The Markup, now a part of CalMatters, uses investigative reporting, data analysis, and software engineering to challenge technology to serve the public good.
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Markup → use → good
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that → sign → inbox
Kaiser Permanente nurses who answer advice and triage calls say their duty of care for patients is being increasingly threatened by workplace surveillance.
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duty → answer → surveillance
Seven current and former nurses told The Markup that those who spend more than 15 minutes on a call with a patient routinely face criticism from Kaiser management or get called into performance evaluation meetings.
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who → tell → meetings
Call time, they said, factors into monthly performance scores they receive.
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they → say → scores
In addition to tracking call length, they said Kaiser uses software that tries to predict on a daily basis whether they’re being unproductive or failing to answer calls quickly.
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they → track → calls
Artificial intelligence systems have also been used to rate their empathy and tone of voice.
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systems → use → voice
Their comments come as the California Nurses Association begins negotiating a new contract with Kaiser this month with AI a likely issue.
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AI → come → Kaiser
Kaiser nurses went on strike against AI for one day in March and picketed against AI last fall.
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nurses → go → AI
The CNA is bargaining for 25,000 nurses, including 1,000 in call centers.
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CNA → bargain → centers
At the same time, California lawmakers are considering several bills regulating AI in the workplace, including one that would protect from retaliation doctors and nurses who override automated care recommendations.
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who → consider → recommendations
Kaiser defended its use of AI, saying it deploys the technology with human oversight and with patient safety in mind.
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it → defend → mind
It said it does not use “average handle time” to assess performance.
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it → say → performance
Kaiser Permanente is the largest private employer in California, providing healthcare services to more than 9 million people in the state and to 3 million other Americans.
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Permanente → provide → Americans
That means the company’s use of artificial intelligence could set important precedents for managing workers with AI.
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use → mean → AI
It could also have a big impact on patient care, providing an early example of how the healthcare sector balances cost-cutting automation with human presence or touch.
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sector → have → presence
Raquel Alvarez Sanchez, a Kaiser Permanente advice nurse in Vallejo since 2010, said she was on a call with a patient who was suicidal last year that took more than an hour because she had to wait for police to arrive before hanging up.
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police → say → hour
She tried to make the man feel cared for, even though she was cognizant that staying on the call that long would throw off her average call time for weeks and could lead to questions from management.
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staying → try → management
Sanchez, a union steward, said she’s accompanied colleagues to performance evaluation meetings, where they were found to have done everything right on a call — except staying on the line for more than 15 minutes.
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they → say → minutes
She said she hasn’t seen nurses get fired for doing that, but she fears that continued pressure can lead nurses to quit or retire early.
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pressure → say → nurses
“I think at some point all of the nurses have been talked to about their average handle time,” she said.
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she → think → time
“The only thing I can think of is they’re doing it for profit.”
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they → think → profit
Another nurse who spoke with The Markup on condition of anonymity due to fear of retribution described how that surveillance affected a call with a patient last year.
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surveillance → speak → patient
Initially she thought her patient, an elderly woman who just received a terminal cancer diagnosis, was suicidal, but quickly came to understand that she was in shock and really needed somebody to talk to.
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she → think → somebody
The nurse wanted to take time to show compassion or comfort to the woman, who acts as a caretaker for her daughter, but she stopped herself out of fear it would hurt her monthly performance score and lead to a reprimand from her manager.
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it → want → manager
She became a nurse to provide people with compassionate care, but “I had to ask myself: Am I going to get disciplined for going off script or saying more than what is necessary?”
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what → become → more
Kaiser Permanente says its performance evaluations help improve patient outcomes.
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evaluations → say → outcomes
A company spokesperson said, “Kaiser Permanente does not use Average Handle Time to assess agent performance or enforce call time metrics.
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Permanente → say → metrics
Any tools used in contact center settings support our quality assurance efforts and have human review and oversight.”
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tools → use → review
In a statement provided to The Markup and CalMatters, spokesperson Vincent Staupe added that Kaiser uses AI responsibly, with human oversight, and by “prioritizing patient safety, privacy, and equity,” but he said, “As a large organization, we do not share specific information about internal technology systems for security and operational reasons.”
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we → provide → reasons
It’s not clear how patient care is affected by algorithmic management, nor is the impact of limiting the length of triage and advice calls on patients.
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impact → ’ → patients
Kaiser call center nurses can’t say for certain whether the pressures they face results in adverse outcomes for patients because their contact with patients ends after they hang up the phone.
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they → say → phone
A 2024 public records request by CalMatters to the California Department of Managed Health Care found no complaints by patients against Kaiser related to call times.
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request → find → times
But nurses insist the risk to patient safety and quality of care is real.
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risk → insist → care
Consumer Watchdog patient advocate Michele Ramos said many Kaiser patients begin their care on the advice line.
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patients → say → line
They later complain to her, mostly about things that happen in Kaiser facilities, but “I can see now where a lot of the problems” start, given the call constraints nurses are under.
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nurses → complain → constraints
Ramos said the time pressures may fit a broader pattern at Kaiser of putting costs over quality.
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pressures → say → quality
The health giant was hit with a record fine, $50 million, as part of a settlement over findings from the California Department of Managed Health Care that it delayed behavioral health appointments beyond statutory limits and too often moved patients into group rather than individual therapy.
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it → hit → therapy
Kaiser also settled with the U.S. Department of Labor after investigations into its substance use and mental health services.
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Kaiser → settle → services
Kaiser faced criticism in 2002 for paying bonuses to call center workers who aren’t nurses for keeping calls short, though call center nurses who spoke with The Markup and CalMatters said they encountered no such practices today.
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they → face → practices
…and 78 more, not listed.
