Friday, May 15, 2009

4 simple questions

As the Administration and some in Congress push forward on ways to make it easier for unions to organize health care workers, and as the President seeks reforms because of a compelling need to control costs and improve the quality of health care, shouldn't reporters or others ask the following questions -- to draw a connection between the two issues?

Is there independent evidence to suggest that in hospitals in which the SEIU or other unions are represented:

1) Care is delivered with greater quality and less harm to patients than in comparable non-union hospitals?
2) Care is delivered at lower cost than in comparable non-union hospitals?
3) Patient satisfaction is better than in comparable non-union hospitals?
4) Worker satisfaction and morale is better than in comparable non-union hospitals?


Anonymous said...

having worked in both unionized and non-union hospitals, I can say that I will never work in a unionized hospital again. Unions accomplish nothing as far as I am concerned. They create great divisions between management and staff, the patient care suffers because nothing ever gets resolved that would move patient care forward, the money that we are forced to pay for dues is extortion because there is no choice and finally, there is no real way to remove people who are unsafe from practice because "the union" protects them.
It has been said over and over that SEIU could be using it's member dues for much better things like actually helping it's members instead of bashing the BIDMC.
It's annoying and I wish they would just go away.

Anonymous said...

Interesting idea. A lot of that data should be easy to obtain. Sounds like a good project for some academic type.

Bill Reenstra said...


The two issues are really not related. If it were to be shown that care was better, costs lower, and/or customer satisfaction greater in non-union hospitals, would Mr. Obama, or any sane president, propose eliminating unionization in hospitals? I think not.

Improving medical care/cost containment and worker rights are not politically related issues. Trying to combine them is a sure way to loose political influence on one issue where voice most needs to be heard.

One Nurse said...

Unionized hospital scare me to death. As a nurse in a hospital that is non union, I have heard stories from fellow co-workers who have worked agency and taken shifts to cover for nursing staff that was on strike at unionized hospitals. This is outrageous to me!! I am in nursing because I care about my patients and truly want to help them. How is it helping them to walk off my shift, and leave them to the care of an agency nurse who may or may not know policy and protocols in my hospital? This totally messes with continuity. I believe it is dangerous and just not good practice to be unionized. Sounds like it is just facilitating discord. AND, I have never been in that situation so I am not sure how I would feel if I did work for a unionized hospital. What i know for sure is that I would NOT abandon my patients and responsibility that way.

e-Patient Dave said...

Given all the (worthy) emphasis on studying outcomes in healthcare, I consider it self-evident that we should examine whether there's any evidence that the claimed benefits actually accrue.

If I recall correctly, SEIU specifically claims that outcomes are better in union hospitals, as part of its justification for itself.

I've personally talked to two people who've seen work be impeded in union hospitals by union rules such as being unable to speak to a supervisor without a union rep present. If my mother were lying in a hospital bed awaiting care and that happened, I'd want to strangle somebody.

I tweeted recently that it might be good if we legislated that every entity that wants to be in the healthcare business must "First do no harm."

NO entity, IMO, should be allowed to stand in the way of care delivery out of its own selfish commercial interests. IMO, our bodies are not markets to be mined for revenue, either by a company or a union. Years ago I fired both a dentist and a plastic surgeon who (separately) seemed to be primarily concerned about their revenue and not about me as a person.

I have no objection to making a living (I prefer to do so myself!) but if someone gets into the business of cutting into or repairing bodies, they damn well better have *care* as their priority. IMO.

You know, living in New Hampshire, it wasn't an obvious choice for me (years and years ago) to get hooked up with a primary physician who's at a big Boston hospital. I did because I wanted to be well positioned if disaster struck. I considered it my personal responsibility to find and get connected to the care resources I might need someday. Now people are calling this attitude "participatory," as in the patient taking an active role in his/her care. And it's not limited to the care event - it starts with being responsible for finding a good care partner.

If I were to stand idly by and watch care be impeded I'd be a fool.

That first Boston hospital wasn't BIDMC, but I subsequently transferred here because that hospital turned out to be full of disempowered employees with a "nuthin I can do about it" mentality (altho the doc himself was great). I didn't want that attitude anywhere near me if the "fit hit the shan," as the saying goes.

It's a strategy that worked out well. And woe and shame on anyone who wants to get in the way of something that's working.

My personal experience is that this hospital gloriously illustrates that healthcare is not a zero-sum game. The place isn't perfect but it sure works. Before anyone changed it I'd want darn good evidence that the proposed change has produced results elsewhere.

Kimberlee ONeill said...

I wish BIDMC employees the best of luck. I worked at another Boston Hospital (not as a clinician) where SEIU has a long history. My position was non-union when I accepted it, but SEIU was able to absorb it because Massachusetts is not a right to work state. I deeply believe that needs to change, but that's another subject altogether. Co-workers with different titles were allowed to vote, but I was not. It deeply hurt morale.
The union may be focusing on emergency or inpatient care in their ads, but they will organize outpatient departments as well, and our hospital has serious problems with patient access. Is that all because of unionization? No, but unionization kills any incentive to improve performance.
Again, I wish BIDMC luck.

Disability Insurance Quote said...

Great article, this is a vety intriguing issue. Regardless of being in a union or not, physicians and nurses should take the necessary steps to protect themselves and their ability to earn an income.

Dennis Shea, Penn State said...

Certainly not the complete answer to the questions asked, but an interesting study nonetheless.

# Title: The Effect of Registered Nurses' Unions on Heart-Attack Mortality
# Author(s): Michael Ash, Jean Ann Seago
# Source: Industrial and Labor Relations Review, Vol. 57, No. 3 (Apr., 2004), pp. 422-442
# Publisher(s): Cornell University, School of Industrial & Labor Relations
# Stable URL:
# Abstract: Although hospital work organization affects patient outcomes and in some states registered nurses (R.N.'s) are increasingly forming unions, the relationship between R.N. unions and patient outcomes has received little attention. This study examines the relationship between R.N. unionization and the mortality rate for acute myocardial infarction (AMI), or heart attack, in acute-care hospitals in California. After controlling for patient and hospital characteristics, the authors find that hospitals with unionized R.N.'s have 5.5% lower heart-attack mortality than do non-union hospitals. This result remains substantively unchanged when the analysis accounts for possible selection bias-specifically, the possibility that unionized hospitals have certain important but unobservable characteristics, independent of unionization, that affect patient care.

Anonymous said...

My wife and my myself are both RNs and have traveled to many hospitals across the country. Without a doubt... we have both discovered that union hospitals are far better for the patient and the employee. Union hospitals often have better patient care, better supplied, more satisfied employees and far better patient satisfaction. Of course that is not all union hospital stay and not all non -union hospitals. But the majority.

Paul Levy said...

Sorry, but I've found no objective support for that conclusion.

Anonymous said...

Today.. and even more in the future... the union will be the only entity that the nurses will have on their corner. Corporate America has hit the hospitals too. Anything goes. But... some nurses only care when it effects them. That is sad... because when it finally effects them.... there will be no union to protect them. Nurses must start to be... forward thinkers... not lemmings.