I have received lots of questions recently from hospital colleagues and others wondering about the status of the Service Employees International Union's apparent plans to organize the Boston teaching hospitals and BIDMC in particular. So, here's the latest, as seen from the corner of Longwood and Brookline Avenues.
Several months ago, I pointed out the type of approach employed by the SEIU when seeking to organize workers in hospitals elsewhere in the country. It consists of publicly denigrating the reputation of the targeted hospital, its senior management, and its board of trustees in an attempt to put pressure on the hospital to agree to certain concessions in the union certification process, i.e., either to agree to a "card check" form of organizing to replace elections or to agree to a so-called "neutrality agreement" during the elections to enhance the probability of winning a certification vote.
A key element of this tactic is to attack the hospital for not carrying out key aspects of its public service mission, aspects inherent in its non-profit status. In this way, trustees are meant to face embarrassing questions from their colleagues in the business world and the community on issues of general concern. "I hear your hospital is not taking care of poor people." "I hear your hospital discriminates against minorities."
Here's how it works in detail. Any hospital the size of BIDMC ($1 billion in revenues, hundreds of thousands of patients, millions of square feet of space) files tons of documents with federal, state, and local regulatory agencies. The union hires several dozen bright, committed young researchers and tells them to scour every line and item in all these reports. You look for inconsistencies, ambiguities, and patterns, and then you issue a public report stating that the hospital was incorrect in the handling of a certain matter or knowingly misrepresented some issue or other. You also ask for a review of the matter by a legislative committee.
The key is to pick a topic that garners a headline and public concern, like provision of care to poor people. It is also helpful to pick an arcane accounting issue that few understand, so that a cogent and concise rebuttal by the hospital is virtually impossible in the regular media.
(Meanwhile, SEIU will point to its membership and participation in various state bodies (like the Connector Authority board) as the rationale for raising these items. It will say that its concern has nothing to do with union organizing or this particular hospital but is only reflective of its interest in matters of public import.)
The next page in the playbook is an important intermediate step. You send letters to the homes of the hospital's board of trustees asserting that they are not carrying out their fiduciary responsibilities in properly supervising the management on the matters raised. Later -- if there is no response or if you don't find the answer fully responsive -- you publicly assert that the hospital's board is not sufficiently diligent about those responsibilities.
And now let's speculate about the next play that could be used to support that proposition: An expose might be released about specific poor people who arrived at the hospital's emergency room and did not get the care to which they were entitled, or who were later hounded by a third-party collection agency. Here would be a vivid (and media savvy -- although I truly hope that people are not used in that fashion) demonstration of the institution's insensitivity to the poor and also a portrayal of the board as ineffective in insuring that the management carries out its public service obligations.
And, what if the patient stories are exaggerated or untrue? Well, since a hospital is not allowed to discuss individual patient cases under HIPAA or state law or under the hospital's quality assurance peer review process, it would be left to give a general response that will not appear persuasive in the public eye.
And so it begins. We are only a few pages into the playbook so far. My colleagues wonder: Is the SEIU taking steps in preparation for a unionization drive at BIDMC, or is it sending a message to other hospitals in the city that it will attack anybody who has the nerve to speak out against its tactics, or both?
And please remember: No matter how this discussion is characterized, this is not about the right of workers to organize, a right we all support under the laws of the nation.