Preparing healthcare organizations for a new, cost-sensitive environment requires executives to involve front-line workers in all facets of organizational planning.
Yet, as providers face growing pressures to consolidate facilities, eliminate redundancy and operate under managed care, there's a tendency for managers to focus on systemwide operational and financial concerns that may neglect or minimize workers' desire for job security and a voice in decisionmaking. Conflict is an inevitable result if workers believe that management is overlooking their concerns about working conditions.
One avenue used by workers who feel underappreciated is unionization. A recent study by Management Science Associates, a labor consulting firm, shows that hospital workers filed 158 petitions for union elections in 1993, up from 19 in 1989. Not all filings result in a collective bargaining agreement or even a union representation election. But filings are a cause for executive concern because data gathered by the National Labor Relations Board show that union organizers continue to be more successful in healthcare settings than with industry overall.
For example, unions won 58.3% of all healthcare elections in 1993, compared with a win rate of about 48% for unions in all industries.
Furthermore, unions' success rate in healthcare elections is rising. The overall healthcare election win rate for 1993 compares with a rate of 55.2% in 1992. The union win rate at hospitals, which stood at 53.1% in 1993, was substantially above the 45.5% win rate in the previous year.
Like executives, rank and file workers are worried about the future direction of the industry and fearful about government efforts to overhaul the system. Some facilities are unilaterally changing work rules and eliminating flexible working hours, such as those that allow nurses who worked two 12-hour shifts on the weekend to receive pay for 40 hours of work. Others are changing staffing patterns to allow more cross-training of employees, and still others are reducing benefit levels.
One hospital went so far as to tell registered nurses they would no longer be paid for their half-hour meal breaks.
This activity is occurring just as a number of unions recently have targeted healthcare workers for organizing efforts, including the Teamsters, United Food and Commercial Workers, and the Service Employees International Union.
Last year, nurses at St. Joseph Medical Center in Joliet, Ill., staged a 61-day strike to protest the practice of pulling nurses from one unit to staff another area in which they didn't necessarily have experience. Their action was characterized as an effort to assure quality patient care and to protect their own licenses.
A recent U.S. Supreme Court ruling highlights the crescendo reached in some worker disputes. At 128-bed McDonough District Hospital in Macomb, Ill., obstetric nurse Cheryl Churchill was fired after complaining about her job evaluation, her managers and the hospital's cross-training policies. The nurse filed suit and the case went to the high court, where justices ruled 7-2 that the hospital was within its rights to fire her because government employers have a legitimate interest in achieving their goals as effectively and efficiently as possible.
But while insubordinate speech may not fall under First Amendment speech protections, the case also illustrates why it can be prudent for employers to avoid situations that lead to costly and tense conflicts.
Executives can accomplish more by improving communications with employees than they can by fighting a holding battle against disgruntled staff. Some hospitals have started employee newsletters to communicate to their staff how re-engineering efforts will involve them. Even better are efforts to include representatives at all staffing levels in designing and implementing institution-wide changes.