1. Leading from the Edge John August Executive Director, Coalition of Kaiser Permanente Unions Union Delegates Conference May 3, 2013

2. Our strength: Empowered frontline teams

3. A model for the nation “Face of the Future of Health Care” New York Times, March 20, 2013

4. What’s happening?

5. 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

6. 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

7. The real problem Share of federal revenue by source 1950s 33% < 5% 34% 9% 2012 Corporate taxes Individual payroll taxes

8. 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.

9. 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 for 65-year-olds, estimated by independent experts $25,000

10. 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%

11. Health care premiums stole your car

12. Deficit is about health care

13. Confidential – For Internal Use Only 12 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. Source: Thorpe, 2009

14. Many Factors Drive and Shape Health Family History and Genetics 30% Environmental and Social Factors 20% Personal Behaviors 40% Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993 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 Medical Care 10% Drivers of Health

15. Falling union density 2013 = 11.3%

16. 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)

17. What shall be done?

18. Organizing the unorganized Outrage at collapse of Bangladesh garment factory, April 24, 2013 New York City fast-food workers on strike, April 4, 2013

19. Fighting back

20. What are we doing?

21. Our Value Compass

22. Bargaining as social dialogue

23. 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

24. 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 same vaccine 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.

25. 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 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. Obstetrics and Gynecology, Hawaii

26. 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 and engagement, 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%

27. The way forward…

28. Look to our roots Memphis, 1968

29. Our Legacy Statement