. And this is what we’ve been trying to tell Kaiser endlessly, in a host of ways without substantive or real response.  It appears to us that Kaiser is making many millions in profits by purposefully limiting the staffing in mental health over multiple years. We think that this policy should end and apparently so do the State regulators.

Re On-Call: In bargaining, the labor team went to great lengths to make multiple requests that primary stakeholders from the ED be present in the bargaining. This request was consistently denied. The labor team requested that the configuration of the management team be broadened to include clinician experts with experience in building after hours emergency services. This request was ignored and refused. These requests were escalated to the office of OAK/RCH Medical Center Compliance and the offices of both OAK/RCH  PIC’s, all of whom have done nothing in response. The Chief of the department was requested to make an appearance to explain the reorganization drivers in detail since those drivers were inconsistently reported and therefore suspect. He has remained largely cloistered and invisible. The labor team identified specific ED leaders that questioned the staffing algorithm and appropriateness of the management proposal. This observation was dismissed and ignored. The labor team cited similar hospital configurations in the Pacific Northwest region with four times the staffing for psychiatric emergency services. This fact was ignored. The union noted that the challenges in hiring and retention would require a long term back-fill strategy that necessarily will call on the inexperienced full staff to cover both on-site and off -site to two emergency rooms simultaneously. This observation was dismissed and ignored. The union raised concerns that the nature of the management plan will likely result in the least experienced staff intervening under the conditions of the highest medical legal exposure, with the most acute psychiatric patients during the most inconvenient times. This observation was dismissed and ignored. The notoriously unreliable Highway 80 corridor was cited as a highly likely problem in maintaining a high quality of timely response to both ER’s simultaneously. This observation was dismissed and ignored.  The labor team has put forth counter proposals and the most salient element of the labor proposal, adequate staffing for two ED’s without requiring simultaneous coverage, has been consistently rejected.

TO BE CLEAR: the union objects to coverage of two ED’s simultaneously after hours UNDER ANY CIRCUMSTANCES. This has been a longstanding element of our regional bargaining proposal and we do not intend to set precedent at the OAK/RCH medical centers. It is considered to be poor care for patients and dangerous for providers. The union has no objection to a dedicated on-call team.  Of course the staff want to be rid of on-call and of course dedicated services are the best; that is not in any way at issue. The union continues to have BIG objections to the size and structure of the dedicated model the management team appears intent upon foisting onto its represented workers. Unfortunately the management proposal is not adequately staffed which will result in anemic recruitment and poor retention for a burn-out job. Then to make matters worse, the back-up plan proposed by the management team would harnesses existing full staff to both on-site and off-site after-hours duties at two sites simultaneously. The management team implores us to simply “try it out and see how it goes.” Unfortunately the HR labor Relations non-clinicians will not be able to save the staff from the regulatory obligation of covering the ED once such a plan is implemented. It is highly likely these positions will devolve into a revolving door for  burn-out jobs that ultimately oblige existing staff to maintain. The union has an obligation to both future and existing members and will NOT sign off on such an obviously poor plan set forth by non-clinicians who have zero experience either working in, nor building an after hours psychiatric emergency program.

In sum it appears to the team and staff that local management has no intention of actually bargaining any alternative to management’s on-call proposal and are poised to implement and optimize their ill conceived program at the great expense of both patients and staff. Like the Cluster Intakes, the union fully anticipates the management team to tender a last best and final offer following their pro-forma nod at participating in bargaining with the union. In effect, their strategy appears to build an emergency service that functions well under the best and optimal circumstances rather than on the worst. Anyone with even a modicum of experience and competence in program development should understand that this is absolutely the worst premise upon which to try and construct an emergency service.

What the facts above reveal yet again is the hypocrisy of an organization that asserts it’s primary value as being quality, when its actions on the ground demonstrate a completely different driver altogether. The staff has authorized this strike action because of the perception that within this organization it is the only viable remaining mechanism left to them to be heard. Please make no mistake that the Oakland staff, Adult, Child and CDRP are highly organized and unified in their advocacy for patients. The Oakland clinicians and their NUHW brothers and sisters throughout the state will not rest until these problems are resolved; this action represents only the first of many until an organization predicated on THRIVE really begins to walk its talk….

Clem Papazian, LCSW, Oakland Adult Service
President, IBHS Chapter, NUHW