A CEO's Guide to Avoiding Unionization Unrest

As workforce unrest takes hold, physician groups look toward unionization.

Workforce unrest in healthcare has been building since the pandemic and it doesn't appear to be calming down anytime soon.

Through several strikes, organized labor is making its presence felt and it's coming during a period in which hospitals and health systems are already stretched thin financially and operationally.

CEOs must be ready to respond to unionization and, ideally, focus on preventing them in the first place, especially as unionization is spreading across the healthcare workforce with greater physician involvement.

A sign of things to come?

In the latest example of bubbling frustration among healthcare workers, around 400 physicians and 150 nurse practitioners and physician assistants across more than 50 clinics operated by Allina Health voted to unionize earlier this month. The vote, which was 325 to 200, according to the National Labor Relations Board, creates what is believed to be the largest group of unionized private-sector physicians in the country.

The union will be represented by the Doctors Council, an affiliate of the Services Employees International Union, which said in a statement on its website: "This is a win not only for the doctors that stood together and the supporters who rallied alongside them but also for the patients and the communities they serve."

Allina said it is not going to appeal the outcome of the vote to the National Labor Relations Board. In response to the vote, Allina said in a statement: "While we are disappointed in the decision by some of our providers to be represented by a union, we remain committed to our ongoing work to create a culture where all employees feel supported and valued. Our focus now is on moving forward to ensure the best interests of our employees, patients and the communities we serve."

Allina's employees unionizing may not be the most indicative of what other organizations could be in for going forward. The health system has been dealing with a range of operational challenges, from posting an operating loss of $122.7 million in the second quarter to ending a controversial policy that restricted care to patients with medical debt after facing public scrutiny.

Yet, the reasons for Allina's physicians choosing to unionize are also present everywhere: understaffing, burnout, administrative burden, and compromised care quality.

Similarly, resident physicians at George Washington University in Washington, D.C., voted to unionize earlier this year, citing pandemic burnout.

By addressing issues such as burnout, or at least showing your workforce you're willing to, CEOs will give employees less incentive to organize.

Prevention is the best medicine

Most of the time when unions form, the assumption is that compensation is the driving factor. While pay is often a sticking point for workers, it is usually in combination with another problem that creates dissatisfaction, such as extended hours on the clock.

Undoubtedly, CEOs must invest in their employees with competitive salaries and benefits to retain talent, but they should also invest in areas to improve efficiencies and reduce workload. Revenue cycle, for example, has opportunities for implementing technology that can both save time for physicians and help an organization's bottom line.

Outside of financial and operational investment, CEOs need to focus on personal investment to keep employees happy and feeling respected. Something like an employee recognition program or other benefits that extend beyond the workplace can go a long way.

Another way CEOs can really stay ahead of the game is by empowering their workers, especially physicians. Larger health systems may be more susceptible to unionization due to consolidation cutting down on independent practices and as a result, taking decision-making out of doctors' hands.

Encouraging physician leadership and valuing input allows doctors to feel like they have a say in how their patients are cared for.

Joe Perras, CEO of Cheshire Medical Center, recently told HealthLeaders: "We need to make sure that we are doing everything we can to improve employee engagement across our hospital. Engaged employees provide higher quality, safe care than unengaged employees. People who believe in the mission will give their all to take care of patients, and we need to foster that."

A union formed. Now what?

If a petition is handed in and a union forms, it can feel like a loss, but the situation is far from unsalvageable.

Once this happens, CEOs need to shift from a reactive mindset to a proactive one. Now, it isn't just about assessing ways to improve the environment for employees, but addressing specific concerns or demands.

Most importantly, CEOs must maintain good working relationships with unions. The greater the friction and tension, the harder it gets to negotiate and find middle ground. Effective, good faith communication can be the difference in trading one demand for another.

Also, be aware of how agreeing to a union's ask will affect the rest of the organization. In the case of the recent Kaiser Permanente strike, the union stood firm on protecting the revenue cycle workforce from outsourcing. Kaiser agreed to that in the new deal, which means it will now have to find other ways to save on costs within revenue cycle, such as implementing automation.

Whether a union forms or not, CEOs should have an idea of where their organization's vulnerabilities lie, what their stance on certain issues are, and whether there's wiggle room to adjust.

This article has been updated to reflect Allina's decision not to appeal the vote of its members to unionize.