Hospitals are being squeezed by two key demands of today's healthcare marketplace: the need to find and retain workers able to do complex tasks and the imperative to improve quality at almost any cost.
A tight labor market is leading to a continued shortage of skilled personnel. That, combined with dissatisfaction among the rank and file, could become fertile ground for labor organizing. That doesn't mean unions will win elections, but it does mean ongoing aggravation for hospital managers.
A case in point was a long-running battle recently resolved by somewhat unconventional means. The Service Employees International Union and Sunrise Hospital and Medical Center in Las Vegas reached an agreement to hold an organizing election by bypassing the arduous National Labor Relations Board process. They called in the Federal Mediation and Conciliation Service, which held a smooth election in early December. The union won, and so far an atmosphere of civility has reigned.
In California, Democrats control both houses of the state Legislature and captured the governor's office in November. Disciplined union support was instrumental in incoming Gov. Gray Davis' election. Now it's payback time, and new regulatory legislation could pass. This might include regulated nurse-to-patient ratios, wider mandatory health plan benefits, easier appeals of coverage denials and more public accountability throughout the healthcare system.
On the quality frontier, we will see increasing efforts to link quality to specific brands. This is going to be a difficult, frustrating task for doctors and hospitals. It's not easy to produce results that show an increment of quality improvement that consumers and payers can comprehend.
Both VHA and Premier, two large hospital alliances, are working on quality initiatives. And the Joint Commission on Accreditation of Healthcare Organizations is using advertising to raise consumer awareness of its seal of approval.
A rear-guard action to evade the quality police is taking place elsewhere. The National Committee on Quality Assurance recently reported that many health plans are declining to publish their quality results. This is not encouraging for patients.
From a marketing perspective, quality is only relative. A rising tide of better care lifts all boats, but no advantage is gained in the marketplace unless your boat floats higher than your neighbor's.
And quality is expensive. The data-collection systems and qualified personnel required to sift through reams of cases cost a bundle. It's hard to justify this infrastructure without guaranteed clear results.
Healthcare executives, let us not forget, are conservative. They don't like to get too far out front of the pack -- or behind it. Therefore the quality revolution threatens to single out and categorize organizations in ways they might not prefer. There's more safety in obscurity and the lack of directly comparable results.