Unions in general have been in decline in the United States over the last 20 years. In 1983 the union membership rate — the percent of wage and salary workers who were members of a union — was 20.1 percent, and there were 17.7 million union workers. In 2012, the union membership rate was 11.3 percent, and there were just 14.4 million union members, according to Bureau of Labor Statistics data.
The healthcare industry, however, is swimming against the stream. Last year, 20.8 percent of healthcare workers — people in healthcare practitioner, technical and support occupations — were members of a union, well above the nationwide union membership rate of 11.3 percent.
There are several reasons more healthcare workers are members of unions. Recently, unions began focusing on healthcare organizations like hospitals and health systems more than ever before. "Unions have had a terrible time with manufacturing," says David Rittof, president of Modern Management and employee relations consultant. "A lot of that is due to lost manufacturing in the country," he says. Much of the nation's once prolific and heavily unionized manufacturing plants have been moved and workers outsourced to other countries, leaving no workers for the unions. On the other hand, "you can't pick up and move a hospital," says Mr. Rittof. "It's a captive audience."
Even hospitals and health systems that have great relationships with unions sometimes hit a rough patch. The reason these relationships can be challenging, says Brandon Edwards, president and CEO of ReviveHealth and former member of Dallas-based Tenet Healthcare's crisis communication team, is simple human nature. "Any time you insert a third party into anything, like between an employer and an employee, [everyone is] going to be anxious," he explains. The union is anxious to prove value, and the hospital will be suspicious naturally. "The existence of a union in a hospital will fundamentally change the relationship between the hospital and its employees. I'm not saying it's necessarily all bad, but it's not the same or as positive."
"In general, with unions, it becomes a 'we/they' or 'us vs. them' mentality instead of a team [mentality]," adds Mr. Rittof. "And in healthcare, delivering patient care is all about collaboration."
Maintaining an unorganized employee base
Many hospitals that do not have organized labor would prefer to stay that way, if only to avoid developing the "us vs. them" mentality that often comes with unionization and to make the team dynamic easier to achieve. For hospitals that currently have no unions, maintaining that status is a possibility even with the unions' newfound interest in healthcare, according to Mr. Rittof. It just takes prepared managers and excellent communication.
Prepare the leaders. Managers in hospitals with no current union presence should be constantly on the look-out for unionizing activity and be trained on how to handle it, says Mr. Rittof. Signs of employees thinking about unionization can be as obvious as seeing a flier posted on a bulletin board or as subtle as employees starting to use combative, negative language. If this activity is happening, hospital managers need to be able to have effective conversations about unionization with the employees. "The most powerful tool is first-line supervisor direct dialogue with employees," Mr. Rittof says. Managers should be able to speak about why unionization would not be ideal for that department or the hospital as a whole.
Engage the employees. "The only way unionization tends to work is where employees want it in the first place. They have to be disengaged from the employer," Mr. Rittof says. Giving employees multiple routes to communicate directly with their employers is one of the most effective ways to facilitate employee engagement and avoid unionization. He suggests employee opinion surveys, lunch events with executives, hotlines for suggestions and an open door policy with human relations and managers as ways to facilitate and track employee engagement levels. Including employees in decision making whenever possible is also effective.
Other simple ways to keep employees happy and the hospital union-free include offering fair and balanced wages and a competitive benefits package, and consistently enforcing personnel policies across all departments, Mr. Rittof says.
Coming to the table
Healthcare markets in many states, like New York, have heavy unionization and relationships with unions that are firmly established. "It's a little late to keep the unions out of the hospital," says Rory McEvoy, partner at Edwards Wildman Palmer in New York and co-chair of its labor and employment practice group.
Since hospitals negotiate with unions on contract agreement generally only every three or so years, it is especially important for hospitals to build positive relationships with unionized employees every day, in between negotiations. Building positive relationships day to day will make negotiation times easier for both sides.
To do so, Mr. Edwards recommends that hospital administrators in a unionized hospital treat their employees as if there is no union to the greatest extent possible. "In many ways, hospitals need to pretend like the union isn't there and communicate effectively and continue to treat them that way," he says.
"The tendency…is that communication [to employees] ends up reading like a lawyer wrote it," because of the regulated environment in unionized hospitals, Mr. Edwards says, but he encourages hospital administrators to resist that urge. "Continue to treat employees the way [you] did in absence of a union. Care about them, communicate with them effectively."
From the union perspective, one of the best ways hospital administrators can ensure positive relationships day to day is by simply honoring the contract. "The contract isn't a cafeteria menu where you can pick and choose the parts…that you honor," says Deborah Burger, co-president of the California Nurses Association, which is a founding member of National Nurses United. If hospitals follow the contract that is in place, the next negotiation is more likely to be a smooth process.
Even if hospitals do all they can to maintain positive relationships with their unions, contentious negotiations can still occur. Mr. Edwards provides three tips for hospitals to keep the peace with unions during such a time.
Stick to the agenda. Before hospital and union officials meet for a negotiation, both parties should agree on a specific agenda. "There's a tendency…to spend so much time on minutia…and lose sight of the big picture," says Mr. Edwards. If both sides keep the big picture and agenda in mind, he explains, "it changes the nature of the negotiations" and keeps them moving forward and positive.
Avoid games. Hospital officials should be sincere in accommodating the other party and vice versa. "We see this a lot, where one party will provide an offer and say it will expire in six hours, or not reply to an offer for six weeks," Mr. Edwards explains. Instead of playing games like those, both parties should keep the end goal of the negotiation in mind and "behave accordingly," he says.
Align on crucial issues. Hospitals and unions need to agree on key issues that need to be solved in order to have a successful negotiation. Mr. Edwards recommends that hospital officials be as clear as possible when explaining the issues important to them. It allows union officials to see where the hospital is coming from and limits the union's ability to project a negative motive onto the hospital's goals.
Ms. Burger adds one point hospitals should consider during union negotiations: Send the right people to the table. "[Hospitals] are sending human resources people…and sometimes even lawyers, but they don't really have the authority to change a proposal at the table," Ms. Burger says. Instead, she says unions would prefer if hospitals sent a person or a team of people who are prepared to listen and engage in a real discussion of the issues and be able to do something after that discussion.
Overall, unionization changes the nature of the relationship between the hospital and its employees. Organizations that are union-free and wish to stay that way should keep their employees happy and engaged. Hospitals that already have a union presence can maintain positive relationships and a team mentality by practicing fair negotiation tactics and continuing to treat employees with respect.