Healthcare Issues & Trends

If your hospital or health system has a long-term care facility, home health agency, or even a comprehensive psychiatric hospital, then you’ll need an entirely new leadership approach to remain union-free.  This is especially true if the effective and relentless gorilla warfare tactics used by Service Employees International Union and the California Nurses Association become more widespread and consistent among all other labor unions.  The non-acute care setting, not hospitals, will likely become the new ground-zero for labor organizing throughout the nation.  Why?  Because the National Labor Relations Board (NLRB) has made it incredibly easy for unions to get into these facilities.

A few years ago, there was an attempt in Congress to change the National Labor Relations Act (NLRA) – the federal labor law which governs unions and union organizing.  The proposed changes were designed to make it easier for unions to organize employees and included eliminating secret ballot elections.  The political reason for changing the NLRA was the dramatic decline in union membership since the 1950s, with less than 8% of the private workforce now represented by a labor union.  This attempt by Congress to make changes to the Federal Labor Law was unsuccessful.

The need to address the issue of declining union membership remained after the failed attempt in Congress, so a different political approach was taken.  The National Labor Relations Board (NLRB) in Washington D.C. changed a number of their internal rules to make the process of forming a union much easier than it has been for the last three decades.

Here are the NLRB Rule Changes:

Quick Elections– Conducting elections immediately after the union files their petition for an election is one change that went into effect on April 30 – but it was placed on hold a few days later by a federal judge due to procedural issues on how the rule change was implemented.  It is likely the rule change will be reinstated in the next few months.  The union’s tactic under this new rule is to build union support as quietly as possible so that the employer is unable to provide counter information until it is too late.  The other benefit of a quick election is the minimal time for employees who may oppose unionization to become motivated to vote or speak out.  A lower voter turnout almost always improves the unions chances of winning an election, since the union supporters are already motivated to vote.

Small Voting Groups–  Another NLRB rule change that will dramatically impact all non-acute care settings.  Since the first of the year, the NLRB now allows unions in non-acute healthcare settings to seek and represent a single job classification or even a single department.  In the past, the typical voting units would be “non-professional” or “professional” employees.  This included large groups of disparate employees, typically with different issues that presented a challenge for the union to effectively bring together without a significant organization-wide issue.  A union can now seek an election for just a single job title (i.e., Mental Health Workers, Hall Aides, Social Workers, Unit Clerks, Account Reps), or even a department with multiple job titles only in that department (i.e., Food and Nutrition).  Any single job classification could be found to be an appropriate bargaining unit.  The new rules also limit the hospitals ability to challenge the appropriateness of the bargaining unit pre-election, and in some cases, even post-election.

Why are small sized bargaining units a problem?  There could be over 50 non-management job titles in a non-acute facility.  Potentially, over 50 different bargaining units could exist, with 50 different unions and 50 different sets of negotiated workplace rules, benefit packages, and wage programs.  There also would be the potential for over 50 different strikes, as well as the cost and expense of negotiating and administrating over 50 different contracts.

The problem of too many bargaining units was identified as an issue by Congress in 1974, when healthcare organizations came under the NLRA.  Congress cautioned the NLRB of the potential for a high level of workplace disruption.  Congress believed that a “proliferation” of bargaining units could have a serious and detrimental impact on the delivery of care, resulting in uncoordinated activities and constant disruption due to the threat of numerous strikes.

Smaller bargaining (voting) also makes it easier for the unions to exploit employees.  A small number of employees could be dissatisfied at a particular time, concerning a very limited issue, and the union could exploit that temporary dissatisfaction.  A short-lived level of dissatisfaction, which would normally pass after the issue was resolved, could now result in long-term union representation, since once the union is in, the ability to decertify and remove them is extremely difficult.

The new union organizing rules will require a new leadership approach.  The new approach requires a higher level of urgency to identify and deal with issues which may create a temporary high level of dissatisfaction among employees in a job classification, work area, or department.  Unions are opportunistic.  The union leaders establish contacts within departments and work units to notify the union when a negative employee event occurs or when a group of employees is particularly dissatisfied.

In the past, methodically addressing an issue within a job classification or work area would not impact the overall union vulnerability of a larger voting unit, unless the issue was widespread and impacted multiple work areas.  Union vulnerability tended to be driven more by hospital-wide issues that were shared by employees in multiple job classifications and departments.

Under the new smaller voting unit rules, a very specific issue among a narrow group of employees that lingers unidentified or requires weeks or months to resolve, could be the opportunity the union is constantly looking to exploit.

Employees look to unions mainly because they believe the union will resolve their issues better than hospital leadership.  On a work unit level, many times this attitude is fleeting and is replaced by indifference to the union or even support for the hospital leadership once an issue is resolved or expectations are managed through communication and discussion.

Other times, employees may be reluctant to discuss an issue until it reaches a high state of discontent.  Once the issue is clearly identified, leadership responds and the situation is diffused.  In both cases, union vulnerability is at a high level for a period of time and then ultimately diminishes.

With the new NLRB rules which allow for quicker elections and smaller bargaining units, it will be vital to create a continual “issue identification culture” that will limit the number and types of issues which can fester before being recognized.  Once the issue is identified, it will be imperative to take quick action, which is counter to the more methodical, process-oriented aspect of care delivery and healthcare management.

To help limit employee perception that a union can identify and resolve issues better than leadership, all employees need to be educated with a uniform level of knowledge of the limits to union bargaining, the costs of union representation, and the impact of strikes on patients, employees and the community.

So that employees are less judgmental of leadership’s attempts to manage and resolve workplace concerns, employees need to understand that a union cannot necessarily resolve their issues and that issue resolution in a union environment can be lengthy with no guarantee of a positive outcome.  There needs to be an identifiable contrast between being represented by a union, and the efforts of leadership to create a positive as possible workplace.

A perception that leadership respects employees for the work they do, and that they value and act on their concerns, needs to exist.  This culture needs to permeate all levels of leadership in the organization so that an expectation can also be established that employees respect leadership and are focused on the care and service provided to patients.

Traditional union avoidance strategies in non-acute care settings are becoming as obsolete as the fax machine.  Think now of ’texting.’  It’s immediate, to the point, and focused.  Timely and focused education as well as issue identification and resolution is needed to overcome the ‘Welcome’ sign the NLRB has put out for unions in non-acute care settings.