CHAPTER 4

Team Structures for Frontline Staff Participation

Effectively, change is almost impossible without . . . collaboration, cooperation and consensus.

—Simon Mainwaring

In chapter 1, we described the evolution of worker participation activities in the United States. The three basic structures used in this pursuit have been unit-based teams, departmental teams, and intensive Study Action Teams, more recently established within structured Labor-Management Partnership (LMP) processes.

Since many union and management leaders are not aware of their choices in structuring and deepening their Partnership process, this chapter provides further details about the inner workings of the three different approaches.¹³⁰ Making an informed choice about the structure of joint work is particularly important for organizations with limited staff time, so that they can make the best use of their resources.

In presenting the options of different structures, we stress that it is a challenge for healthcare institutions, or for most organizations for that matter, to jump immediately into a complex and broad engagement process such as departmental and intensive Study Action Teams without adequate preparation.¹³¹ Luckily, employee participation processes can be approached with an initial series of shallow dives, rather than beginning with a leap from the high-diving board. Some organizations may find it most cost-effective to choose these less complicated options for their purposes.

Unit-Based Teams

Unit-based teams enable labor and management to focus on issues they agree upon as representing discrete, solvable patient care problems. As such, they represent an excellent means of initiating a worker participation process. They provide frontline staff with a direct role in improving both care and working conditions in a particular work area.

Many partnerships function successfully at a contained, unit-based level. At Kaiser, unit-based teams have remained the predominant and preferred method of frontline staff participation, obtaining significant improvements in patient care, patient safety, and staff safety, and in achieving more meaningful jobs.¹³²

An example of a successful unit-based team is the Laboratory team at Maimonides Medical Center, one of the first projects of their Partnership process. This unit-based team was composed of lab technicians and their supervisor working in the laboratory that analyzed both inpatient and outpatient blood samples. Marie-Cecile Charlier, a lab technician and a key member of this team, viewed unit-based teams as important vehicles for improving the flexibility and effectiveness of the lab and for improving staff morale. For years, Charlier had suggested to upper management ways to achieve better efficiency in lab operations, but her suggestions were routinely ignored. “Finally, we had a chance to be heard,”¹³³ commented Charlier when asked why she decided to join the laboratory’s unit-based team. When she learned about the new Partnership activities planned at Maimonides, Charlier became guardedly optimistic that she and other co-workers might finally find a real voice for decision making, or at least for offering input, about their unit.

Once the Maimonides Strategic Alliance Council identified the lab as one of the first unit-based areas for work, Charlier encouraged six other lab technicians to work with her to evaluate and propose improvements for the lab’s operations. She was able to do this fairly easily, since Charlier, a natural leader, was known for her energy, for her respect for her co-workers, and for her integrity. Absolutely serious about and committed to her job, Charlier also spent her spare time working with community arts and cultural organizations. When she suggested that they join, her co-workers did so readily. Her lab supervisor, on the other hand, agreed to join the team somewhat reluctantly. She made it clear that she didn’t feel the staff could contribute any practical insights for improving lab effectiveness but eventually agreed to participate in this “experiment.”¹³⁴

To help this unit-based team get started, a member of the Labor-Management Project from SEIU 1199¹³⁵ provided problem-solving and conflict-resolution strategies and tools to analyze the departmental workflow and the layout of their equipment. Lazes encouraged the team to create ground rules for working together that could serve to minimize any disruptive or distracting behavior within the team.

The team’s initial goal was broadly framed: “To increase staff flexibility and reduce turnaround time.” While reducing turnaround time was a goal that might be planned for and measured, “increasing staff flexibility” was quite vague. Realizing this, the team spent the first two meetings assessing what might represent a solvable approach to obviously low staff morale. They identified a particularly loaded issue: virtually all staff members were upset at having to work at least one weekend per month and several holidays each year. The team became convinced that this scheduling problem could be resolved and that doing so would improve staff morale and productivity.

One of the team’s first activities involved collecting data on current turnaround time for getting lab results back to clinicians in the Emergency Department (ED). The ED turnaround time was not consistent: the average return was measured at 1 hour but could reach 1½ to 2 hours. Reducing laboratory turnaround was important for ED patients, particularly those patients in critical condition. After consulting with lab staff from all shifts, the team concluded that it was realistic to try to reduce this time to under 30 minutes. To accomplish this, team members solicited suggestions for changes from lab and ED staff. At the same time, two team members were assigned to research articles about methods used in other settings to reduce laboratory test turnaround time. The entire team then carefully reviewed all of this data.

After the initial team meetings, Marie-Cecile Charlier was elected as the team leader. Her responsibilities involved creating the agenda for each meeting in consultation with the other team members, keeping basic notes of decisions made at each meeting, making sure that follow-up assignments were completed, and checking with all team members and invited guests to ensure that they could attend the weekly meetings. After analyzing the research articles and data collected from lab staff about the current process, the team was prepared to contemplate potential changes.

Before finalizing their recommendations, however, they requested the opportunity to test new equipment they had learned about and to perform a modest redesign of their lab based on their workflow analysis. Having conducted multiple tests of each, after three months of work the team offered its recommendations. These included redesigning the layout of lab equipment to maximize the use of each workstation; purchasing new equipment that was easier to use and required fewer reagents; cross-training the staff so that they could perform all lab tests rather than just the ones they had previously been assigned, thus increasing efficiency and expanding job descriptions; increasing compensation so that each lab staff member would be paid for becoming multiskilled; moving phlebotomists from the laboratory to the ED so that blood could be drawn more quickly; and hiring additional part-time staff so that full-time staff wouldn’t need to work weekends and holidays.

When the lab team presented their recommendations to senior managers and labor leaders, all were accepted, and a sidebar agreement was created to guarantee that employees would have opportunities for training to perform multiple tests and receive compensation for these new responsibilities. It took the hospital a little over two months to renovate the laboratory and another month to accomplish cross-training, recruit new part-time staff, and obtain new equipment.

As a result of this unit-based team’s work, turnaround times for test results transmitted to the ER were reduced to less than 30 minutes. In fact, similar turnaround times were achieved for all hospital departments once phlebotomists were assigned directly to each hospital department. Staff morale soared as a result of these improvements and of eliminating weekend and holiday shifts.

After working on the lab team and seeing its impact, Charlier became eager to spread worker participation opportunities at Maimonides. Pam Brier and John Reid soon recruited her for the new role of Developer (internal consultant) for the hospital. They had witnessed Charlier in action: she was clearly an employee with considerable skills and a passion for partnership activities and for improving patient care. Several years later, Charlier was elected as a vice president of SEIU 1199 representing workers at Maimonides. Each of these positions enabled her to continue encouraging and supporting worker participation activities.

Department-Based Study Groups

In 2005, six unexpected fatalities occurred in the Maimonides Cardiology Department’s four inpatient units. An initial investigation by hospital administrators and risk management staff (the group assigned to investigate troubling clinical outcomes) concluded that each incident occurred after a significant delay in response to cardiac telemetry monitor alarms. Two nurses were blamed for causing several of the deaths through lateness in responding to these alarms and were suspended until the investigation was completed.

When Veronica Richardson, shop steward for the nurses (New York State Nurses Association), and Marie-Cecile Charlier, now a Developer and an SEIU 1199 shop steward,¹³⁶ learned of the suspensions, they and other colleagues requested that the executive director of the Cardiology Department, Louise Valero, initiate a process to identify the root causes of the fatal delays. This would require a department-wide, systemic approach rather than a unit-based study. Shifting from unit-based work to departmental LMP teams was already being contemplated at Maimonides, but the seriousness of the situation in Cardiology hastened this decision for both the administration and the Cardiology staff.

The Cardiology Department Labor-Management Committee was formed in 2006 to analyze all facets of the issues that led to the six deaths. In addition to Marie-Cecile Charlier and Veronica Richardson, 12 other members composed the department-based work group. These included Cardiology interns and residents, nurse practitioners, physician assistants, attending physicians, nurses, patient care technicians, ward clerks, and transporters for cardiac patients. Team members included employees from all four cardiac units (Intensive Care and three “step-down” units). Evening and night-shift staff members attended the weekly group meetings, receiving overtime pay for coming in early or staying late in order to participate.

The first tasks for the committee included a literature review of methods utilized elsewhere for reducing time to respond to cardiac monitors, a review of the data from the Risk Management Department of the circumstances surrounding the recent fatalities, and the tracking of response times to alarms and monitors in all cardiac units for one month. Staff on all shifts were interviewed to identify any difficulties they had with the current cardiac alarm systems.

Two major issues became apparent from the data collected and from staff interviews: the nursing staff had difficulty in accurately setting patients’ cardiac alarms, and they lacked a standard process for determining acuity levels across all cardiac units. (An acuity level determines the extent of nursing assistance that a patient requires, which in turn affects the number of patients assigned to any nurse, and thus their workload.) Other problems that were identified were difficulty in hearing alarms from the cardiac monitors at the nurses’ stations, and lack of staff qualified to respond to monitors or to assess patients’ cardiac status as they transported patients to tests outside their immediate units.

While this departmental team met biweekly to discuss the details of the ongoing analysis, a smaller work group compiled findings from their research and interviews to present to the larger group. This work group included Agnes Aban, a dedicated nurse, shy but determined, who found strength in representing her unit in this department-wide team; Maureen O’Neil, a nurse practitioner, a natural, respected leader whose lovely sense of humor paired with great discipline; and Ron Barranco, a thoughtful nurse who helped encourage employees who were too shy to speak up. Veronica Richardson and Marie-Cecile Charlier, with Louise Valero, RN, the charismatic and strong-willed executive director of Cardiac Services, provided support for the overall project and attended most of the smaller work group meetings. The director of Organizational Performance and the director of Risk Management also worked with the team and eventually helped track outcomes of their recommendations as they were implemented.

Reaching a consensus on standardizing acuity levels for all four units was a particular challenge for this team, due to its size and the diversity of its staff. Some physicians and physician assistants on the team were initially reluctant to engage in such a process. Each practitioner felt it important to “have the freedom as professionals” to determine how much nursing care was needed for their patient. “This is what we are trained to do: to make clinical judgments,” contended one clinician in discussing the controversy.

After several meetings of the entire committee during which this matter was debated, Charlier and Valero decided to meet with these practitioners individually. They discussed the rationale for standardizing acuity levels and the importance of this work for the nursing staff. Charlier and Valero carefully listened to each of the staff members’ concerns and eventually crafted and presented a proposal to the team that incorporated feedback from these meetings.

The process of being heard and of having their suggestions incorporated into the final proposal led these clinicians to endorse and support the final agreement. Three acuity levels would be established for each of the four cardiac units. Each physician, resident, or physician assistant responsible for a particular patient would evaluate general risk factors and individualized considerations in order to determine one of the three levels for that patient. Nurses’ assignments—and thus their daily workload—would then be determined by the acuity levels of the patients on each unit.

After meeting for three months and consulting with other co-workers, the departmental team recommended five changes: (1) purchasing new telemetry equipment that nurses could more easily adjust; (2) holding interdisciplinary rounds at the start of each shift to clarify or adjust patient acuity levels and to recheck the alarm settings on all telemetry equipment; (3) reducing noise at the nurses’ stations by forbidding unnecessary conversations in these areas so that patient call bells and telemetry alarms could be better heard; (4) requiring a licensed independent practitioner (LIP) to accompany an acuity level 3 patient (the most critical patients) being transferred in or out of the units; and (5) conducting in-service training for nurses on properly setting and performing minor repairs to the telemetry monitors, as well as recognizing which readings required immediate responses from unit physicians.

It took several months to implement all five recommendations. To follow up the project’s results, the hospital’s Department of Organizational Performance designed an effective tool, which the team accepted, for collecting future data on alarm response times on all four units.

Overall response time to cardiac monitor alarms has stayed consistently at or below 1 minute since this project’s recommendations were implemented, as opposed to between 2.5 and 8 minutes previously. Notably, there have been no adverse patient events due to delayed alarm responses on these units since the project was completed in 2007.¹³⁷

“The interdisciplinary team approach to extremely serious problems in the Cardiology Department far exceeded our expectations. The Departmental Labor Management Committee strengthened relationships among all care providers, in addition to its other impressive results. The project will serve as the model for future departmental collaboration and for all subsequent joint work with the departments of Organizational Performance and Risk Management,”¹³⁸ Louise Valero emphasized when interviewed a few months after the implementation of the team’s recommendations. This departmental team continues to initiate other projects within Cardiology, addressing other patient care issues.

While a unit-based team structure focuses on the concerns of individual units, departmental Partnership structures strengthen inter-unit functionality within a department and between departments. This approach also helped the Medical Center to maximize limited resources.¹³⁹ “It was an important decision to refocus our Partnership activities from discrete unit-based projects to departmental activities. We had limited resources and wanted to make sure we used them most effectively. We also saw that many of the problems identified within our units overlapped with others within their department. So, we wanted to be sure we had the most effective structures in place to help get at the bottom of all these issues,”¹⁴⁰ explained Pam Brier, former CEO and president of Maimonides.

As a result of the impressive outcomes of the Cardiology Alarm/ Monitor project, the federal Medicare oversight group MedPAC requested a presentation on this approach, which was made in October 2008 in Washington, DC.¹⁴¹

Study Action Teams

As stated in chapter 1, the intensive Study Action Team (SAT) is employed to create breakthroughs that result in new system-wide structures and processes. This approach is now a proven strategy for companies and healthcare organizations to use when they recognize that significant changes are needed, but the end goal is not yet clear.¹⁴²

Initially implemented at Xerox with their union ACTWU, a Study Action Team process enabled the company to achieve plant-wide changes¹⁴³ during a critical time.¹⁴⁴ As noted in chapter 1, the Xerox SAT process saved the company $3.7 million and avoided a layoff of 180 employees. The process resulted in an overall 28 percent reduction in manufacturing costs.¹⁴⁵ To fully understand how the Study Action Team process worked, some background information about Xerox’s Labor-Management Partnership will provide a context.

Xerox had initiated a robust Labor-Management Partnership in 1980, and by 1981 over 19 percent of their workforce was engaged in some form of worker participation activity.¹⁴⁶ At the end of 1981, a new challenge arose. A year-long secret study by a strategic planning team of engineers and financial analysts revealed that several Xerox copiers were no longer competitive because of the high cost of some of their component parts. In the preceding years, competition had intensified with companies like Ricoh, Sharp, and Canon in Japan and with Kodak and IBM in the United States. Xerox’s market share had dropped from 90 percent to 43 percent by the early 1980s.¹⁴⁷ The confidential report suggested that to remain competitive in the United States, Xerox needed to start manufacturing component copier parts in Mexico, where labor costs were significantly lower.

These parts would then be transported to the United States for assembly, so that Xerox copiers could still be advertised as “manufactured in the U.S.” The first copier component selected for manufacture in Mexico was the wire harness. This is the section of Xerox copiers in which all the internal wires come together through an expensive and complex manufacturing process.

As the labor-management consultant working with Xerox and the ACTWU union at the time, Lazes discovered this internal report from informal conversations with several engineers while exploring ways for them to work with the current problem-solving teams. He was given a copy, and immediately after reading it, requested meetings with key union and management leaders: Tony Costanza (general shop chairman of ACTWU), Les Calder (vice president for the Xerox division of ACTWU), Bill Asher (vice president for labor relations for Xerox), and David Kearns (CEO and president of Xerox). After individual discussions with each leader, he organized a joint meeting with all four. In a private meeting with Asher, he had stressed that it might be unwise for the union to try to solve the huge cost-reduction goal, as he thought it unlikely to be achievable without significant wage and benefit reductions. Asher felt that engaging the union in a “doomed” process might jeopardize Xerox’s good relationship with ACTWU and reduce the union’s willingness to participate further in joint activities. The union leaders, on the other hand, felt that the workers deserved to try to discover ways to reduce production costs and, by doing so, to save the 180 jobs.

While these discussions were taking place, Lazes spent time conversing with production workers and engineers about methods to achieve extensive cost savings. Cross-departmental work groups alone seemed unlikely to achieve the necessary results. He felt out on a limb, since he now had persuaded both labor and management to work jointly on finding ways to avoid this layoff: What kind of process should be employed? While jogging one morning before reporting to the Xerox plant, he flashed on a potential solution: to create a special team of frontline workers, managers, and technical advisers who would be reassigned to work full-time for six months on an extensive cost-saving analysis.

The engineers with whom he discussed this plan thought it was a long shot, as they had already spent a year themselves trying to find a solution. Nonetheless, they felt that the new Study Action Team idea might enable more outside-the-box thinking. The new work group not only would have the opportunity to redesign the production process but also could suggest changes in equipment, supplies, and actual job structures. Further, it could suggest changes to the company’s contract with the union, something that had been off-limits to the engineers during their initial analysis. The engineers acknowledged, too, that the frontline production workers actually knew more than they did about which practical changes might be feasible. Their guarded yet positive feedback gave me the confidence to suggest the new, more far-reaching participation process to Asher, Calder, Costanza, and Kearns.

After several meetings, Lazes persuaded them to establish this innovative strategy. The process would enable frontline staff and the union to have a direct role in finding ways to save their jobs, rather than to simply react defensively to a management proposal. Although senior management remained concerned that the new process might jeopardize their relationship with the union, the workforce agreed to go forward with the new team process. It was stated clearly that if this work group couldn’t achieve the needed cost savings, management would need to implement a layoff.

Management and union leaders decided upon a full-time team of six production workers, one engineer, and the supervisor for the wire harness area to compose the new work group. More than 160 production workers from the Components Manufacturing Operations (CMO) plant applied to become members. Calder and Costanza, along with several shop stewards, interviewed all of the candidates for this project. Job criteria included having participated on a current problem-solving team, demonstrating excellent communication and writing skills, possessing knowledge of the current contract, showing evidence of strategic or analytical thinking, and being well-respected by their peers.

The team’s task was defined by a new sidebar agreement to the existing contract: it would seek “to find ways to be competitive, improve quality, cost and delivery performance of the business to levels which will assure a positive competitive position and ultimately, to secure jobs.”¹⁴⁸ It was understood that if their eventual proposal involved new job responsibilities or other changes that affected the collective bargaining agreement with the union, management and union leaders would need to agree to these changes before their implementation.

During the initial week of the SAT process, the team spent time strengthening problem-solving and communications skills, discussing how best to work together and how to divide up their tasks. They developed a strategy of actively engaging all plant employees, soliciting their suggestions and encouraging their support. Work group members met with the plant’s finance staff to establish a focus on areas in the production process that could yield the greatest cost reductions. The finance staff also provided information about Xerox’s accounting process and the basic financial methods used to calculate production costs.

An Executive Labor-Management Oversight Committee was formed to assist the Study Action Team process, composed of local and national union leaders and Xerox executives. This group provided technical assistance to the team and ensured that they would have access to critical data about production costs and to any staff whom they desired to meet: production workers, engineers, managers, equipment vendors, and others. The Oversight Committee was given the ultimate authority on contractual language changes and for securing funds to purchase new equipment. The need for this executive committee was anticipated from the start, as it was likely that the Study Action Team’s recommendations would need approval beyond the authority of local management and labor leaders at the CMO manufacturing plant.

From the beginning, the Study Action Team members actively solicited ideas and information from all employees about their work responsibilities, workflow through the plant, the quality of supplier parts, and the efficiency of current equipment. Over their six months of work, the SAT kept frontline staff, engineers, and managers of the CMO plant informed of their progress and continued soliciting their feedback, knowing that this process of connecting to frontline staff would be crucial for the eventual acceptance of any recommendations.

Key areas for improvement that the team explored included potential purchasing and layout of new equipment, changes in the assembly processes, new sources for component parts for assembling the wire harness, and a more effective use of space in the CMO. The team made weekly “walk-around visits” to the wire harness production department to apprise the production workers there of their ongoing analysis and to ask questions. However, since they were contemplating significant changes in the overall manufacturing process, in the purchase of new equipment, and in the responsibilities of hourly employees and management, the team agreed that until there was agreement on their final proposal, their final recommendations would remain confidential. This was important because every aspect of the final proposal would depend on the acceptance of the other proposed changes, so discussing a particular component of a potential solution in isolation would be counterproductive.

In addition to extensive engagement with all wire harness department workers, members of the Study Action Team visited competitors to learn how they organized the manufacturing of similar parts. Several of these trips were made to nonunion plants that used very different production methods and equipment. In considering new equipment, the study team had production workers test the equipment on a trial basis to evaluate whether it reduced costs and increased efficiency.

After six months of analysis and proposal development, the SAT provided data to support 40 recommendations for producing a higher quality, more cost-efficient wire harness. The key categories of recommendations included (1) purchasing new equipment to assemble the wire harness faster and more efficiently; (2) changing suppliers to ensure a higher quality of component parts—this would reduce the need for rework and thus achieve significant cost savings; (3) rearranging equipment and parts bins so that employees could reduce wasted time accessing parts while assembling the wire harness; and (4) creating self-managing work groups instead of the existing production line process, reducing the need for rework and making employees’ jobs more interesting. Adopting this new work structure meant that employees could easily switch jobs as needed whenever changes in production schedules or in product mixes dictated this. Lastly (5), overhead costs were reduced by consolidating the assembly process in one section of the CMO building. The SAT identified total cost savings amounting to $3.7 million, or $500,000 more than the agreed-upon target.¹⁴⁹

After several work sessions with the Executive Labor-Management Oversight Committee to review and analyze the recommendations, senior labor and management leaders accepted all recommendations and agreed to make specific changes to the collective bargaining agreement that would enable frontline staff to work in the new production work groups and to receive compensation for becoming multiskilled.

It took several months to fully implement the SAT recommendations. “When fully in place, this process succeeded far beyond everyone’s expectations and opened up major possibilities for new ways of having labor and management work together. We realized that this process could continue helping us to improve the quality of parts and to reduce costs in our manufacturing division,”¹⁵⁰ commented Bill Asher, Xerox’s vice president for labor relations and an important SAT adviser. As result of the team’s success, Xerox decided to use a similar process to evaluate all other component parts assembly methods for their copiers.¹⁵¹

The impressive results of the Xerox Study Action Teams were described in journal articles, books, and newspapers, including a special report by the U.S. Department of Labor.¹⁵² Several U.S. manufacturing companies began to employ Study Action Teams to reduce costs, improve product quality, and save the jobs of American workers.¹⁵³

Although the SAT process was initially established in manufacturing companies to obtain cost and quality outcomes, this method has now been used to improve patient satisfaction, cost-effectiveness, and quality of care in healthcare systems.¹⁵⁴

Summary

Choosing among the different structures of Labor-Management Partnerships described previously should be guided by the characteristics and situations of each organization: shaped by its particular needs and values, by the attitudes of its union partner(s), by its management culture, and by the existing relationship between the two. In some organizations, an entrenched, adversarial relationship between labor and management makes partnerships difficult if not impossible. When labor and management are willing to invest in finding ways to work together, however, such activities can achieve impressive results (see table 3).¹⁵⁵

Implementing Labor-Management Partnership initiatives in healthcare and in other organizations is an evolving process. Beginning with one approach doesn’t preclude shifting to another over time to adjust to new needs.

Kaiser Permanente, Maimonides Medical Center, Hathaway shirt company, and Xerox Corporation Partnerships all demonstrated a flexible approach to their Partnership work as their process matured and as they continued to respond to the changing needs of their patients or customers.

Table 3. Comparing Forms of Worker Participation Activities

As stated earlier in this chapter, many of the initial Labor-Management Partnerships focused on shop floor and then departmental problem-solving teams, yet there is increasing awareness that for future Labor-Management Partnerships to be effective, particularly in healthcare organizations where many see disruptive innovation as necessary,¹⁵⁶ they need to focus on both shop floor and strategic/systemic activities. Regardless of the approach used, we need to continue working on ways to improve how care is delivered.

Also, whether in restructuring the manufacturing process at the Hathaway shirt company or shifting to an integrated health-care delivery system in the Los Angeles County Department of Health Services, unions have played a strategic role in organizational decision making, helping to make these organizations more effective and efficient. The involvement of national unions has enabled several Labor-Management Partnerships to secure financial and at times technical resources to help sustain and spread Labor-Management Partnerships. At LA-DHS, SEIU 721 helped to expand the ability of L.A. County to obtain Medicaid funds to pay for uninsured patients and funds for staff retraining.

Establishing a high-involvement work system is much easier when a new organization is created: in organizations like Saturn and at some Volvo plants. These organizations generally have fewer of the constraints inherent in an existing culture or long-favored but no longer efficient work practices. Shifting or transforming existing organizations to more effective ones is clearly more complicated than starting from scratch; unfortunately, most of us don’t have the opportunity to start from scratch. In these situations, collaborative leadership interventions—combined with a felt necessity—can help create openness to new ways of working. A collaborative leadership process can lend legitimacy to a new partnership. However, labor and management leaders need to keep in mind that in both new and traditional organizations, it is essential not to get too far ahead, too quickly, of what either frontline staff or management can accept, or resistance to change will occur. The particular challenges associated with creating a Labor-Management Partnership process within an existing organization are presented in chapter 8.