1. Managing with Organized Labor

2.  Address the relationship of organized labor and management in healthcare  Distinguish the different phases of the labor relations process  Describe the evolving role of unions in the healthcare workforce  Examine legislative and judicial rulings that affect management of organized labor in healthcare settings  Review emerging healthcare labor trends  Consider the potential impact of the Internet on the labor management relationship

3.  Labor relation process occurs when management and the union JOINTLY determine and administer the rules of the workplace.  This is especially important for health care because labor costs account for 70% - 80% of expenditures.  Just because a union has won the right to represent the employees does not mean management must accept all of the terms.

4.  Ranges of Labor Management Relationship in Healthcare: ◦ Positive ◦ Neutral ◦ Negative

5.  Union membership is declining  Public vs. Private Sector  Healthcare workforce

6.  National Labor Relations Act  Outlines the labor relations process and is legally binding  Key Participants ◦ Management ◦ Union Officials ◦ The Government ◦ Arbitrators

7.  Recognition Phase ◦ This is Unions attempt to be recognized as representing the employees  Often Management will attempt to prevent the Unions from being able to recognize the employees  Many of these tactics can be considered unfair labor practices.  3 Reasons Employees want to Form and Union: ◦ Wages ◦ Benefits ◦ Perception about the workplace

8.  Warning Indicators for potential Union Organizing ◦ Increased Turnover ◦ Increased Employee Generated Incidents ◦ Increased Grievances ◦ Decreased Communication ◦ Increase in informational requests (IE: policy and procedures) ◦ Increase in employees meeting off-site ◦ Increase in Grapevine activity ◦ Increase in Absenteeism and Tardiness

9.  Process ◦ Union will solicit signed authorizations ◦ When at least 30% of the employees have agreed to be represented then the Union can ask the company to voluntarily recognize them  The company rarely agrees to this (less than 2%)  When refused the Union is now allowed to seek NLRB assistance to petition other employees

10.  Bargaining Units ◦ The NLRB determines who can be represented by a Union  These “groups” are called Bargaining Units  The NLRB doe not all managers or supervisors to be part of a Bargaining Unit

11.  Elections ◦ The Union is permitted to conduct pre-election campaign ◦ Management may not make threats regarding the outcome of the election ◦ Management is allowed to conduct their own meeting with employees to tell them what changes will occur if a Union with the election  To win the Union needs a simple majority

12.  The process of negotiating is called “Collective Bargaining”  The NLRA requires negotiation to occur in Good Faith  Types of Bargaining: ◦ Concessionary ◦ Integrative ◦ Distributive

13.  Agreements of the negotiation must be applied and enforced  Management may discipline employees and must base all procedures on due process ◦ Arbitrators will usually side with Management is progressive discipline was used  Grievance Procedures  This is a useful tool to manage the terms of the agreement  Arbitration ◦ Unresolved issues are sent to arbitration ◦ Arbitration is typically limited the terms of the agreement and the application of those terms.

14.  Important Cases ◦ NLRB v. Kentucky River Community Care, Inc. ◦ NLRB Ruling: Oakwood Heritage Hospital, Taylor, Michigan  Important Legislation ◦ The Taft-Hartley Act ◦ 1974 Healthcare Amendments to the Taft-Hartley Act

15.  Unions  Physicians  House Staff (Medical Residents, Interns and Fellows) and Medical Students  Nurses  The Impact of the Internet

16.  Create a policy on Unionization  Must have policies and procedures that ensure a proper fit of personnel with specific jobs  Provide necessary training for implementing policy and procedures  Implement consistent disciplinary actions  Each phase of the labor relations process in interrelated.