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As unions grow, healthcare execs need to know how to handle them

Hospital employees may be tempted to join to protect their positions and wages knowing there’s pressure on organizations to reduce costs.

Susan Morse, Managing Editor

California nurses on strike. Image from <em>California Nurses Association</em>.California nurses on strike. Image from California Nurses Association.

As more unions try to lure healthcare workers, including nurses, in the wake of easier rules, healthcare managers should know that conflict between unions and management can be avoided.

Big labor is making inroads into healthcare, driven by new regulations. A new National Labor Relations Board rule that took effect April 14 expedites the election process from about 42 days to 14 to 21 days, giving management as little as two weeks after a petition is filed to counter union claims of the benefits to organizing.

Hospitals are a focus because they are often the largest employer in an area, have jobs that can't be shifted offshore, and now, are in the middle of an industry being pressured to reduce costs. All of which unions have tried to capitalize on.

Since the rule went into effect, union petitions have increased by 10 percent across all industries, according to a report by IRI Consultants and the American Society for Healthcare Human Resources Administration.

The study also found union elections were negatively correlated with Hospital Consumer Assessment of Healthcare Providers and Systems scores that play a large part in determining Medicare reimbursement. Hospitals with union elections, whether the election was successful or not, had 2013-2013 HCAHPS scores of 2.54 (out of 5) compared to 2.61 at hospitals with no union elections. This is a percentage difference between 10 and 20 percent, the study found.

The IRI study also looked at readmission rates, and found a small difference. Hospitals with union elections in between 2012 and 2013 had readmission rates of 20.8 per 1,000 patients, compared to 20.4 per 1,000 in those without an election.

In healthcare organizations, unions continue to win a disproportionate share of elections compared to non-health related businesses: 77 percent versus more than 60 percent in other industries, according to the study.

The "quickie elections" are a "communications effort for hearts and minds of employees," said Jim Trivisonno, president of IRI Analytics.

Unionization has a financial effect on hospitals, Trivisonno argued. Additional staffing, the expense of negotiating contracts every three years, and if there's a strike, the hiring of replacement employees can add up. For example, a strike nurse is paid $75 an hour for a minimum of five days, according to Trivisonno. (Representatives from the major healthcare union, Service Employees International Union, were unable to comment for this story.)

The best way to avoid a union is to avoid giving employees incentive to organize in the first place, according to the experts. Treatment, and not wages, is what motivate employees to unionize, they said.

"There's always a triggering incident. People don't vote for a union because of wages and benefits. They vote for a union because of dignity and respect or lack thereof," Trivisonno said.

"I've had union campaigns start because employers wouldn't fix the microwave," said David Rittof, president and CEO of Modern Management, Inc. "Unions do not drive wages, the market drives wages."

Recent National Labor Relations Board rules that went into effect in April require employers to provide union organizers with more of an employee's personal information. This includes job location, phone number, home address and e-mail. The information enables organizers to contact employees to drum up support to unionize.

Management must provide the information, whether the employee objects to it being given out or not, within two days of a union petition being filed. Employers previously had five days. "It's a mad dash," Rittof said.

As unions try to keep organization discreet, the petition may come as a surprise. The union representative may choose to present the petition to the hospital CEO, the vice president of human resources or another senior executive. Within seven days, management must have its position statement ready.

"It's the second time in its history since 1935, that they went back and did rule-making," Rittof said of the National Labor Relations Board.

The first attempt in 1991, did not create as broad a change, he indicated. So far, attempts to change the regulation have not been successful.

On June 3, a federal district judge in Texas dismissed a lawsuit filed against the NLRB election rule. The U.S. Chamber of Commerce has also led a lawsuit in Washington, D.C. against the ruling.

Rittof believes not much can be done to alter the NLRB's decision. Once a union forms, be prepared to deal in good faith over the long haul, as decertification is rare, said Rittof. "You're kind of in this for life."

In healthcare, an estimated 14 to 17 percent of the workforce is unionized, compared to 11.1 percent of the total workforce. 

There are an estimated eight bargaining units for nurses though more nursing staff remain non-union than are unionized.

Physicians were targeted for organization a decade ago, as more joined hospitals as staff. However, union organizers found doctors to be tough to organize. "It was hard to get them to agree to anything," Rittof said.

Rittof said hospitals facing union advances should have a plan ready in case a petition is handed-in. There will be little time once a petition is filed. Do not gather employee information such as email addresses ahead of time. The NLRB rule says e-mail addresses must be provided "if you have them," he said.

Also, do a vulnerability assessment of the organization and don't sit on the issues you find. Small issues can easily become a larger complaint. Treat employees well and create an environment that motivates employees. This will also produce better quality and patient care.

Also, have an active problem-resolution process that allows employees to open up, such as a peer review program. But don't skimp on training supervisors. The first line supervisor is critical to employees as the most trusted source of information.

And, always watch for signs of organizing.

"Union avoidance is something called good management," Trivisonno said, "but if you have a union, you should have a good working relationship with them."

Twitter: @SusanMorseHFN