Organized About Labor

In our annual Industry Survey, a majority of healthcare leaders cited organized labor a threat, placing it among their organization's top three concerns.

What is the nature of that threat and what is the best way for leaders to address this? 

Wright Lassiter III
CEO
Alameda County Medical Center
Oakland, Calif.

On Creating a Dialogue: Almost 90% of our employees are represented by unions. When I arrived at ACMC it was contentious largely because there wasn't good communication. In the organization oftentimes you've had a lot of financial strife, and leadership turnover doesn't allow leadership to sit down with unions and develop a partnership. So in our case we have pretty positive relationships with the majority of our labor unions and they understand that the purpose of the partnership isn't for them to threaten us or force us to do things that aren't economically viable or to be a barrier to creating a culture of excellence. They are really there to partner.

You walk around our organization now and look at the boards for labor unions and you will see things like "Working on a partnership to be an employer of choice" instead of things like "Management is evil" or "Down with Wright Lassiter!" 

On Building a Relationship: In the past they weren't always sure that some of the stories were as dire as they actually were. We used the phrase, "We are going to open the kimono and you guys can look at what you want to look at." And we are going to include union leadership on committees to fix things. We had conversations about things that weren't comfortable for either party at times, but I really believe it was a large part about the sincerity and transparency and open dialogue and not being afraid to say "impasse." Let's just stop bickering over this thing because we aren't going to resolve it, so this is how we are going to approach it with a little bit of give-and-take without giving the farm away

John Haupert
President and CEO
Grady Health System
Atlanta

Reduced reimbursements, healthcare reform, and the future role of safety-net hospitals rank way higher for us than do issues related to organized labor. Southern states are big into right to work and are not very organized labor-friendly. I prefer that. It's not that I am anti-union but I don't want to work in an environment where I have to go through a representative to interact with employees who are providing care to the patients. That isn't good for patient care or safety or workforce relationships and I personally prefer not to work in that environment.

The best defense is a good offense. We all as employers—regardless of if it is healthcare or any other industry—have a huge obligation to work to create a highly engaged and committed workforce. If you go through the effort of doing that it creates a much better organization. You fend off the desire of employees to reach out to unions. In organizations where senior leaders don't pay attention to what the front line is telling them about working conditions and the quality of frontline and midlevel leaders, benefits, pay, if you turn a deaf ear to that, you really open up the window for employees to engage unions in a discussion.

No. 1 is making sure you hear the voice of the employee.

Britt Berrett, PhD, FACHE
President
Texas Health Presbyterian Hospital–Dallas

The threat is probably regional in nature. Unions are very limited in the entire state of Texas but I was very familiar with unions when I was a CEO in the Sharp HealthCare system in San Diego. I'm always concerned when there is a need for a third-party intermediary, such as a union, to represent the interests of members of your team. To have a third-party voice for those professionals seems unseemly.

There is a strong interest by unions to penetrate healthcare because it is filled with professionals who have not been unionized in the past. Healthcare is almost a $3 trillion industry and healthcare professionals have an ability to move from one organization to another almost seamlessly.

Also healthcare is in a constant state of change. Unions represent more static industries. We are nimble. The nurse requirements of today will be significantly different in 36 months from today. To demand static conditions of employment is unreasonable.

One of our key performance indicators is based on our ability to retain top performers. We measure that every month by department. Yesterday I had a lengthy conversation on why one of the clerical staff left. Yes, really. We are all interdependent and if we have clerical staff who don't feel engaged, I have to know.

Joseph Pepe, MD
President and CEO
Catholic Medical Center
Manchester, N.H.

It's a top threat but I wouldn't put it in the Top 3. Most of the time you can't see this threat. But I tell my senior staff to rest assured that it is always there, hiding in the shadows and ready to pounce if the timing is right. It's best to be proactive and do what's right for employees all the time and not just when the threat comes out of the shadows.

The most important key is open and frequent communication. I have open forums with employees every month. I meet with representatives of the various departments every other month and I meet with the physicians' cabinet every month. It is important in these meetings to make them feel safe to ask questions and I encourage them to do so.

Respect is another key. This starts at the top with the CEO and senior leaders treating everyone with respect. I expect them to respect not only their supervisors and patients but also to respect each other. This is a place that is opposite from a toxic environment.

It's important to be visible. I round on the floors once a week and I encourage my senior staff to do the same. When there is a crisis, I go there either right away or shortly after that to show my support and ask if everyone is okay. Just being visible shows that you care.