Friday, September 07, 2007

Another page from the playbook

Several weeks ago, I gave an update on the tactics that have been used by the Service Employees International Union in its attempt to organize unions at hospitals. Here is another page from the playbook.

Recently, many of our doctors received a letter from the union in which the following points were made: (1) that the BIDMC's administration has mischaracterized its position; and (2) that the SEIU has asked that the management of Boston's not-yet-union hospitals agree to a "free and fair election code of conduct", "free for workers to make up their own minds under fair secret ballot voting conditions." This code would include "a commitment by hospital executives to neither devote patient care funds toward disruptive anti-union campaigns, nor divert health care workers' time from their patient care duties to attend mandatory anti-union meetings." The code of conduct would "call on all parties to allow workers to make their own decisions in an environment free of coercion and to honor the outcome of a secret ballot election." The union says, "The secret ballot point is noteworthy, given that one CEO has been publicly arguing against a code of conduct by asserting that he supports secret ballot elections."

While it is awkward to impute another's motivation, it appears that the letter has three purposes. First, to obfuscate the statements made by management of hospitals about this issue. Second, to present a revisionist view of what the union itself has said in other forums -- like in the US Congress, where it has strenuously argued for an elimination of elections. Third, to attempt to drive a wedge between the management and a hospital's physicians by using these mischaracterizations and appealing to the doctors' underlying sense of fairness and fondness for the workers in the hospital.

I am not sure to which CEO the SEIU is referring. On the off chance it refers to me, you can judge for yourself in that the statements I have made are clear and available here for you to see in many of these blog postings. At BIDMC, we surely support a free and fair election, and our Board of Directors has adopted and published a code of conduct on this matter that properly reflects the federal rules and regulations governing such matters. Here it is:

Beth Israel Deaconess Medical Center
General Code of Conduct Regarding Organizing Activities

BIDMC has a strong commitment to its mission of community service in providing excellent clinical care, conducting medical research, and training future generations of medical professionals. As an academic medical center and prominent member of the corporate and civic communities, BIDMC is committed to an environment of respectful and open discourse and debate among its management, employees and physicians. It is of the utmost concern to the Board of Directors that this fair and unhindered exchange of points of view is maintained and supported during all times, including any attempt by unions to organize staff at BIDMC. Therefore the Board of Directors adopts this General Code of Conduct.

Conduct Standards

BIDMC has long believed that managers, supervisors and employees best serve the interests of patients by working together. Further, it is imperative that everyone in the work environment remain focused on patient care while continuing to have open communication and professional interaction respecting everyone's freedom of belief.

Managerial and Supervisory Employees of BIDMC

When communicating with employees, including regarding union activities, managers and supervisors are encouraged to promote an open and robust dialogue and share with employees factual information. Managers and supervisors also should feel free to express their opinions and encourage employees to ask questions. On the other hand, in any discussions with employees, respect is paramount. Specifically in the union activities context, managers and supervisors must not threaten or interrogate employees about their union activities, nor may managers or supervisors make promises to employees to induce them to be against the union. Finally, managers and supervisors must not conduct surveillance of union activities.

Non-Managerial/Supervisory Employees of BIDMC

Non-managerial and non-supervisory employees may engage in union organizing activities only on non-working time and only in non-patient care areas. BIDMC’s “No Solicitation and No Distribution” policy, “Use of Public Space Policy” and the Human Resources Department are available as resources to answer questions in this regard.


Finally, individuals not employed by BIDMC may not engage in union organizing activities on BIDMC property.

Additional Information

Anyone with questions or concerns regarding this General Code of Conduct is urged to contact the Beth Israel Deaconess Human Resources Department or the Beth Israel Deaconess Office of Business Conduct.

Now, I know this may not be what the SEIU has in mind. But what it has in mind is not consistent with the balanced approach adopted by the Congress and the courts under the National Labor Relations Act.

Let me give just one example that is problematic in the approach suggested by the SEIU, its point of not using patient care funds for anti-union activities. The term "patient care funds" is highly ambiguous. All hospitals have multiple sources of revenues -- Medicare, Medicaid, private insurance companies, philanthropy, interest, dividends, intellectual property, sales of real estate -- and these dollars are indistinguishable once they are received. Some of these sources contribute to the hospital's margin, i.e, excess of revenues over costs. But in other cases, like Medicaid, the state underpays hospitals relative to patient care costs, and so those services are subsidized by a number of other sources. To prove that "patient care funds" were not being used, say, for legal counsel during a unionization drive would be a CPA's dream, in terms of billable hours, because there is no methodology for an auditable resolution to this matter.

I don't know if the SEIU has indeed asked any hospitals in Boston to adopt its proposed code of conduct, but I do know that there are no public reports of a hospital having agreed to do so. If one of them has, please submit a comment on this blog so we will all know that you have. The union's attempt to suggest that there is only one CEO in this city who believes along these lines has not been supported in any way whatsoever. If there is a CEO out there who agrees with the SEIU's proposal, please publish the code you have adopted and speak up so we can all understand why you have agreed to such a code.


Anonymous said...

Almost ten years ago, as Chief of Staff at then Columbia Sunrise hospital in Las Vegas, and as President of my county medical society, I threw all my (modest) political influence behind the ultimately successful SEIU campaign to organize our nursing staff. I did this because I thought the healthcare delivery system had become a bar brawl, with professional health care workers; doctors and nurses mainly, cast in the role of unarmed victims. I had hoped the SEIU would become a tool the nurses could use to defend themselves and their/our patients. I was terribly disappointed, therefore, when, having succeeded, the local went on to "business as usual." The local executive director (since departed) was quoted by one of the nurse leaders (in private conversation with me) as expressing the view that all the nurses cared about was their "25 cents" an hour, and that representing them was no different than representing janitors. Meanwhile, the California Nurses Association was making great strides in partnering with Kaiser over issues of quality of care and patient well being. I have a number of dear friends made during that organizing battle; some are still with the SEIU (and some have left and returned). They are high minded to a man (and women); no different in ultimate motivation, really, than you or me; only the team colors change (I look terrible in purple and yellow). They assure me that the SEIU has refocused on the truly relevant issues in healthcare, which is to say, beyond simply worker incomes and benefits. I can't say that I see it here in Las Vegas; as well, it's hard to tell if the rising tide for nursing is the consequence of union representation, or is the result of overall market forces reflecting the ongoing shortage of nurses. Some of both, probably. I can say two things; one, the local nursing schools have accelerated graduating nurses with very brief clinical training, akin to the "two week wonder" lieutenants graduated from OCS during WW II to replenish attrition. This phenomenon has heretofore gone largely unremarked in the local market by ANY party, for reasons I can only guess at. And two, the SEIU seems to be partnering very effectively with the local Catholic Healthcare West System, which has been led by the CEO Rod Davis for as long as I've been here (>20 years.) I say that it's effective based on my observation that mid-level operational management (unit managers, supervisors) express satisfaction with the interactions. It might be worth it to give Rod a call; he's easy to find, and a good man. I also suggest you call Andy Stern; although I haven't talked with him for 10 years, and much has changed (for the good and bad) for him, I found him to be reasonable and open. Hopefully, the "blood debt," engendered by the organizing bump-and-grind won't poison ongoing relations should the union succeed.


Anonymous said...

Boy, this is confusing. Why does the union say that a CEO (I think we can assume we know which CEO to whom they are referring)is arguing AGAINST a code of conduct by asserting he supports secret ballot elections? (which is what the union wants, right?)That statement seems self contradictory to me; what am I missing?

It is interesting to watch this play out, to someone never before exposed to such activity. I know nothing about this, but common sense would seem to dictate the union and hospital management meet beforehand to agree on a common code of conduct, rather than trying to dictate each other's conduct.

This might have the effect of delaying the election indefinitely. Which country was the U.S. negotiating with years ago, when they spent months debating the shape and size of the conference table?

Also, were these letters sent to the Dr's homes? Is this an invasion of privacy? I wouldn't want such a letter sent to me. Advice to the medical staff: stay the heck out of this; you can't win either way.

Anonymous said...

Dear non local MD,

These organizing campaigns and elections are subject to the jurisdiction of the National Labor Relations Board, which has long-standing standards that must be complied with by both sides. (If a party feels aggrieved by the actions of the other, it can file a complaint with the NLRB claiming an unfair labor practice.) The BIDMC code of conduct is based on the NLRB standards, and our Board adopted it to put the major points in clear language for our employees to be able to understand.

The letters that I have seen were sent to the doctors' offices in the hospital.

Unknown said...

This topic, and your blog, came up in my health care class last weekend when we started talking on Unions. I had passed your last post on to the professor last time the topic came up here.

It makes for an interesting read, especially since unions aren't very prominent here in Louisiana.

Oh...Paul, my assignment for class is a presentation on information in the hospital, how its used etc. Would you be willing to share a dashboard or what you feel is important to look at for an executive such as yourself?

Anonymous said...


Start with this:

Unknown said...

Hey Paul, Actually I read that and had planned on using that for the long term strategic planning and budgeting process. Is there anything you look at on a day by day / week by week, or bi weekly basis?

The term Dashboard or balanced scorecard keeps coming up, and I look to a lot, but they dont have very many good examples for health care. They were even trying to figure out what a bed control system was for and how it was a dashboard.

I provide stats to our management and board, I do all the productivity stuff

Anonymous said...

Good discussion, however, need to correct a point made by the former Las Vegas administrator above...the California Nursing Association is most definitely not partnering with Kaiser Permanente in California. CNA has constantly and bitterly denounced SEIU for its own partnership efforts with Kaiser. CNA styles itself as a militant leftwing union and attacks any other organization within the labor movement, such as SEIU, for raising the idea of partnership with Kaiser, Catholic Healthcare West, and other hospitals...

Rob said...

I am a naif, I admit. In my idealistic world, I would, in the hospital CEO's position, make darned sure that I was above-board in all my dealings, impeccable in the way I dealt with communications both to "workers" and "management" and be darned sure to counter low tactics with accurate, timely, readable information that turns out to be, gosh, true.

If that meant showing everyone the balance sheet and the pay rates and competing pay rates, then I can't think of anything more useful.

I am an idealist. I know that, at some point, you want to just haul off and slug these people for their obviously manipulative tactics.

Just remember that, gee, if being in a union is all that good for everyone, why do they have to play games?

I think I'd ask that. Out loud. In public. And then count the days that I didn't get an answer.

Unknown said...

Having dealt with the SEIU "up close and personal" as a manager in a sucessful acute care hospital in California, I can only say that they have no real interest in playing fair. They are ideologues who do not have the interests of their members or potential members in mind. Their rhetoric notwithstanding, they can be ruthless. They are the labor equivalent of terrorists.

Anonymous said...

Gerald: denigrating SEIU as "terrorists" is beyond the pale, especially in a posting dated on September 11.

you may have had some disagreements with SEIU, but they didn't fly a plane into your hospital. let's try to keep some perspective.

if nothing else, let's remember that the firefighters who died in the towers were union members. there are plenty of local elected officials who think that the firefighter union is a pain in the neck, but i've never met a member of the firefighter union who wasn't proud of his or her work and their union.

Anonymous said...

Absolutely right. We don't need to use language like that.