CHAPTER 1

The Evolution and Value of Labor-Management Partnerships

In the long history of humankind (and animal kind too) those who learned to collaborate and improvise most effectively have prevailed.

—Charles Darwin

“Environmental services workers want to know the effect our work has on patients and their visitors. We also want to offer suggestions about changing what isn’t working,” William Quintana, an environmental services employee at Maimonides Medical Center, in Brooklyn, New York, thus described his motivation to work in a Labor-Management Partnership (LMP) there. A tall, burly, somewhat quiet man, Quintana had made suggestions throughout his first year at Maimonides about ways to improve hospital cleanliness. His supervisor ignored these ideas, but his union steward took notice of them and recommended that he be included in a Study Action Team about hospital cleanliness being formed by the Maimonides LMP. By that point, Quintana was reluctant to join, as he had already felt unheard and was not convinced that he would be listened to now. However, he was persuaded to participate in the team’s process and became increasingly enthusiastic about it. Along with other housekeeping staff, Quintana collected and examined outcome data about their work on maintaining a clean hospital, proposed a detailed plan to increase their effectiveness, and took responsibility for implementing their suggested changes. “Now we are getting access to follow-up information to make sure that our plan is working,”²² he emphasized proudly in an interview conducted after his group finished their work. The results of their study included a 25 percent reduction in housekeeping employee absenteeism, a 75 percent increase in patient satisfaction with hospital cleanliness, and an approximately 45 percent savings on housekeeping supplies. Empowered by the respect he experienced during the Study Action Team process, Quintana decided to return to college, became involved in coaching other LMP teams, and eventually was elected as a union shop steward at Maimonides.

Quintana’s work and that of his team exemplifies the benefits of Labor-Management Partnerships for quality improvement, cost savings, and job satisfaction in hospital environments (see table 1). The Labor-Management Partnership in which they worked represents the product of an evolution in collaborative methods between workers and managers that has developed in the United States since the 1950s.

Evolution of Labor-Management Collaborative Efforts in the United States

Developing formal ways to unleash the intelligence, knowledge, skills, and imagination of frontline staff has improved the productivity and effectiveness of U.S. organizations since the start of World War II.²³ The history of employee participation in the United States is important, as these activities have established a strong and effective foundation for current approaches to improving healthcare delivery systems and other organizations.

The history of employee participation and eventual development of Labor-Management Partnerships in the United States began with Walter Reuther, a tool and die maker and former head of the General Motors (GM) division of the United Auto Workers (UAW) union. Reuther espoused a broad vision for the role of labor in the American economy. He felt that although the primary job of the union was to protect workers and to improve their economic situations, it also had a primary obligation to strengthen the U.S. economy and simultaneously bring greater dignity to workers.²⁴

Table 1. Significant Outcomes of Labor-Management Partnerships

To this end, he and other union leaders became strong advocates of employee participation processes to accelerate production of aircraft and tanks during World War II. Workers in the automotive industry believed that the quickest way to produce planes for the war effort was to manufacture them in automobile plants. “Time will not permit us to wait until new mass production factories for aircraft and aircraft engines finally swing into action. Emergencies require short-cut solutions. This plan is labor’s answer to a crisis,”²⁵ Reuther said in 1940. Reuther’s “500 Planes a Day” proposal created a blueprint for converting auto plants into factories manufacturing planes. His plan included sustaining wages at current levels and agreeing not to strike, in order to maintain labor peace during the war. President Franklin D. Roosevelt had made known his interest in having labor advise him about domestic manufacturing as the war was being waged, so Reuther’s plan was well received by the key administrators responsible for building military aircraft.²⁶

Although the automotive unions’ war efforts were successful, enthusiasm in the United States for labor participation in managerial decisions faded with the dawning of the McCarthy era, the “Red Scare,” and the Cold War with the Soviet Union. The idea of promoting workers’ participation or increasing the role of unions in the workplace now met with suspicion and hostility as being communist-inspired. Discouraged, unions retreated to their traditional roles of collective bargaining, defending workers’ jobs, and representing workers in grievance hearings: roles that became increasingly predictable, entrenched, and static.

By the 1970s, however, American political culture had changed enough that the idea of workers’ participation in redesigning their jobs regained acceptability. A new breed of management scholars had begun to advocate for job enrichment and work-enhancement activities. They saw these approaches as important for reducing workers’ alienation by allowing workers to control their work pace (job enhancement) and to expand some of their job responsibilities (job enrichment).²⁷ At this time, UAW leaders such as Irving Bluestone, vice president of the union’s GM division, also began to advocate for creation of more meaningful work for their members, in addition to better pay and more generous benefits.

Bluestone understood that the workforce wanted more from their jobs than just a paycheck. Many workers felt aggrieved by monotonous working conditions and by their inability to alter work practices they knew were wasteful or could be accomplished more efficiently. Bluestone’s articulation of the need for more gratifying work for his members coincided with the new academic concepts of job enrichment and enhancement.

Gary Bryner, president of the UAW 1112 at the GM assembly plant in Lordstown, Ohio, described the problem of worker alienation before the U.S. Senate’s Subcommittee on Employment, Manpower, and Poverty on July 25, 1972:

There are symptoms of the alienated worker in our plant—the absentee rate has gone continually higher. Turnoverrate is enormous. The use of alcohol and drugs is becoming a bigger and bigger problem. So has apathy within our union movement towards union leaders and towards the Government. . . . [The worker] has become alienated to the point where he casts off the leadership of his union, his Government. He is disassociated with the whole establishment. That is going to lead to chaos.²⁸

Rising up against alienating working conditions, the union went on strike at the Lordstown assembly plant in 1972. Its members wanted a voice in decision making in their workplace. After the monthlong strike, workers won greater opportunities to choose their jobs, to change jobs on a regular basis, and to select the equipment and supplies they used on the assembly line. The Lordstown strike received national attention due to the unusual nature of the workers’ demands. More recently, the 2019 Chicago teachers strike focused on class size and services for students, not just on wage increases.²⁹

After the Lordstown strike, the quality of work life, and not simply adequate wages and benefits, became for the UAW a critical requirement of future contracts with management. Blue-stone hoped that similar outcomes could be achieved elsewhere:

U.S. management has always paid lip service to the idea that it is the people performing the work who are the most important in the production process. As a matter of fact, however, the treatment given the workers has belittled the worker. . . . Management should cooperate with the workers to find ways to enhance the human dignity of labor and to tap the creative resources of each human being in developing a more satisfying work life, with emphasis on worker participation in the decision-making process.³⁰

In 1974, Bluestone identified a potential site for a quality of work life initiative. At a GM plant in Tarrytown, New York, a receptive plant manager, labor relations executive, and local union president were willing to consider starting such a project, which would give workers a role in decision making about the effectiveness of their jobs as they were currently structured. Although labor relations at this plant were poor, and management “acted like despots to employees,”³¹ Bluestone considered the Tarrytown plant a good site because of the visionary leadership of its local union president and because a new plant manager wanted to work with the union in a new way.³² All the key players agreed that they needed to try to work together differently, hoping perhaps to set an example for the industry.

Bluestone became the project broker. His life’s purpose, again, focused on enriching the lives of workers, their families, and their communities. “Only a strong labor movement can preserve democracy,” he contended. “The first thing Hitler did was to destroy the labor parties in Germany.”³³ Doug Frazer, then the president of the UAW, crystalized Bluestone’s role in advocating for increased worker participation: “Unlike the rest of us, who tended to be screamers, he had tremendous patience with management. I used to get impatient with his patience.”³⁴ Bluestone convinced the Tarrytown local union president that a quality of work life initiative could improve his members’ working conditions. “We as a union knew that our primary job was to protect the worker and improve his economic life. But times had changed, and we began to realize we had a broader obligation to the workers—to become more involved in decisions affecting their own jobs, to get their ideas, and to help to improve the whole quality of life at work beyond the paycheck,”³⁵ reasoned the Tarrytown local UAW president.

Quality of work life activities, exemplified by the Tarrytown effort (described shortly), constituted an early approach to collaboration between labor and management in the United States. These activities aimed primarily at increasing productivity and creating more meaningful jobs, although many activities improved the processes and quality of production within the industry.

What follow are details of the evolution of worker participation activities in the United States.

Approach #1: Quality of Work Life Initiatives

The first step of the 1972 Tarrytown plant Quality of Work Life (QWL) initiative was the formation of two problem-solving teams to find solutions to difficulties in the quality of their production process. Both workers and managers had observed significant inefficiencies and quality issues in the trimming and glass-sealing operations at the plant. Flaws in these operations were resulting in water leaks through car windows and trim during rainstorms and problems of glass breakage.

After initial problem-analysis training, each team of five frontline workers, meeting weekly, quickly located the origins of the production problems that caused the leaks. Plant engineers had not been able to solve this problem previously. Because these initial teams succeeded in resolving the water leakage, an agreement was reached to train all plant employees in basic problem-solving skills and to establish more teams to address other production issues. To assist workers in these new problem-solving teams, management made critical production information available, data never previously shared with hourly employees.³⁶ All teams received time off from their production jobs to work on resolving the various quality issues. Their meetings lasted an hour every week or every other week, based on the importance of the issue they were addressing.

Within four years after establishing the QWL initiative, the Tarrytown plant went from one of the poorest in quality (measured by inspection counts and dealer complaints) to one of the best in an 18-plant division. Besides repairing water leaks, another important quality problem that a QWL team addressed successfully was reducing window glass breakage.

Implementing the QWL process at the Tarrytown plant decreased absenteeism from 7.3 percent in 1970 to 2.5 percent in 1978, while the number of grievance complaints between workers and managers fell drastically during those years from 2,000 to only 32.³⁷ Unfortunately, in 1974, management initiated two series of layoffs because of the OPEC oil crisis, which decreased General Motors car sales. Nonetheless, QWL teams continued to improve the quality of the cars they produced, and absenteeism remained at a reduced level. Tarrytown’s impressive results encouraged the UAW to establish similar QWL activities at Ford and other GM assembly plants.

QWL programs such as the one at Tarrytown gained increasing popularity in the late 1970s and ’80s. Hundreds of these initiatives were implemented at AT&T with the Communications Workers of America, in the steel industry with the United Steelworkers, in men’s and women’s apparel plants with the Amalgamated Clothing and Textile Workers Union and the International Ladies’ Garment Workers’ Union, and in some schools and state government offices with the American Federation of Teachers and the American Federation of State, County and Municipal Employees.

Greenberg and Glaser summarized QWL activities as “process[es] by which an organization attempts to unlock the creative potential of its people by involving them in decisions affecting their work lives.”³⁸ Dick Walton, another researcher tracking the development of QWL activities, offered a similar definition: “An organization responds to employees’ needs by developing mechanisms to allow them to share fully in making the decisions that define their lives at work.”³⁹ Walton stressed that QWL opens communication channels between labor and management to help build mutual trust.⁴⁰

QWL activities gave workers the ability to tackle problems in their immediate work areas as well as in their departments. The problem-solving teams established through QWL initiatives resembled the quality control circles (QC circles) that had already become highly successful in Japan for improving product quality, particularly in the auto industry. QC circles comprised groups of 5 to 15 frontline staff who received training in problem solving and quality improvement skills, as well as in documenting their results. The Japanese used QC circles to balance the command-and-control management structures in their plants with a self-governing process that they believed would enhance quality outcomes.⁴¹ QC circles helped Japanese manufacturing companies outperform their American counterparts during the late 1980s and ’90s.

Although similar to QC circles, the QWL activities adopted in the United States tended to include unions as partners in overseeing development of the problem-solving teams, including selection of team members, choice of relevant work areas, and ensuring effective team training.⁴² QWL activities also tended to seek not only to solve production or work unit problems, but also to improve workers’ job satisfaction and job commitment. Employee participation activities such as QWL initiatives and Labor-Management Partnerships often do achieve that, as the dramatic reduction in Tarrytown absenteeism and the cases of William Quintana and others suggest.

Approach #2: Quality Improvement Activities

By the early 1980s, increasing competition from countries such as Japan, plus customer demands for better-quality products and services, began to place considerable pressure on North American manufacturers. To respond to these demands, companies needed to find ways to reduce costs and bring products to market faster. One strategy toward these ends was the creation of more structured worker participation processes to improve services and products system-wide and cut costs while still creating meaningful work for employees.⁴³

An example of this shift in focus of worker participation activities occurred in the early 1980s, involving the Amalgamated Clothing and Textile Workers Union at the Xerox Corporation. Xerox, like many other manufacturing companies, started their worker participation process by establishing problem-solving teams at the four plants in Webster, New York, which then manufactured all Xerox machines. These teams were initially patterned largely on QC circle practices, rather than employing the QWL processes described previously.⁴⁴

Although highly effective in Japan, QC circles (QCC) were difficult to implement in the United States. A study by S. G. Hayward concluded that this was because senior management was often not committed to full employee participation, because a process that was fully under management control alienated employees, and because QCC goals seemed only vaguely connected to overall company strategies.⁴⁵ In traditional QC circles, unlike in QWL teams, unions and frontline staff had no role in overseeing the change process and had limited ability to choose which problems to address.

In 1980, the first year of Xerox employee involvement activities, this was essentially the case. Within a year, however, senior management and union leaders became aware of the limitations in their problem-solving team approach and resolved to improve it. These leaders, along with technical staff and assembly line workers, engaged in sessions to analyze the problems with their participation process. Peter Lazes, co-author of this book, consulted at these meetings, which concluded that to more fully engage frontline workers in their teams, they needed to be involved in choosing the problem areas to study, as they were detecting significant production issues that were being neglected.

It was recognized, in fact, that a much larger set of production issues needed to be studied in order to help Xerox maintain its market share: shortening the time it took to bring products to the market, improving the quality of products and customer service, and reducing the cost to customers of copiers, paper, and toners. The group chose to adopt Lazes’ suggestion, as their consultant, to begin a targeted Labor-Management Partnership process for this expanded endeavor.

All the stakeholders would participate in hammering out its specific goals and ground rules. Within the Partnership, the union would have the ability to co-determine⁴⁶ critical areas for investigation and problem solving as well as responsibility for selecting problem-solving team members. Union leaders created the innovative practice of using frontline workers with particularly good communication skills and problem-solving team experience as internal coaches and trainers for the new teams.

In addition to these ground rules involving the union, an employment security clause (in the form of a sidebar agreement⁴⁷) guaranteed that no employee would lose her or his job as a result of changes brought about by Labor-Management Partnership activities.⁴⁸ This agreement was critical in arresting workers’ fears that these activities might result in layoffs as a primary cost-saving solution. Other activities were established to support the Labor-Management Partnership, to ensure that it would become “the way we work” at Xerox. These included distributing a bimonthly newsletter updating all employees on outcomes of the different problem-solving teams, conducting a yearly conference to share and spread best practices throughout the company, and creating an annual review process for managers and supervisors to evaluate the extent to which they promoted employee participation activities in their departments. Another innovation was that problem-solving teams became responsible for implementing their own solutions to production issues.

Over a three-year period, all Xerox employees in the four manufacturing plants who volunteered to become members of problem-solving teams were trained in problem-solving tools, in running effective meetings, in cost-benefit analysis, and in conflict resolution. Meanwhile, each plant formed a Labor-Management Planning and Policy Committee and a Xerox Division Labor-Management Planning Committee to help identify plant- or system-wide problems on which to focus.⁴⁹ These Xerox Labor-Management Planning and Policy Committees had the authority to create interdepartmental workgroups to tackle problems requiring several departments to work together. Meanwhile, many other labor-management teams at Xerox continued to focus on improving the quality of Xerox machines in their particular department.⁵⁰

The creation of Labor-Management Partnerships in the early 1980s, then, represented a shift from approaches in which teams of employees solved very real but isolated production problems to the broader process of improving manufacturing quality and reliability within an entire system.

The Xerox Labor-Management Partnership process resulted in improved quality of new and refurbished Xerox machines and in methods that brought the new models to market faster. The U.S. Department of Labor circulated news of the impact of Xerox’s Labor-Management Partnership work nationally and internationally, and it became a model for future Labor-Management Partnership work, ultimately replicated in many other organizations.⁵¹ Its success eventually resulted in an overall shift from undertaking quality of work life activities without an overlying, systemic focus and structure, to embedding such activities within a Labor-Management Partnership with clear goals, ground rules, staff, and a budget.

Influenced by existing manufacturing company QWL activities, some hospital systems had begun to focus on unit-based problem-solving activities to improve patient care and create more meaningful work. In 1997, Kaiser Permanente developed its Labor-Management Partnership (LMP) process, one of the first in healthcare organizations along with the LMP at Maimonides Medical Center mentioned earlier. The LMP at Kaiser established a basic contract for joint work between its unions and managers, budgeted for Partnership activities, and hired staff as internal consultants and researchers.

In recent years, the Partnership has focused on providing frontline staff with opportunities for making changes in their departments about patient care and safety, as well as the implementation of a new medical records system and of community support programs for patients. Unit-based teams at Kaiser have also worked on such projects as developing a safe lifting process for nursing staff and reducing needle sticks, a significant staff safety issue. Kaiser teams have focused, too, on creating better shift-to-shift communications and on reducing hospital-acquired infections.

Other hospital systems that have adopted the unit-based team approach include the Maimonides Medical Center in Brooklyn, New York, and the Allegheny Health Network in Pittsburgh, Pennsylvania. At Allegheny, unit-based teams have focused on such issues as improving handoffs between shifts, prevention of catheter-associated urinary tract infections, and prevention of central line–associated bloodstream infections. Practices that contribute to the success of such unit-based activities within Labor-Management Partnerships are described in more detail in chapter 3.

Approach #3: Transformative Activities to Create New Delivery Systems

While frontline staff teams have been quite successful at tackling discrete problems within and between hospital units and departments, they cannot address systemic issues in a hospital or healthcare delivery system. Different strategies are essential to create transformative changes in an entire organization’s operation. In addition to employing unit-based and departmental strategies, Maimonides Medical Center and the Los Angeles County Department of Health Services each needed to enact systemic changes in order to create new, more effective delivery systems. They used two transformative approaches toward this end: sector strategies (at LA-DHS) and Study Action Teams (at Maimonides Medical Center). These approaches have been applied to underperforming organizations since the 1980s to enhance service quality while controlling costs and offering employees more meaningful work,⁵² but they have only recently been employed within healthcare systems.

Sector strategies are research-proven best practices within a given industry that enable an organization to increase the performance of current systems. Using a sector strategy maximizes resources by using proven methods already in practice, rather than having each individual organization attempt to reinvent the wheel. Union and management leaders establish familiarity with the new strategies in their sector by conferring with colleagues in their industry (e.g., healthcare, automobiles, men’s apparel, education) or, more commonly, by doing their own research to identify novel strategies within the sector. Consultants working with multiple organizations in a sector who become familiar with best practices can also be hired to educate the different stakeholders about them.

Although radically changing a production process or health-care delivery system seems risky, having access to the outcomes of a proven sector strategy provides labor and management leaders with data to justify investing in a new approach.

The use of sector strategies has recently been an important element in improving patient care at the LA-DHS, as it was in improving quality and reducing costs at the C. F. Hathaway Company, a shirt manufacturer in Waterville, Maine, where coauthor Lazes consulted in 1994. The latter consultation resulted in the first use of sector strategies in a Labor-Management Partnership process. Spurred by a management threat to close their plant, Hathaway union and management representatives, with myself as their consultant, met with the Harvard Center for Textile and Apparel Research to seek an alternative to relocation abroad. The Harvard group advised the delegation to adopt a new modular manufacturing approach as the best strategy for improving quality and reducing shirt manufacturing costs.

This method alters the traditional assembly line process, where each person performs one specific sewing job, to a system in which a group of workers assemble garments together in a more efficient manner. After extensive pressure from the union and from community organizations, Hathaway management agreed to implement this strategy instead of closing and relocating. The company’s decision to adopt the modular manufacturing approach resulted in significant improvements in their shirt quality, in radical cost reduction, and in a more rapid plant adjustment to color, fabric, and design changes in their products.⁵³ This new manufacturing process enabled the Hathaway plant to remain open for eight more years after this intervention, until 2002 when it was closed, with all work outsourced.

At the Los Angeles County Department of Health Services, Dr. Mitchell Katz and other senior managers researched methods for improving patient access to treatment and for receiving coordinated care. They were particularly interested in data about Patient-Centered Medical Homes (PCMH), an important sector strategy for healthcare delivery systems, which were yielding extremely positive outcomes in improving patient access and the quality of patient care.⁵⁴ This system creates a permanent team of practitioners and specialists who see patients on a regular basis, rather than the traditional, impersonal L.A. County outpatient clinic approach, in which rotating practitioners never really got to know their patients. Besides providing them a consistent team of healthcare professionals, PCMHs enable patients with chronic illnesses to receive comprehensive care, with primary care providers following clear protocols.⁵⁵

When fully implemented, this approach increases coordination between primary care and behavioral health services. Patient-Centered Medical Homes control healthcare costs by reducing emergency room use for routine care, by eliminating duplicative lab and radiological testing, and by helping chronic care patients avoid hospitalization through treating their conditions with regular visits to a primary care provider and specialists. Although departmental and unit-based problem-solving teams (continuous improvement teams) also have been used to improve basic services in LA-DHS ambulatory care facilities, adapting the PCMH approach was critical in creating more fully integrated services across departments. The Medical Home approach entailed practices ensuring that patients received needed supportive services within their community as a result of creating the position of care coordinators.

When a sector strategy isn’t available and a work system needs significant changes,⁵⁶ the Study Action Team (SAT) process has been an extremely important tool in Labor-Management Partnerships. An SAT differs from unit- or department-based teams in offering a more intensive approach and a wider focus. A small group (usually six to eight) of employees, managers, and technical staff are freed full-time from their normal jobs for several months to investigate current operations and propose methods to address overall systemic problems. This analysis of the effectiveness of operations throughout an organization can radically redesign organizational work systems, resulting in significant changes in jobs, new operating procedures, and reassessment of which technologies to use. Implementing an SAT process can yield vast quality improvements and cost reductions. The Study Action Team process thus transcends the scope of work of traditional Labor-Management Partnerships that principally focus on improving existing systems.⁵⁷

Similar to a sector strategy, the SAT process enables an organization to discover new ways of working without being constrained by current jobs, technology, work rules, and compensation systems.

In 1981, the Xerox Corporation used the SAT approach for the first time in North America at their Components Manufacturing Operations (CMO) in Webster, New York. The union representing Xerox workers persuaded management to collaborate in an SAT process to counter the potential move of Xerox’s wire harness manufacturing plant to Mexico, which would result in a layoff of 180 workers. Xerox management felt that moving to Mexico was the only way to remain competitive, as relocating outside of the United States would save 30 percent of manufacturing costs per year.⁵⁸ The possibility of such a huge layoff, involving more than half of the CMO plant workers, spurred the union to suggest the fairly radical SAT process for discovering cost-saving changes to implement at their plant. Xerox management agreed to this experiment, promising not to relocate their manufacturing department if the $3.2 million they could save by moving was matched in cost savings at the current plant.

Although the SAT process was unproven at that time and could result in radically altered jobs and production processes, the union felt it worth this risk in order to save 180 jobs.

The SAT process at Xerox saved $3.7 million and kept all 180 threatened jobs in Webster through designing and implementing a more effective manufacturing process and purchasing more-efficient new equipment. Soon after the SAT recommendations were implemented, the plant hired a second shift of employees to keep up with new production needs.

In recent years, some manufacturing companies, as well as Maimonides Medical Center,⁵⁹ have used the SAT process. More details about how this process works are in chapter 4.

Why Sector Strategies and Study Action Teams Matter in Healthcare

Research by scholars such as the late Clayton Christensen at Harvard University has documented that disruptive changes in healthcare organizations are needed to transform existing systems into those that better serve patients. For Christensen, the new system that is created makes the prior one obsolete.⁶⁰ He focuses particularly on the parameters of quality of care, cost control, and treatment outcomes, but does not offer specific suggestions for achieving such significant change.⁶¹ We suggest and will describe the use of sector strategies and Study Action Teams as practical, low-cost methods to foster such disruptive change in healthcare while maximizing resources and limiting risk-taking.

As the U.S. healthcare systems require significant changes to improve the quality of care they provide, improve patient satisfaction, control costs, and respond to new regulations, the need for managed disruptions is becoming increasingly evident: previously dysfunctional systems must change to those that are more staff and patient centered and effective.⁶²

Summary

In this chapter, we have discussed the different steps in the evolution of employee participation projects that improve the productivity and effectiveness of their workplaces.

During World War II, the United Auto Workers, led by Walther Reuther, advocated for workers to become involved in discovering methods to accelerate the production of aircraft and tanks for the war effort. This effort was endorsed by President Roosevelt and proved highly successful.

With the Red Scare of the 1950s, the idea of worker and union participation in organizational planning receded, however, as unions began to be viewed with suspicion as Communist inspired. By the 1970s, management scholars had begun to advocate for job enhancement (worker control over the pace of work) and enrichment (employee involvement in ordering materials and planning some aspects of work) to reduce growing worker alienation and absenteeism.

Following a 1972 strike at the Lordstown automotive assembly plant by workers who demanded to play a part in decision making there, the quality of employees’ work lives became a critical part of labor negotiations, in addition to strategic discussions about wages and benefits. Shortly afterward, Irving Bluestone organized a QWL initiative at an automotive plant in Tarrytown, New York. Early QWL programs included workers in problem-solving teams that aimed to find solutions to production process problems. At Tarrytown, these teams were quite successful in improving car quality and, as employees felt productively engaged, absenteeism was significantly reduced. During the 1970s and ’80s, hundreds of organizations adopted QWL activities. These resembled the QC activities adopted in Japan but included labor unions in overseeing the selection of team members, choosing work areas to focus on, and training teams. QWL activities also focused on improving processes central to the overall organizational strategy, which QC circles often did not.

Over the following decade, several manufacturers adopted the Xerox Corporation’s strategy of creating LMPs, which organized improvement activities within structured agreements between employees and administrators. Such Partnerships were based on negotiated agreements listing mutual goals, ground rules, staff assignments, and budgets. In 1997, Kaiser Permanente developed the first healthcare LMP. Shortly after, Maimonides Hospital and the Los Angeles County Department of Health Services created LMPs, which (1) used sector strategies (at DHS) to adopt Patient Centered Medical Homes for its hospitals and clinics and (2) developed Study Action Teams (Maimonides) to successfully redesign their Hospital Cleanliness system.