Study shows ways to win, avoid union elections - ways in which hospitals can lessen employee dissatisfaction

Healthcare Financial Management, Sept, 1991 by Matthew Goodfellow

Hospitals are becoming fair game for labor unions. In 1990, unions won elections at 71 hospitals across the country, (a) and an April Supreme Court ruling upholding a move by the National Labor Relations Board (NLRB) likely will increase that number.

After extensive hearings, the National Labor Relations Board announced two-and-a-half years ago a fundamental change in its policy. Up to that time, only two union bargaining units--professionals and non-professionals--had been recognized in hospitals. As of April 1989, the NLRB said it would recognize eight different bargaining units. Because union organizing efforts are more effective with smaller than with larger units, the NLRB policy change was a victory for unions.

The American Hospital Association (AHA) immediately challenged the NLRB ruling. A Federal district court initially upheld the AHA's position, but the Circuit court of Appeals in Chicago, Ill., ruled against the AHA. The matter then went before the Supreme Court, which in April upheld the NLRB's authority to establish collective bargaining units in hospitals.

The Supreme Court decision allows the NLRB to organize the following separate groups in hospitals:

* Physicians;

* Registered nurses;

* All professionals except physicians and registered nurses;

* All guards;

* All non-professional service workers except technical, skilled maintenance, business office clerical employees, and guards;

* Technical workers;

* Maintenance personnel; and

* Clerical employees.

Lack of knowledge about hospitals is no handicap for unions in organizing hospital employees and winning a representation election. Exhibit 1 shows non-healthcare-oriented unions that have won elections at hospitals.

Three-year study

With the cooperation of the NLRB, the University Research Center, Inc., of Chicago studied 427 NLRB elections, including 46 elections at hospitals, between January 1988 and January 1991. The geographic distribution of the study group was determined in proportion to employment in the 48 continental states, weighted for distribution of manufacturing, service, and healthcare facilities. Forty-four hospitals studied were large (more than 250 employees), and two were medium-sized (100-250 employees).

The experience of one hospital in the study illustrates typical developments leading to a union election in a hospital.

SCENARIO. At noon one Monday at the gate of a Southeastern hospital with 1,100 employees, two men passed out handbills urging employees to sign cards designating a national union as their bargaining agent. Later that day, the hospital administrator called a meeting with assistants, the personnel director, departmental supervisors and the hospital attorney to discuss the union threat.

The personnel director told the group that the hospital paid market rates and benefits for the area and community. Supervisors said they had encountered no union sentiment, but "one or two radicals" in the hospital might be pushing a union. Supervisors were instructed to be alert for any employee conversations about unions.

Three days later, a supervisor reported that she found a union card on the floow of an employee lounge. Two weeks later, a second shift supervisor in housekeeping saw two employees wearing union buttons.

Every Monday at noon for three weeks, union organizers stood at the gates passing out handbills. On the fifth Monday, the handbills announced a meeting at a local motel. After the meeting, the hospital administrator called a meeting of supervisors and asked each supervisor to estimate union sentiment with each employee under his or her supervision.

On the first shift, it seemed, the hospital could have won an election by a nearly and third shifts reported similar findings.

About 10 days later, the administrator received notice from the NLRB that the union had filed a petition for a representation election for all service employees in housekeeping, laundry, dietary transport, central supply, and engineering. After a meeting at NLRB offices to determine the voting unit, the NLRB set an election date.

After a four-week campaign that included letters sent to emplyees' homes, bulletin board posters, administrators' speeches to hospital employees, and union handbills and meetings, the election was held. Fifty percent of the employees voted for the union, 42 percent voted for the hospital, and the union was certified as the employees' bargaining agent.

Four months of painful contract negotiations and a nine-day strike ensued before an agreement finally was reached. Housekeeping, laundry, dietary, and other service departments become union shops, which meant a 100 percent dues check-off, union stewards on every shift, a formal seniority system, and grievance procedures.

UNIONIZATION COST. In a classic study published in the Harvard Business Review, Woodruff Imberman supported Yale University Law School professor Luis Kutner's calculation that a company's total strike cost is approximately $1,000 per day for every employee on strike. (b) On that basis, a hospital strike of 250 employees for nine days would mean a total loss of $2.25 million.