tag:blogger.com,1999:blog-32053362.post4511474895709160120..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Pages from the PlaybookPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger37125tag:blogger.com,1999:blog-32053362.post-6125068039668128132008-02-22T15:52:00.000-05:002008-02-22T15:52:00.000-05:00The current system of employment is inherently unj...The current system of employment is inherently unjust for all employees. Without a union, it is fundamentally UNSAFE for any employee to talk about unionizing, or anything they are unhappy about, without being fired for no reason. Without a union, employers have the right to fire employees for no reason whatsoever. <BR/><BR/>So anything that can be done to give employees more access to unions, to make it easier for them to become unionized, is a good thing. <BR/><BR/>Unionization in health care is the ONLY thing that will save the disaster we call our health care system. Currently it is run by corporate interests and for the benefit of making a profit, not taking care of people. When we start taking care of the people who are actually doing the work on the front lines, when we start listening to them, then maybe we will have a functional health care system.Evehttps://www.blogger.com/profile/08695149244974199579noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-18303007843030621662008-02-22T13:41:00.000-05:002008-02-22T13:41:00.000-05:00Eve,There is a process under federal law that can ...Eve,<BR/><BR/>There is a process under federal law that can be used for organizing here or at any other hospital in Boston. We support that process. That has never been at issue.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-35930422965611103772008-02-22T12:28:00.000-05:002008-02-22T12:28:00.000-05:00It is clear that you know very little about union ...It is clear that you know very little about union organizing. <BR/><BR/>Unions don't "target" a company without there already being a quorum of people at that company who want to be unionized. As anyone can see from reading the comments on this post, clearly there is a need for a union at Beth Israel. There are concerns that are not being addressed any other way, and unionizing is the only way workers can be heard and not feel their job is threatened. <BR/><BR/>The only compassionate, decent thing an employer can do when faced with a request from their employees to unionize is to recognize their union and bargain fairly. <BR/><BR/>As a Boston resident who is searching for a hospital to use for ongoing care, I will be watching closely to see how you respond to this situation. I will not support a hospital that engages in union-busting tactics and treats its workers unfairly.Evehttps://www.blogger.com/profile/08695149244974199579noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-38906561437327663412007-11-04T05:58:00.000-05:002007-11-04T05:58:00.000-05:00I have posted my salary on this blog, and it is al...I have posted my salary on this blog, and it is also public information in the From 990 filed with the state,and is written about in the Boston Globe every year.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-816906834610463092007-11-03T17:21:00.000-04:002007-11-03T17:21:00.000-04:00So, your comment is "it didn't happen and if it di...So, your comment is "it didn't happen and if it did happen, we can't discuss it". Clever.<BR/><BR/>There was no personal attack in my comments, only if you choose to see your own reflection in the description.<BR/><BR/>You obviously hate Unions and would not engage in discussions if you could avoid them. <BR/>The SEIU is not trying to do away with elections. The SEIU is trying to do away with employer intimidation of pro Union employees. What part of "If a majority" of employees sign cards don't you understand?<BR/><BR/>Will you personally agree to work for only TEN times the salary of your lowest paid employee and have the same benefit package?<BR/><BR/>Will you agree to have your benefits and pay set by a council of employees with no input from you?<BR/><BR/>Hospitals all over the country have denied input from their nurses re patient care. They have fought having an impartial arbitrator be a part of the process.<BR/><BR/>You impugn Union and your supporters say it all about dues.<BR/>Please post your salary and benefit package and then we can discuss the issue.Thomas Maherhttps://www.blogger.com/profile/08066752825667543839noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-69208459962303388022007-10-07T07:28:00.000-04:002007-10-07T07:28:00.000-04:00Dear nasbars,I was predicting the use of that tact...Dear nasbars,<BR/><BR/>I was predicting the use of that tactic by the union. I don't know of any such patients. If I ever heard of any such, we would certainly act to remedy the problems. But, by the way, HIPAA would preclude us from discussing the case publicly.<BR/><BR/>On your second point, it is hard for me to imagine how anything I have said amounts to not wanting or having fair elections. And, please remember, it is this union that has supported legislation to eliminate elections altogether.<BR/><BR/>On your third point, I expect to be judged by both my comments and my actions. I don't know if we have ever met, but your use of personal attacks is not worthy of this debate. It is particularly inappropriate if you chose to remain anonymous.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80827323887057201302007-10-06T21:49:00.000-04:002007-10-06T21:49:00.000-04:00You said, "An expose might be released about speci...You said, "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."<BR/><BR/>You issued no denials, you showed almost no concern for the patient if it did happen and did not promise to make sure it would not happen.<BR/><BR/>You also said to paraphrase "asking for a fair atmosphere to hold elections in, is not something we will do"<BR/><BR/>You may be judged by your own comments. Your true concerns, certainly not the patients or your employees are so obvious I do not need to be a medical expert to diagnose greed and "control freak" syndrome.Thomas Maherhttps://www.blogger.com/profile/08066752825667543839noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-70678302133497277882007-08-13T09:53:00.000-04:002007-08-13T09:53:00.000-04:00The issue of having a union "represent" employees ...The issue of having a union "represent" employees is indeed very complicated. The problems that usually makes staff want a union are not.<BR/><BR/>I work at BIDMC. <BR/><BR/>First, I very much intend to retire from BIDMC. I have worked as a nurse in several other hospitals and I find that BIDMC and I "fit".<BR/><BR/>Second, unions have both benefits and detractions and can be held to both sides of an opinion depending on one's view of the problem.<BR/><BR/>Third, union's are usually "invited" by employees for introductions and feeling out periods. If BIDMC's RN's are seeking out this type of representation might there be a problem at BIDMC?<BR/><BR/>I see the problem of the need for unions is the inaction of BIDMC management to solve little problems. Let me present two issues that are buring on the various floors at BIDMC.<BR/><BR/>Meal breaks: They don't exist as a nurse. To work 8-12 hours without a break is unsafe for the patient and the employee. I can honestly say in my past few shifts that I have not even had time to run to the rest room. Meal breaks are required by law, in addition to a 15 minute break. On my floor there is in excess of 13 hours of meal and break time in a 24 hour period for nursing staff. How does one go to break when you need to sign off to a colleague and they have 5-7 patients of their own and now they need to cover your patient assignment? They cannot. Increase staffing to allow for the breaks. You'll have a happier staff and in return happier patients.<BR/><BR/>Vacation: At BIDMC it is called ET time. It is the lumping together of vacation, sick and holiday time into a "bank" that the individual must manage. As a nurse at BIDMC, department dependent, you must work weekends. There is no exception to this rule. The usual rotation is once every three weekends, some are every other, and even fewer work every weekend.<BR/><BR/>The problem is that this requirement is met by an additional policy that you cannot use vacation time on weekends. Let's looks at this again. The RN must work weekends and in doing so accrues ET time. However, you cannot have weekends off using ET time.<BR/><BR/>So, how does one get weekend time off? The RN must self arrange swaps with other staff. This usually invovles working a different weekend for someone else and they then work for you at a later time. BIDMC uses these swaps to save millions of dollars in overtime each year. A HUGE benefit for BIDMC.<BR/><BR/>This in turn might cause an RN to work 60 or more hours in a week to get time off later. These hours are at straight time, to avoid the overtime payment, as it is a swap.<BR/><BR/>The other more critical event is the sick call. Staff whom do not get coverage call in sick. This then creates a staffing hole that goes unfilled or filled with an employee at over time. In the end this one sick call results in compensation of between time and one half to double time. Add that to the sick time pay and the cost of filling this 12 hour shift can almost equal 36 hours of pay. Where is the rationale in maintaining this policy?<BR/><BR/>How about giving your staff weekend time off? I agree that it cannot be a free for all, as everyone would take weekends off. It would seem reasonable to provide two weekends a year off, with the hospital left to cover. A system with the allowance of one summer/fall and a winter/spring weekend off would be fantastic. After that then revert to the current system that is widely held to be unfair and of questionable legal status.<BR/><BR/>Paul, fix the small stuff and your nurse's will not need a union.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-27380991644386768052007-08-08T20:12:00.000-04:002007-08-08T20:12:00.000-04:00It appears that the unions have finished their wor...It appears that the unions have finished their work in the auto industry (nice job!) and are now switching to a less complex one, healthcare. Great choice!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-45205635043610929022007-08-08T11:29:00.000-04:002007-08-08T11:29:00.000-04:00I followed Mr. Fadel's link and reviewed the SEIU ...I followed Mr. Fadel's link and reviewed the SEIU report in full. Before I comment let me say a little about myself. I am a nurse. I have worked in healthcare for more than 20 years, in both staff and management roles in 3 of the 21 organizations listed in the report. This includes both community and tertiary hospitals, union and non-union, safety net and non-safety net. I am currently in a management role. I know operations well, hospital financing makes my head hurt a bit.<BR/>With that said, here are my concerns about the SEIU report. The report is based on "20 largest hospitals". This implies that they are comparable, they are not. You cannot compare the cost basis for community hospitals with academic medical centers, as this report does. You cannot compare the cost basis for emergency rooms providing adult level I trauma care (6 of the 20) with those that do not. You cannot compare the costs of hospitals with inpatient psychiatry (few) with those that do not. The list name ("20 largest hospitals")is actually misleading as it includes networks, not hospitals (ie., Southcoast, Hallmark, Northeast Hospital Corporation) all of which only become "large hospitals" by aggregating the beds in a number of small community hospitals. So, all in all, an apples and oranges mix, clearly constructed to tell a particular, inflamatory, story. It should be understood as such, and not as a valid comparison.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-35540290374671954742007-08-08T09:54:00.000-04:002007-08-08T09:54:00.000-04:00Dear mi;I am the retired physician who posted the ...Dear mi;<BR/><BR/>I am the retired physician who posted the comment above to Mr. Fadel. I AM asking - are BIDMC workers treated fairly? Let them say so in this blog, from their home computers if need be!<BR/><BR/>But the next question inevitably is, would a union improve that situation without "side effects"<BR/>unpleasant to the worker as well as to management? <BR/><BR/>You must decide.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-17593948691529727302007-08-07T19:13:00.000-04:002007-08-07T19:13:00.000-04:00wow! good for you exposing the tactics the unions...wow! good for you exposing the tactics the unions are allowed to use to gain membership. Well said and thank you!!!<BR/><BR/>Unions have no place in healthcare. Go back to the factories where you belong. The well being of me and my family is just to darn important to be played with in this fashion. With the $$ I spend on health insurance I expect the very best care - and I sure don't think a union is qualified to tell me about it.<BR/><BR/>Chris<BR/>NHAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-77510899091901272622007-08-07T13:30:00.000-04:002007-08-07T13:30:00.000-04:00as a registered nurse, I have never and would neve...as a registered nurse, I have never and would never wish to work in a hospital that was unionized. I don't trust them, find them to be totally self-serving, and not interested in the welfare of the people who are in the hospital to begin with, as pointed out by several of the excellent comments posted.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-32596276604886292872007-08-07T10:12:00.000-04:002007-08-07T10:12:00.000-04:00Wow. Mr. Fadel proves that a little knowledge is a...Wow. Mr. Fadel proves that a little knowledge is a dangerous thing. "Emergency Bad Debt" is what happens when a hospital can't get paid for taking care of people with emergency (not elective) catastrophic injuries or illness who arrive in their emergency departments. Worse, not all patients survive that situation. Is it shocking that a non-profit medical teaching facility founded as a charity doesn't (and in some cases can't) chase patients to the ends of the earth for payment? It is horrible for Mr. Fadel to reduce these the reality of these daily human tragedies into a distorted tale of dollars and cents. Bravo to you and your medical miracle workers in Boston. Perhaps Mr. Fadel would be satisfied if you bludgeoned severely ill patients with paperwork before attempting to save their lives in your Emergency Room.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-56103864513259129052007-08-06T22:47:00.000-04:002007-08-06T22:47:00.000-04:00To anon Aug 6, 11:44, (I removed a commonly used, ...To anon Aug 6, 11:44, <BR/>(I removed a commonly used, but unpleasant, word from your posting and have reposted the rest of your comment here. Sorry about the editing, but I am trying to avoid that kind of language in this blog.) This is the rest of what you said:<BR/><BR/>'Unions do not exist to defend "the little guy" merely instead insert their bloated structure into an already overbloated expensive system - allowing new cash cows to sip at the trough.<BR/><BR/>'Don't like working at BI? Get a job at one of the zillions of hospitals in the midwest that desperately need you.'Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-42634317985872688642007-08-06T17:43:00.000-04:002007-08-06T17:43:00.000-04:00Because of the nature of my current position, I mu...Because of the nature of my current position, I must respond to this article anonymously. However, I was present at a management level in a for-profit California hospital when the SEIU began its organizing efforts. They were simply the most ideological, scurrilous bunch of people I have ever had to deal with. Through virtual capitulation on the part of hospital senior management , SEIU prevailed. It has fostered a mentality among its members that is absolutely antithetical to the concept of professional patient care. It has wrecked the communal atmosphere of our local hospital and replaced it with an attitude typically found among mercenaries. What appalled me most was the complacency or naivete of our senior management when there was still time to expose SEIU for what it is and to wage a battle for the hearts and minds of our staff... a battle, by the way that could have been won. Now we have groups like the SEIU and CNA dictating the terms of healthcare in this state. The last thing that they are interested in is the welfare of the sick.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-26120305506721675842007-08-06T16:19:00.000-04:002007-08-06T16:19:00.000-04:00It's a good point--unions began to deal with poor ...It's a good point--unions began to deal with poor working conditions/wages/etc. <BR/><BR/>So to respond to those of you wondering if workers at BIDMC are happy: <BR/>In a country where health care (all!) workers are, year after year, required to pay more money out-of-pocket for health insurance; we are losing vacation and sick time; after years of dedicated service to our facilities, while the cost of living is increasing, our wages are being capped; why don't you ASK the BIDMC workers if they're happy with their wages/benefits/working conditions? <BR/><BR/>Ask them.<BR/><BR/>Ask them, off-site, without management around, without the use of "3rd party" consultants who set up surveys on computers AT WORK.<BR/><BR/>Just ask them.<BR/><BR/>I can guarantee you, that's what union staff will be doing before talk of any union election.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82372103812493911092007-08-03T15:07:00.000-04:002007-08-03T15:07:00.000-04:00Not weighing in for one side or the other - I'm pr...Not weighing in for one side or the other - I'm pro-union, especially the SEIU, despite their shortcomings, and I also think that the BIDMC is a wonderful place to work, despite its shortcomings. <BR/><BR/>So just a sidenote: The SEIU's strategy of focusing on charity care, or lack thereof, has hard-hitting financial implications, in addition to the PR impact. <BR/><BR/>Over the last calendar year, Provena in Illinois paid 5 million in property taxes after the state revoked their tax-exempt status, finding they had not performed enough charity work. <BR/><BR/>At the time that Provena lost their tax exempt status, "a policy director at the Service Employees International Union (SEIU)—an active critic of hospital billing and charity care policies—predicted that the decision will prompt hospitals to expand their charity care programs, an action the SEIU has long endorsed. " (advisory.com, 10/13/06)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-61436192603866883072007-08-03T09:28:00.000-04:002007-08-03T09:28:00.000-04:00I do not favor the tactics of the SEIU but I think...I do not favor the tactics of the SEIU but I think the issues they, or others, raise about whether a hospital is doing "enough" to justify its tax exempt status is a valid point of discussion. Most large not-for-profit health systems and hospitals across the country can show little to differentiate themselves from the for-profit systems. Also in the past sloppy accounting of charity care have caused the numbers in many hospitals to be understated. In know in our state you saw a dramatic rise in the percent of charity care in 2005 and 2006 because this issue was being highlighted. Do some hospitals deserve to have their tax exempt status removed? I think the answer is yes. This is not an indictment of all tax exempt hospitals but we as an industry created our own dilemma to some degree.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-9775036748896614782007-08-02T09:57:00.000-04:002007-08-02T09:57:00.000-04:00Paul;I am anon 7.50, and you speak to the issue I ...Paul;<BR/><BR/>I am anon 7.50, and you speak to the issue I forgot to add - that is, all of the issues Mr. Fadel raises are subject to oversight by regulatory and/or governmental bodies. The IRS and Congress are even now looking into how much charity care is provided nationally by nonprofit hospitals, so this is high on the agenda already. It would seem the union should concentrate on its primary mission of ensuring fair and safe working conditions, rather than repeating work others are already doing.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-38592340457211015022007-08-02T09:44:00.000-04:002007-08-02T09:44:00.000-04:00Another thought on Mr. Fadel's comment. I was so ...Another thought on Mr. Fadel's comment. I was so taken by his writing skills and the need to respond to his choice of wording that I neglected to make a couple of substantive points. First, the accounting issues brought up by the SEIU in their reports are complicated. But please rest assured that all the calculations and figures prepared by BIDMC are subject to full review and audit by several governmental bodies, and we have always been ready and willing to discuss them at length with the appropriate oversight bodies in the legislative and executive branches. Second, please know, too, that our hospital's commitment to serving the poor and the underprivileged is unwavering and constant. That is a heritage of both the BI and the Deaconess that is extremely important and part of our ongoing practice.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-6368745094139590542007-08-02T09:33:00.000-04:002007-08-02T09:33:00.000-04:00One of the factors that account for the very high ...One of the factors that account for the very high healthcare (and health insurance) costs in New York City (and the state overall) is excess hospital capacity, especially in NYC. An independent commission recently developed a plan to restructure the system which includes closing a number of hospitals and downsizing or reconfiguring others. One of the key opponents fighting this effort is SEIU 1199 and its political friends in Albany.<BR/><BR/>While the restructuring would save money, it also means that jobs would be lost including those of some SEIU 1199 members. The union's main priorities are to maximize the number of dues paying members and to maximize its members' pay and benefits. If the union cares about such issues as healthcare quality and costs or the economic competitiveness of New York City and the rest of the state, it is well down their priority list from the first two. The more members it has, the more dues it collects and the more political power it wields in Albany and NYC to further its interests at the expense of the rest of the public.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-22794367553358243032007-08-01T23:26:00.000-04:002007-08-01T23:26:00.000-04:00These are deplorable tactics on the part of the un...These are deplorable tactics on the part of the union. I don't think that I want any organization that acts in this manner to be involved in any aspect of my healthcare. I have always been treated with compassion and respect as a patient at BIDMC - I suspect that would be hard to pull off if the staff there did not feel engaged and cared for in their place of work. And, by the way, if there is one aspect in which BIDMC is an outlier, it is in pushing the envelope on greater organizational transparency.<BR/><BR/>I agree entirely with the comments of the retired physician (anon 7.50) above. As I read Mr. Fadel's note, it seems to be full of verbal code language and subliminal messaging that seems to muddy the issues raised. The Bush administration - huh???Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-89607344549484163702007-08-01T19:50:00.000-04:002007-08-01T19:50:00.000-04:00Dear Mr. Fadel;I am a retired physician who lives ...Dear Mr. Fadel;<BR/><BR/>I am a retired physician who lives considerably south of Boston and have never been to any of its hospitals. I read Mr. Levy's blog because many posts remind me of my own experiences during my practice. Unions are entirely outside my experience, as my hospital system was not unionized, although several in the metropolitan area were. So let me ask a simple question:<BR/><BR/>My understanding of traditional unionization in the U.S. is that it occurs as a consequence of "unfair" (e.g. low wages, poor working conditions, nasty/arbitrary management, wholesale layoffs, etc.) treatment of employees <BR/>by management. In fact, the hospitals in my area who were unionized had experienced exactly these or similar problems.<BR/><BR/>My question is, what is the relevance of all the points you have raised, to the reason you (should)want to unionize Boston hospitals? These are unrelated to the purpose of a union, despite all your undoubted good works.<BR/><BR/>To forestall a reply about how you were responding to Mr. Levy's statement that the union doesn't "care about patient care" - I interpreted his statement to mean that a union would want to drive up wages and benefits, drive down working hours,etc., and therefore weaken the hospital's staffing in an already difficult environment. While this may or may not be true, complaining about BIDMC's billing practices or charity care seems to do what you accuse him of - sidestep the real issue. Are workers being treated unfairly at BIDMC?<BR/><BR/>From an outside reader's perspective, you seem to be using exactly the tactics that he predicted.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-54352399069193275982007-08-01T19:36:00.000-04:002007-08-01T19:36:00.000-04:00I have to admit that Mr. Fadel is very good at tur...I have to admit that Mr. Fadel is very good at turning a phrase and, indeed, at offering responses to things I never said. I don't think I said that the union is disloyal. (By the way, how can you be disloyal if you are not even part of the organization in question? Disloyalty implies an underlying relationship that would ordinarily encompass loyalty.) Likewise, I don't think I said that the union doesn't care about delivery of health care. I said that it employs certain tactics as part of its organizing campaigns. <BR/><BR/>Odd, too, that he compares me to the Bush administration. Where on earth does that come from? Why is it persuasive on these matters? Is it some kind of attempt to portray me as -- ohmygosh! -- a Republic loyalist in largely Democractic Massachusetts? If I were (and I am not, by the way), would it matter in any way?<BR/><BR/>We do agree on one thing, apparently, that here are better forums than a blog like this to delve into technical accounting questions.Anonymousnoreply@blogger.com