Bringing the Workforce into Health Care Reform!

As Congress debates the best way to invest a trillion dollars or so in health care reform it appears to be on the verge of making the infamous General Motors blunder. In the 1980s GM invested over $50 billion in automation in an ill-fated effort to improve the productivity and quality of its car manufacturing plants. Because GM failed to engage its workforce and unions in how to modernize its production processes, it became the most automated but still the highest cost and least efficient auto producer in the U.S.

In the two decades since GM made this strategic blunder, a broad range of industry specific research studies have demonstrated that large-scale financial and technological investments like GM's and the ones we are about to make in health care only pay off in higher quality and lower costs when matched with equivalent investments in workforce training and development and workplace innovations that ensure employees are engaged and work together in a coordinated way and that labor and management cooperate in fostering these modern workplace practices.

These findings from other industries have now been replicated in research carried out in a variety of hospital and outpatient settings. Specifically, Jody Hoffer Gittell's new book High Performance Health Care shows that, similar to her earlier research at Southwest Airlines, achieving high quality requires teamwork and coordination across the full range of health care professionals and service providers--doctors, nurses, technicians, and service workers. Adam Seth Litwin's MIT PhD dissertation documented that worker and union engagement in the design and deployment of electronic medical records technologies (EMRs) at Kaiser Permanente, one of the national leaders in implementing EMRs, is essential for these technologies to realize their promised benefits of improved quality and efficiency. And in our book Healing Together my coauthors and I document how the decade long labor management partnership at Kaiser Permanente is leading the way in involving front line workers in team based problem solving and work processes that are driving quality improvements and cost reductions.

The lesson from this work is clear: Congress and the Administration need to add a workforce development and workplace innovation component to whatever health care reform package is signed into law.

All parties -- health care providers and unions alike -- should be held accountable for engaging the workforce, investing in the training required to support teamwork and coordinated work processes, and building and sustaining the types of modern labor management partnerships needed to make our public investments in health care pay off. Specifically, the legislation and rules governing implementation of the reforms should do three things:

1. Prohibit use of public funds to fight workers if and when they try to organize. Fighting workers in this way ensures that, regardless of whether a union wins or loses the organizing battle, an adversarial worker-management climate is produced that is incapable of fostering the cooperation and engagement needed to improve quality and lower costs.

2. Reimbursement rates should be made contingent on demonstrating that the full workforce is engaged in working together to coordinate service delivery, and where unions are present, union and management leaders should be required to show they are working in partnership to foster employee engagement, teamwork and the coordinated work systems needed to get a positive return on the public's financial and technological investments.

3. The Independent Advisory Board that will help oversee quality and cost control initiatives should be charged and given resources to work proactively with health care providers and union leaders to diffuse state of the art workforce and workplace practices throughout the nation's new health care system.

It is not too late to avoid the GM blunder.

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