Healthcare Issues & Trends

Advice & Insights for healthcare's Leaders & HR Professionals

Our Top 8 Most Popular Industry Intel

Posted on May 15, 2013 by Gallagher Integrated

In honor of National Healthcare Week, we at INTEGRATED wanted to give back to the dedicated professionals that make our healthcare facilities the places of trusted care that they are.  We thank the men and women in our hospitals nation-wide that play an essential role as providers of care.

Our experts are constantly developing new and insightful content for our clients and the healthcare industry. And here, we've pulled together the top eight most-popular items from the past year, ranging from articles to webinars to videos.

We hope these resources provide your organization with intel that help it operate more effectively, and prepare better for the future. 

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The Force Behind Decreasing Union Representation: Human Resource Leaders

Posted on March 12, 2013 by Kevin Haeberle

Since 1983, the percentage of private sector employees represented by a union has decreased from 16.5% of the workforce to 6.9%.  In those 30 years, union leaders have looked for answers through a self-examination which has returned a litany of results:  blaming and attacking each other, launching corporate campaigns, creating strategies around a radically new direction of political influence, and then back to an organizing and striking focus.  Despite all the efforts and gnashing of teeth, no significant union membership growth resulted, and instead even produced a political backlash culminating in Michigan becoming a “right to work state.”

Why are Unions Failing?
Even with hundreds of millions of dollars spent from members’ dues, labor unions have experienced one failed strategy after another.  There are a number of possible variables contributing to the failure, but one thing remains constant over the same 30 year period - an ever-improving employee relations workplace environment led by Human Resource leaders across the country.  Simply put, employees today are managed and led better than they were 30 years ago.
Findings from the INTEGRATED Healthcare Strategies Employee Engagement Surveys show that most healthcare employees believe they have a meaningful voice in the workplace, they are paid competitively, they are treated with dignity and respect, and they have trust in their leadership team.  Even job security concerns are low, both from indiscriminate employment action and staff reductions.  With these type of results dominating the landscape in healthcare, there is little opportunity for union leaders and organizers to exploit employee discontent. 

What are Union Leaders to Do?
It is in a labor union’s  nature to be adversarial and to attack.  A nature that has resulted from the federal labor law that governs and manages union relations. The National Labor Relations Act (NLRA) was enacted in 1935, and unfortunately cemented the workplace relationship of the early industrial period.  Over 80 years ago, lawmakers never thought that the workplace would become more of a partnership and that an industrial-based workplace would be replaced by a service-based economy.  Congress members from 1935 would be amazed at the incredibly positive workplace relationships that now exist (especially compared to 1935).
Union leaders are faced with quite a dilemma.  Employees generally have a positive view of their workplace and a good relationship with leadership.  Further afflicting their cause, union leaders have still not figured out how to make their product more attractive to this new generation of workers.
The solution is as simple as it is beguiling.  If you cannot convince a majority of employees to vote for a union, simply change the rules so that the union only needs a small number of disgruntled employees to bring in the union.  But, this cannot possibly happen in a democracy, right?
The proposed regulatory changes for how unions initially get into a workplace are designed to create such a world.  The changes range from a very short education campaign period which results in the majority of employees being uniformed and not motivated to even vote, to creating small voting units in non-acute care settings.  The unions have thrown any political nicety aside and are using their current influence to simply change the playing field from a level surface, to one heavily tilted to their side.
Our research shows that 6% to 10% of the workforce is inherently negative.  This group of employees is naturally skeptical to the point of paranoia, and believe the organization and its leaders are acting badly no matter how positive the news.  Unions have always marshaled this group of employees to be their internal organizers and usually to become union stewards and negotiators if the union wins the election.  Fortunately, in most healthcare workplaces, the negative voice of this small number of employees is usually drowned out by the positive attitude of the majority.  As long as an employer created an overall positive workplace, the threat of a successful union organizing attempt was minimal.

A Round of Applause for the Human Resource Professionals
The constantly evolving Human Resources teams have helped lead the way in creating and maintaining a workplace where most employees have a positive outlook, and trust that the organization has their best interests in mind.  This incredible transition in the last 30 years has pushed union representation to become almost negligible in the modern workplace.  Unfortunately, unions have possibly come up with a  successful strategy in circumventing all of HR’s hard work.
Human Resource leaders know the issues.  How do you gain the attention of healthcare executives to a problem that does not yet exist?  With all the pressures of the changing healthcare environment facing healthcare leaders, directing any of their precious leadership focus time to prepare for a potential union strategy onslaught is no small feat.  It does not help that predictions over the last five years that the union “sky is falling” have not come to fruition.  So, it will probably take a major event before the issue gets attention.  The year 2013 appears to be the time when a major event may occur at a number of hospitals across the nation.
The message here is that healthcare organizations need to prepare now so they are in the best shape to stand up against their labor union adversaries when they attack, and not wait until it is too late.

Will Physicians Follow RNs and Wear the Union Label?

Posted on January 14, 2013 by Kevin Haeberle

Authored by Kevin Haeberle, Senior Vice President and Senior Advisor with INTEGRATED Healthcare Strategies.

Starting in the early 1990’s, a wave of union organizing swept across hospitals.  Registered Nurses (RNs) were targeted because the National Labor Relations Board (NLRB) changed the rules and allowed RNs to organize separately as a group.  Particularly on the West Coast, hospitals began losing the battle to keep unions at bay, and the percentage of RNs represented by unions grew dramatically.
During the same period, many physicians grew restless and were threatened by the possibility of managed care and a fundamental shift in reimbursement.  In a few areas on the East Coast, physicians even attempted to petition the NLRB to form a union that would negotiate with insurance companies.
Even though physicians were independent practitioners and there was not a direct employment relationship with an insurance company (which is typically required for union bargaining), a legal argument was presented stating that since insurers were in fact controlling compensation and dictating how physicians should practice, they had become a de facto employer.  The argument was ultimately dismissed and physician union representation was relegated to a few isolated residency programs and faculty practices.
Fast forward twenty years.  RN union representation has reached a plateau, with California now dominated by RN unions mainly due to “neutrality” agreements with hospitals that limit any counter information.  New York and Massachusetts also have long-standing RN union representation, as do a few metropolitan areas such as Chicago and Minneapolis.
Even with RN representation growing at a slow rate the last few years, physicians have seen RNs become more aggressive and less concerned about the impact of their collective actions on healthcare and to patients.  The patented “one-day” strike by RN unions, although innocent sounding, will have the same devastating impact for current patients and their families on that single day as it would for a three week or even three month strike.  Although RN wages are actually growing at an expected rate along with inflation (whether represented by a union or not), physician wages are trending down.
As physicians watched the RNs and their unions, a change also occurred in their relationship with hospitals and insurance companies.  Hospitals and health systems now directly employ physicians (or in states that do not allow direct employment, going to a modified Foundation or Clinic model), so the lack of a true employment relationship which stifled physician union organizing in the 90’s is no longer an issue.
As all these moving parts come together, physicians have begun viewing organized labor unions as more attractive.  Particularly for younger physicians just entering the profession.  There is a higher desire among these new physicians to enter into an employment relationship which brings more predictability and less risk to their work environment.  Unfortunately, these new physicians also want the same income opportunity that independent physicians were able to generate when they ran their own practice and worked long hours with a high level of business risk.
Increasing employment with a group having high income level expectations in a declining reimbursement environment is a  formula for physician dissatisfaction.  The situation is ripe for pushing physicians to look at the model developed by RN unions – leave the responsibility for patient care to the hospital or ACO leadership, and use collective bargaining to leverage their unique skills and position in the health care model.
In the United States, physicians have been promoted to gatekeepers of proper treatment.  They are asked to go against their self interests and to only prescribe treatment or procedures that are necessary, even if it means a financial diminishment to the physician.  Union representation, which by definition is selfishly designed to focus on the needs of those in the union (regardless of the impact to others), goes against the gatekeeper  status which physicians hold in our health care delivery model.
Although physicians are represented by unions in other countries, those physicians are much more limited in discretionary decision making.  In many cases, physicians in other countries are government employees, and health care decisions are directed by a government regulatory system.
The threat of physician unions will increase as health care reform continues to gain steam and more and more physicians become directly employed.  Although most hospitals have prepared their management team to both identify union organizing efforts early, and to effectively communicate and manage a union threat, the same cannot be said of those managing and leading physicians.
Because the notion of physician union representation seems so out of character and is viewed as a remote threat, little preparation has occurred to date.  It is critically important to include the topic of union avoidance when discussing physician employment, just as it was necessary for hospitals across the country to do in the early 90’s in regard to nurses.  The hospitals that did not prepare and look through a union –avoidance lense during nursing employment decisions were the first to be organized.
Leaders across the country are dealing with the challenges of healthcare reform, and the changes it brings to their physician relationships.  It is important to also consider the threat of union collective bargaining and a possible fundamental shift in how healthcare decisions are made in America.

Healthcare's Most Talked About Topics

Posted on December 20, 2012 by Gallagher Integrated

INTEGRATED Healthcare Strategies just published our latest insights and reviews on some of the healthcare industry's most talked about topics.

Here are summaries of the featured articles.  Click here to see the full enewsletter.

Protecting Your Executives and the Hospital from Adverse IRS Audit Findings
Executive compensation is already highly scrutinized - so during an IRS audit, you can expect abnormally large figures will raise questions.  There are often good explanations for the high compensation numbers on Form 990 reports, but you'll want to follow these three tips to make sure you protect your executives and organization.  Read more>>
Market Trends in Cardiology Compensation
As payments shift from volume to value, the compensation models for cardiology will continue to shift from individual to group incentives.  Focus on productivity will continue to be encouraged with consideration for financial performance and patient access, but models will continue to evolve to incorporate shared savings and panel size.  In addition, financial affordability and commercial reasonableness concerns will be paramount during the transition period.   Read more>>
"Right to Work" in Michigan -  Why It Happened
Michigan is the latest state to enact anti-union legislation.  Though one of the union stronghold states for over a half-century, the economy in these states has shifted to service-oriented jobs. This has resulted in a growing number of citizens adopting an attitude that unions had their place, but are no longer needed, and can even be a problem.  Read more>>
Physician Leadership Training - What Are the Essential Elements?
Effective physician leadership development programs should teach both "hard" content (operational, legal, policies) and "soft" skills (people management).  In addition, they need to focus on core competencies for successful leadership programs, and incorporate flexible teaching formats that blend multiple techniques to produce the best results.  Read more>>
Effective Leaders in US Healthcare Set Cultures of Celebration
As demands for enhanced patient care experiences increase, a premium is being placed on leaders who can create and nurture high-performance organizational cultures. Follow three steps to begin developing cultures of celebration that yield personal and organizational successes.  Read more>>
Extended Deadline:  Salary Increase & Benefit Trends Survey
The latest in our quarterly INTEGRATED Salary Increase and Benefit Trends Survey opened last month. The deadline to participate is January 18th, so don't miss your chance to submit your survey and get a complimentary copy of the results report!  Read more and participate>> 

Our Latest Healthcare Industry Research and Insights

Posted on December 2, 2012 by Gallagher Integrated

We're pleased to release the latest issue of our monthly newsletter!  Check it out to see insights from the thought-leaders at INTEGRATED; This issue covers topics on Physician Recruiting; Managing Reform; Rising CEO Pay; Physician Pay; Employee Engagement; Salary Trends and more

We hope you enjoy the reading!

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