Friday, August 25, 2006

Union Issues

One of the issues facing many hospitals is the desire of the Service Employees International Union to organize members of our workforce. The SEIU last year announced its intent to do this in the Boston teaching hospitals.

In October, 2005, I wrote to the following message to our staff as part of a fall update on a variety of topics:

"The other major change in the local environment is the announcement by a national union that it intends to organize the workers in the academic medical centers in Boston. I want to make our position clear with regard to this effort and union organizing efforts in general. We intend to follow the law with regard to labor relations, a law that is designed to give a fair opportunity both to employees who favor unionization and those who oppose it. Congress has been very clear that employers have to give workers a fair choice in these matters. Accordingly, we will vigorously oppose any efforts to short-circuit the legitimate process by which employees of this hospital can consider, debate, and vote on this issue. For me the underlying question is whether a union at BIDMC would enhance your ability to deliver the kind of patient care that is so important to all of us, to strengthen our research program, to improve our education programs, to strengthen our ability to serve the community, and to improve our employees' chances for personal and professional development and advancement. I do not believe that it would, and so I intend to advise you against creating a union here. Ultimately, though, the choice will be yours, and we will respect your judgment on that matter if and when the time comes for a fair and free vote on this issue."

Here is a more recent (early August, 2006) email I sent to my staff on the topic:

"On the union front, you may recall that I wrote last fall to inform you that the Service Employees International Union had announced plans to organize workers in the Boston hospitals. They appear to be interested in BIDMC. During the last months and weeks, the SEIU has submitted Freedom of Information Act requests about several of our researchers and research projects funded by the NIH; has submitted an FOIA request at Mass HEFA, the state agency that issues our bonds; and most recently has been conducting telephone surveys of our some of our employees. Some of you may have received these calls. These activities are entirely legal, although you might wonder, as we do, what relevance our peer-reviewed research has to a union organizing process.
In other situations, the SEIU has attempted to get hospitals to agree to bypass or modify the normal union organizing procedure envisioned under the National Labor Relations Act. A normal unionization process consists of getting authorization cards from 30% of the members of a future bargaining unit, followed by a secret ballot election of that group of workers, under federal rules and monitored by the National Labor Relations Board. Each employee, unencumbered by peer pressure or other outside forces, gets to vote "yes" or "no" in the sanctity of a private voting place.
Instead, in some cases the SEIU has pushed for a "card check" system, in which the election process is bypassed once 50% of the workers sign authorization cards, and the management of the hospital agrees to not talk about unionization - a process called "neutrality". In some other instances, the union has agreed to an election, but with the same one-sided "neutrality" terms during collection of signatures and the voting.
My belief is that a topic as important as unionization deserves a free exchange of views. If the management of the hospital agrees to a "neutrality" agreement that limits our ability to discuss the pro's and con's of the issue, that would be at variance with the history and culture of this academic medical center, a tradition steeped in open dialogue and exchange of views.
Let me say again: We believe in free elections in which each employee, unencumbered by peer pressure or other outside forces, gets to vote "yes" or "no" in the sanctity of a private voting place. Thus, we cannot agree to a "neutrality" agreement nor to a system that bypasses the federal NLRB election processs.
In other parts of the country, hospitals that have taken similar positions to ours have found themselves subject to massive public relations attack by unions. The object of these attacks seems to be to denigrate the reputation of the hospitals and to put pressure on volunteer boards of trustees and management to agree to the unions' organizing terms.
We hope and trust that the SEIU will not use these tactics in Boston. It is hard for us to imagine that a union that says that it is dedicated to improving the healthcare system would intentionally undermine public confidence in one of the world's best hospitals. But this has happened elsewhere, so we must be prepared for that eventuality. We will hold fast to our principles and would participate in a union organizing process based on the rules and regulations set forth in federal law, a process designed to protect the rights of all parties. We have too much respect for our employees to bargain away your rights to a free and fair election. We trust the people who work here, and we would respect your judgment should an election be authorized. You earn that trust every day by the way you take care of patients, participate in research, train medical professionals and one another, and support a wide variety of community activities.
In closing, if any of you have concerns or questions about any of these matters, please contact me directly, or your Human Resources representative, or your supervisor."

I would welcome your thoughts about what I have said in both of these notes.

Wednesday, August 16, 2006

Sad and beautiful story

This is a note I received. (I have removed the patient's name and other identifiers, as well as the name of the nurse.) I can't begin to tell you what a privilege it is to be part of a team that can do this kind of thing. The underlying values of our staff often come through, especially during these incredibly important moments.

Dear Mr. Levy,
A great hospital is measured not only by its ability to save lives, but in its skill and sensitivity in aiding and comforting terminally ill patients who can't be cured and their families. My 93-year old mother was admitted to the BID on Thursday for what was initially thought to be pneumonia. Further tests revealed a massive and inoperable massive tumor in her lung that had invaded her rib cage and was strangling vessels to her heart.
My mother had made it clear she wanted no heroic measures. The staff made every reasonable effort to stabilize her prior to moving her home for hospice care. The oncologist who called us late on Friday night to discuss her condition did not sugarcoat the diagnosis or prognosis, nor was he cruelly blunt. Instead,with great skill and wisdom in his choice of words, he clearly helped us understand the grim reality. It helped prepare us for the call that came at 5:30 AM Saturday alerting us to her rapidly deteriorating condition. Twenty-eight years ago, the B.I. did not make it easy to stay with my father during his last hours, and we were not called until well after his death. This time, we could be at her bedside and shepherd her through the process.
During her last hours, my mother was fortunate to be under the care of S.K. We could not have asked for a better nurse or human being.
S. was acutely sensitive to my mother’s discomfort and our monitoring of her changing condition. She explained options clearly and carefully. She cleaned her, adjusted her bedding and took steps to move her from side to side to alleviate other problems. She helped to block undesired intrusions to provide the family with much desired privacy. And in a loving gesture that will forever be remembered by those of us at her bedside, she fluffed my mother’s hair to make it more presentable. In one of our last conversations my mother had said that she wanted to go out "like a lady."
With S’s help, she did. There are many others who helped contribute to my mother's care.
My husband and my sister join me in thanking them and you for the caring kindness and professional expertise of the Beth Israel Deaconess staff.

Friday, August 11, 2006

Single Payer

Many people think that a single payer system would improve the cost and quality of medical care in America. I disagree. This topic was recently covered very well in a new book by Michael Porter and Elizabeth Teisberg, called Redefining Health Care, published by the Harvard University Press. (By the way, here is a review I recently wrote about the book. You have to register to read the review, but there is no fee to register.)

I think they make a persuasive argument that a government-controlled single payer system would inevitably face budgetary pressures and would shift costs to providers, suppliers, and patients, and would ultimately lead to rationing of services and a slowing down of innovation.I'm not saying the current US system is ideal, but at least it offers the possibility of competition among insurance companies and gives my hospital a chance to negotiate better reimbursement rates in return for offering higher quality and better value to consumers than my competitors provide.

What do you think?

Wednesday, August 02, 2006

Running a hospital


The other day, I was reading a NY Times article that menitoned that only 1 CEO of a Fortune 500 company had a blog. I don't run a Fortune 500 company, but I do run Beth Israel Deaconess Medical Center, a large academic medical center in Boston. I thought it would be fun to share thoughts with people about my experience here and their experiences in the hospital world. This is my first blogging experience, so please excuse if I mess things up . . .

A few rules: I cannot comment on individual and legally confidential patient care issues in this forum -- although I can refer patients of our hospital to the appropriate people if they have problems or complaints. I also cannot comment on individual and legally confidential personnel matters of our employees -- although I can refer people to the appropriate folks in the hospital to help them.

So, that's it. Feel free to open this up with questions about what it is like to run a 600-bed hospital; or to offer your thoughts about the state of medical care in general; or to comment about how wonderful (!) our hospital was during a recent visit; or what it is like to work at our hospital or whereever you work.

My first comment is this: I am new to health care, and I have never worked in a place where people are so consistently caring and devoted to alleviating human suffering caused by disease. It is, in many ways, a beautiful place to work. But many of the forces facing hospitals, doctors, nurses, and others make it really hard to do the job well.