In September, SEIU and 24 other AFL-CIO unions representing some 64,000 health care workers reached a nationwide agreement with Kaiser Permanente.

The contract is historic and unprecedented.

Labor powerfully demonstrated the added value that unions bring to answering the challenge of how to provide quality, affordable health care for our nation.

The agreement is the first national labor contract in health care and the largest health care pact ever negotiated in the United States. More than 7.6 million of Kaiser Permanente's 8.1 million patients nationwide and members of 25 local unions in California, Oregon, Washington, Ohio, Texas, Missouri, Kansas, Colorado, Maryland, Virginia and Washington, D.C. are affected.

To be sure, the pact provides annual pay raises, benefits and improvements in working conditions. But the significant feature of the contract is the important voice that front-line staff will now have in patient care decisions.

The agreement sets a new standard for staffing, setting-up joint labor-management teams to create annual department-level staffing plans for every Kaiser facility covered by the agreement. The staffing plans will cover mutually acceptable numbers, mix, and qualifications for staff in each unit. Bedside caregivers and other employees will have a real voice in staffing decisions, so they can make sure patients get the time and care they deserve.

Another unique aspect was the process under which these negotiations were conducted. Kaiser Permanente is the largest unionized health care provider in the nation. In fact, unions helped get Kaiser started as a non-profit more than a half-century ago to provide a high-quality, low-cost health care plan that working families could afford. Both labor and Kaiser Permanente share common goals as social benefit organizations.

Labor has been increasingly concerned that health care in the U.S. has become dominated by for- profit health plans that take decision-making out of the hands of physicians and caregivers. In 1997, the Coalition of Kaiser Permanente Unions, of which SEIU is part, proposed a partnership to demonstrate that labor and management, working together with the involvement of caregivers, could provide superior health care, market-leading competitive performance and an outstanding workplace for Kaiser Permanente employees.

Management agreed and we went to work to create a process and a structure to what has since become the largest, most complex labor-management partnership in history. Given the number of unions, operating units and employees, the nationwide scope and diversity of jobs and job skills, we achieved an amazing success.

The current contract is a result of our efforts. We negotiated over several months using a "common issues" bargaining process instead of traditional adversarial bargaining. In fact, more than 250 Kaiser employees from across the country brought their issues and joined with union leaders and management at the bargaining table.

The process showed that health care workers can join with management to ensure quality patient care when they have a real voice on the job.

With this agreement, we created new standards for quality and performance in Kaiser Permanente and for the entire health care industry. Specifically, the agreement attempts to "align quality of care goals with workforce practices" by:

increasing the contribution of front-line staff in decisions about important consumer issues like quality of care, service, staffing and enhancing patient safety, as well as about business planning.

providing for joint labor-management development, administration, promotion, and evaluation of a state-of-the-art reporting system to enhance patient safety and quality of care;

maintaining fair and equitable wages and benefits and improving standards of employment;

providing for performance improvement through continuing joint efforts to redesign business systems and work processes that involve affected employees and their unions, and providing fair opportunity for current employees to perform new work through retraining or re-deployment;

providing for the establishment of mutually agreed-upon performance targets that support the enhancement of quality care and patient satisfaction, and increased efficiency;

providing greater opportunity for employees to impact organizational performance and share in the success of Kaiser Permanente;

enhancing Kaiser Permanente's reputation as the employer of choice for highly skilled and motivated health care workers.

In addition, the contract provides numerous additional opportunities for improving the work environment for employees. We also created a jointly financed and jointly administered Labor- Management Trust Fund to further training and other requirements of advancing the partnership at all levels in Kaiser Permanente.

The bottom line is more input to patient care by front-line caregivers, which in the long run will lead to cost savings and better care. The implications for health care workers are dramatic, but the real benefits of this agreement will be enjoyed by Kaiser members and patients.

At a time when some 43 million working Americans have no access to health care, union members want to work with good union employers to provide the best possible care at the most affordable cost. The new agreement with Kaiser Permanente is just one example of the added value that unions bring to health care. We encourage all consumers to look for quality health care from institutions such as Kaiser Permanente that respect and value the contributions of their union employees.

Q. Even at union worksites, some co-workers may not understand the value of the union and may even be skeptics. But I know from experience that bystanders can be persuaded and even critical voices can become powerful allies if worksite leaders listen, educate, and lead the way. What strategies help change apathy into activism?

Grace Blanks
SEIU Local 79, Detroit, Michigan

A. President Stern: Unions win the best contracts where members are most active. Nothing underscores more the value of having a union than achieving better pay, benefits, and working conditions at the bargaining table. And there is a direct tie between contract victories and member activism.

Unions aren't some far-off third party able to swoop in to handle any crisis that arises. Workers themselves are the union, and it can be as powerful and responsive as they are willing to make it.

Tried and true methods of increasing participation in the union are regular worksite gatherings and meeting with legislators and policy-makers to familiarize members with the political process. One key to ensuring wider involvement in the union is speaking in first person about what activism has achieved and sharing responsibilities for event planning and other union functions among different members.