Kaiser’s Labor Strife Points to Wider Health-Care Understaffing

Kaiser Permanente will restart labor talks Thursday after more than 75,000 workers completed the largest health-care strike in the nation’s history, with one major point of contention continuing to be systemic staffing shortages that have plagued the industry as a whole.

The collective bargaining discussions come amid ongoing labor unrest in the health sector, which has accounted for a third of strikes involving more than 1,000 workers since the beginning of 2022, according to the Bureau of Labor Statistics. This year alone, worker protests have included union and non-union walkouts by hospital nurses, as well as pharmacists for CVS Health Corp. and Walgreens Inc.

The Coalition of Kaiser Permanente Unions said it will aim to build a “comprehensive” solution to staffing issues that improves workplace conditions for current employees and attracts new hires.

The tactic signals a slight departure from short staffing solutions other health-care unions and labor advocates have pursued, such as implementing quotas or worker-patient ratio policies in individual contracts or through state and federal action.

Caroline Lucas, executive director of the coalition, said the union’s proposal tackles understaffing by changing how worker schedules are made, creates new education and re-training programs to allow current workers to move up, reduces the outsourcing of labor, and increases pay and benefits packages to attract candidates for open positions.

The group of unions identified staffing as the biggest crisis facing workers in an April message to members, saying that over 11% of union job positions are vacant. Industry stakeholders say this is a crisis that is consistent across the health-care sector.

“Kaiser has been trumpeting that its met the goal of hiring 10,000 people this year but they’re not saying that they’ve also lost 4,000 in that same time,” Lucas said. “We’ve had one-off solutions like this but we need a fully-rounded solution.”

Another Strike Looming?

Thousands of Kaiser employees walked off the job last week in six states and Washington, D.C. The three-day work stoppage interrupted routine medical services for nearly 13 million people, but emergency services remained open. Acting Labor Secretary Julie Su will be present at Thursday’s bargaining session to help advance the talks.

The Kaiser coalition has warned executives that workers would strike again next month if they didn’t reach a contract agreement by Nov. 1. The potential second strike would last a week, until Nov. 8, the union said.

Kaiser spokesperson Wayne Davis said in an emailed statement the company is “committed to every area of staffing that is still challenging.”

“Our Coalition-represented employees like working here and stay an average of 11 years,” Davis said. “We are a leader in compensation in every market we’re in, have great benefits, training and development, and an inclusive culture.”

‘Caught in the Middle’

The American Hospital Association said in a report last year that job openings across the sector are at an all-time high, and nearly 1,400 hospitals reported a critical staffing shortage to the federal government in 2022.

The AHA report said there were a multitude of reasons for the staffing crises, including an aging US population increasing demands for medical care, record levels of burnout leading to nearly half of medical professionals planning to leave their jobs by 2025, and inadequate faculty levels at medical schools limiting the amount of students coming into the profession.

Health-care workers, including those involved in negotiations with Kaiser, often take the brunt of the burden from short-staffing, said Patricia Pittman, director of the Health Workforce Research Center at George Washington University.

“The workers who remain are now feeling overwhelmed and betrayed,” she said. “They’re caught in the middle between administrators who are trying to squeeze more work out of them for less money and patients who are seeing their level of care suffer.”

These increased pressures have forced many health-care workers to turn to unions in search of solutions. Both physicians and medical residents have organized in record numbers within the past two years,, according to the Bureau of Labor Statistics.

Staffing Quotas

One way unions and labor advocates have sought to address the worker shortage is through various kinds of staffing quotas. Nursing unions, like National Nurses United, have been particularly vocal about nurse-patient staffing ratios, arguing that legislation or a commitment from an employer will help lower burnout rates and improve patient care.

Nurses in two New York hospitals earlier this year ended a three-day strike by agreeing to a contract with higher staffing standards, including a path to take staffing disputes to an arbitrator if the hospital fails to meet the requirement.

On the legislative front, California and Massachusetts are the only states so far to institute health-care staffing ratios for acute care and specialty workers, but legislators in other states such as Oregon, Maine, and Pennsylvania have proposed similar policies. President Joe Biden this year announced proposed rules to mandate staffing levels in nursing homes.

But health-care employers are less likely to agree to these kinds of staffing solutions either at the bargaining table or in the legislature because companies prefer to retain flexibility in their staffing levels, said Matthew Fontana, a partner at employer-side Faegre Drinker LLC.

“On one hand, this kind of legislation does force companies to address these issues, but on the other hand, it’s only tackling this one narrow problem and leaves more systemic issues unaddressed,” he said.

Kaiser union Executive Director Lucas said the staffing quotas have been crucial to fill workforce holes in the short-term, but the coalition is looking for longer-term solutions in its negotiations with Kaiser.

“I think that we need to move beyond just legislative mandates on patient-staff ratios into looking at a comprehensive, holistic approach to how we deliver patient care,” she said. “How many nurses you have is important but there’s other critical staff that gets overlooked in that.”

Systemic Issues

Other industry observers say that the staffing crisis is a symptom of widespread flaws within the health-care industry and can’t be solved with a quota requirement.

Eric Dickerson, managing director of recruiting firm Kaye/Bassman International, said employers can only do so much to fill staffing quotas if they don’t have the operating budget to cover salaries or if there are few applicants to be found.

“If these companies agree to a ratio and they can’t find anyone to hire permanently, that means they need to then hire contracted or temporary staffing,” he said. “If they do that, their labor costs will more than double and it doesn’t take a whole lot of that to significantly cut into margins.”

Health-care companies have experienced revenue losses during and after the pandemic as the price of supplies and labor rose while compensation from insurance providers remains stagnant. The AHA reported that hospital margins could drop by as much as 133% compared to pre-pandemic levels, leaving two-thirds of hospitals operating in the red.

But Lucas pushed back on the idea that Kaiser can’t afford staffing solutions, citing the company’s 2023 profit margin of $2 billion and the $16 million paycheck for Chief Executive Officer Gregory Adams. The nonprofit managed care consortium operates 39 hospitals and 622 medical offices and employs almost 213,000 workers.

“Kaiser is doing very well financially and can afford to invest in what the institution needs, which is a stable health-care workforce that’s well trained,” she said.

Weighing Effect on Patient Care

Policies that set standards for safe staffing levels could be a piece of the solution, but can’t be the only solution, Daniel DeBehnke, vice president and chief physician executive of health-care consulting firm Premier Inc., said.

Beyond quotas, there are plenty of proposed solutions to worker shortages, including opening up more visas for health-care professionals, investing in universities to expand their medical programs, or getting creative on a corporate level to free-up funds.

“At face value, are staffing quotas good for patient welfare? Absolutely. But that quota comes with an expense and if the health system isn’t getting the support to take on that expense, it will collapse,” DeBehnke said. “That might result in hospitals or clinics closing or reducing operations and is that good for patient care? I’m not so sure.”