While the Service Employees International Union continued its assault this summer on Catholic Healthcare West for its labor relations record, the SEIU and two dozen other unions were bargaining their first-ever national labor contract with Kaiser Permanente, a CHW rival in California.
"It just goes to show there are some enlightened employers that truly appreciate and understand if they want to be the healthcare provider of choice, they need to involve the people who do the work," says Sal Rosselli, president of SEIU Local 250 in Northern California.
Announced late last month, the new Kaiser contract covers 64,000 employees--more than two-thirds of the company's total nonphysician workforce. Kaiser, headquartered in Oakland, Calif., has 8 million members in 11 states and the District of Columbia.
The contract is another step in Kaiser's management-union collaboration efforts.
For Kaiser, the contract "gives us a period of at least five years of labor peace," says Leslie Margolin, the company's senior vice president of workforce development.
For the unions, the contract not only improves wages and benefits, it also gives them a voice on a variety of issues, including staffing, patient safety and issue resolution.
But relations between unions and management aren't always this amicable. The formation of large hospital companies--either for-profit or not-for-profit--and increased financial pressures on providers have put the squeeze on labor relations.
Consequently, unions have changed their tack and taken an equally corporate and unified approach to their organizing and bargaining.
Hospitals and health systems throughout the country are dealing with contentious labor negotiations and the threat--or reality--of strikes.
The new deal. The Kaiser agreement was announced with much fanfare Sept. 26 during a press conference at the National Press Club in Washington.
Edward Montgomery, deputy secretary of the U.S. Department of Labor, hailed the Kaiser agreement as "collective bargaining at its very best."
The root of this new agreement is a landmark pact that Kaiser--which has had its share of labor strife--signed in 1997 with the AFL-CIO to partner with 26 unions to smooth the company's labor relations and involve workers in decisions about the company's operations.
Twenty-five of the 26 unions that were part of the 1997 partnership took part in the new national contract.
Negotiations on the contract lasted seven months, a "long and arduous but very exciting process," said David Lawrence, M.D., Kaiser's chief executive officer.
Three years ago, when Kaiser entered its partnership with the unions, collective bargaining was not a goal because so many other areas of collaboration were involved, Kaiser's Margolin says.
But about a year ago, as the relationship between Kaiser and the partnership unions developed and their level of trust improved, "it just made sense," rather than having to engage in traditional contentious labor negotiations, she says.
Montgomery says it is "in their self-interest" for others in the healthcare industry to follow Kaiser's lead in labor-management partnerships.
"I think others in the industry hopefully will follow," he says.
One union that didn't buy into Kaiser's partnership or its new national labor contract is the California Nurses Association.
The CNA represents more than 9,500 registered nurses at Kaiser facilities.
CNA spokesman Charles Idelson says unions in the Kaiser partnership "have become a shill for Kaiser."
During the press conference announcing Kaiser's new contract, John Sweeney, president of the 13 million-member AFL-CIO, said the unions would promote Kaiser as the healthcare provider of choice.
Doing that is antithetical to the CNA's way of thinking, Idelson says.
"We think the managed-care model itself is systemically and irrevocably flawed," Idelson says. "We think it would be consumer fraud to recommend any particular model of health plan to consumers."
Nurses, Idelson says, should be patient advocates and not too cozy with their employers.
But Kathy Sackman, president of the United Nurses Associations of California, which is part of Kaiser's union partnership and its new labor contract, says the CNA's position doesn't make sense.
"There's no question in my mind we're working with the employer to provide patient care. You have to," says Sackman, whose union represents 7,000 nurses at Kaiser facilities in Southern California.
Nurses, she says, have to work with their employers, supervisors and physicians, especially to conduct basic business such as buying equipment.
"You can't do that by yourself," she says.
No love lost. Kaiser's relationship with some of its unions is a veritable love fest compared with the experiences of other healthcare providers.
When it comes to corporate targeting by unions, one of the most widely publicized and contentious campaigns is the one the SEIU is waging against San Francisco-based CHW.
The SEIU took its campaign national this summer when it demonstrated outside a San Francisco hotel hosting the Catholic Health Association's annual meeting.
SEIU members infiltrated the meeting and distributed fliers and videotapes denouncing CHW and its labor-relations record (June 19, p. 8).
The union says CHW doesn't want more of its workers to unionize because it will interfere with its corporate plan, which, the SEIU charges, puts making money before patient care. In the past, CHW has employed the services of two anti-labor consulting firms.
The SEIU already represents about 4,000 CHW workers.
Collectively, about 20% of CHW's 40,000 workers are represented by nine unions, says Julie Collins, senior vice president of human resources at CHW, which operates 48 hospitals in three states.
Collins says the SEIU's organizing efforts are self-serving.
"The SEIU has to grow to survive," she says.
In corporate campaigns, such as the SEIU's against CHW, the union attempts to get an agreement from the system's top management that the system won't mount an anti-union campaign--a stance called neutrality--and then will let employees decide whether or not they want a union.
But a position of neutrality isn't something CHW is interested in, Collins says.
She says CHW supports letting people choose whether they want to be in a union, but "what the SEIU has said to us is what neutrality means is that we will not . . . communicate at all with our employees concerning the union organizing."
That, Collins says, is unacceptable to the system's management and the nine religious congregations that sponsor CHW.
Rosselli says the SEIU has both won and lost elections at CHW to represent new units of workers.
Despite its losses, the SEIU's strategy is: "We're not going to give up."
The reason, Rosselli says, is CHW's anti-union campaign has included false promises to workers and illegal union-busting tactics.
Nurses rally. Although the CNA isn't part of Kaiser's union partnership, it still has a desire to work with other unions.
The move for more unity among unions continued to grow last month when more than 300 leaders from nurses' unions in the U.S. and Canada gathered at a hotel in Berkeley, Calif., for what was billed as a school for nurse activists.
On their agenda: creating a new national nurses' union to help better coordinate patient advocacy and union activities around the country.
"When you have consolidation in the healthcare industry . . . it really requires a phenomenal amount of coordination among the front-line caregivers," says Rose Ann DeMoro, executive director of the CNA, headquartered in Oakland, which hosted the four-day event.
During the meeting, nurses took the first step in exploring a new national collection of nurses' unions.
While nothing was made official, "I'm sure this is going to occur," says CNA President Kay McVay.
The American Nurses Association in Washington has its own national nurses' union, but the CNA-led effort wants to go its own way.
The gripe some nursing factions have had with the ANA is its mix of allegiances, because it includes both unionized and nonunionized nurses and nurse managers. Some also perceive a lack of aggressiveness by the ANA when confronting issues affecting staff nurses.
Susan Bianchi-Sand, director of the 100,000-member United American Nurses, the union arm of the ANA, says she was invited to and attended the gathering of nurses in California.
"They are interested in forming what we have," Bianchi-Sand says. "But they would be the leaders."
For the nurses who want to form a new national union, it's all about patient advocacy and workplace issues.
"The corporatization of healthcare and the destruction of the healthcare system is a common problem we are facing," McVay says. "We all agree we need to take profit out of healthcare and take healthcare off the stock market."
Julie Pinkham, director of the labor program at the Canton-based Massachusetts Nurses Association, says unions have to think beyond their individual hospitals and look at hospital chains as a total corporation when negotiating.
"You're going to get blindsided if you don't," she says.
Powerful teams. Unions, she says, need to work together.
For example, when Pinkham's union was negotiating a contract with Santa Barbara, Calif.-based Tenet Healthcare Corp. for its hospital in Worcester, Mass., her union talked to the CNA about its negotiations with Tenet there.
Union leaders say working together helps unions achieve standards in contract bargaining. That, she says, is key. If one union agrees to a contract with lower pay or less-favorable labor terms, then it makes it harder for other unions to bargain for higher pay and better terms.
"Whoever sets the lowest standard has a dramatic impact on the rest of the contracts," Pinkham says.
For example, Pinkham says Tenet tries to negotiate union contracts that are so-called "open shop," which means employees can decide whether or not to be in the union.
Pinkham calls this a typical union-busting tactic on the company's part, because it aims to weaken the power of the union.
When Tenet's 369-bed Saint Vincent Hospital in Worcester was negotiating a new contract, it wanted this open-shop arrangement, which the Massachusetts Nurses Association resisted.
The union prefers a closed-shop arrangement, in which employees either pay union dues or what's called an agency fee if they don't want to be in the union.
The agency fee is to cover the cost of collective bargaining, because a union in Massachusetts is legally required to represent all workers whether or not they are dues-paying members.
Pinkham says the union lobbied state and federal legislators to make Tenet agree to a closed-shop arrangement.
"For-profits aren't even welcome in Massachusetts as far as we're concerned," Pinkham says.
The first Worcester contract was completed in June, Pinkham says.
The Massachusetts Nurses Association represents 21,000 nurses in 50 hospitals around the state.
Tenet, which has 110 hospitals in 17 states, has 106,000 workers, and fewer than 8% of them are unionized, says Harry Anderson, senior director of corporate communications.
"We are predominantly a nonunion company and we prefer it that way because we think that direct communication in this industry these days is preferable to dealing through union intermediaries," Anderson says.
He says he doesn't think Tenet is a corporate target of unionizing activity.
"We've never been notified that we are," Anderson says.
Unions, especially those representing nurses, realize the power they can wield over management.
"The registered nurses are essentially the power block in a hospital," Pinkham says. "It's very difficult to run a hospital without registered nurses."