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PubMed1982

The impact of employment impasse and its resolution in the allied health professions.

Although conflict within organizations is inevitable, any of its damaging consequences may be minimized or controlled if a consensual process for its rational resolution exists. Since collective bargaining is becoming an increasingly prevalent mechanism for governing the relationships between employees and employers in the allied health professions, knowledge about the various formal conflict resolution mechanisms available is vital. The concept of impasse and its resolution in negotiations and in administration of a labor contract are analyzed. The impact of impasse resolution is summarized, in order to emphasize the interdependent nature of the employment relationship.

Collective Bargaining↗
PubMed1989

The role of union democracy in the struggle for workers' health in Mexico.

In this article, the author analyzes the struggle for workers' health in Mexico, emphasizing the importance of the general and specific political context. In an overview of the legislation on industrial health and safety, the state institutions involved in the issue, and the characteristics of union organization in Mexico, the author shows that the limited activities related to workers' health have more to do with the relative political weakness of the Mexican working class than with the formal structures of legislation, state institutions, and unions. The second part of the article deals with the four most important struggles for health and safety in Mexico during the last ten years, which show some similarities. These struggles are consistently linked to processes of union democratization and tend to decline when union democracy is lost. The strategies of the companies show a common pattern: removing health issues from collective bargaining and putting them in the hands of state institutions. When workers have opposed this solution, management has used selective repression to solve the conflict. The state institutions subordinate their position to the companies' by postponing action or by doing a technically poor job. Changing the existing situation involves the social legitimation of the workers' health issue, since this would have an impact on the political processes involved, i.e., corporate control over workers, authoritarian labor relations and professionalism, and resources of the state institutions.

Collective Bargaining↗
PubMed1979

Changing images of professionalism: the case of public health nurses.

A survey of 89 public health nurses in a California county explored factors that might account for the growing support of unions and subsequent militancy among nurses. As predicted, changes in the backgrounds of public health nurses have occurred over time: 1) older nurses are more likely to have graduated from a diploma program and to have parents of lower educational and occupational attainment than younger nurses; 2) older nurses are more likely to view nursing as a calling and less likely to desire representation in collective bargaining by the union or to believe striking professional; 3) older nurses and those from lower social class backgrounds were less likely to belong to the union and less likely to participate in a county-wide strike. Because age and parental background factors are independently related to our indicators of militancy--union membership and participation in a strike--the results are interpreted as a change in nurses' images of professionalism.

Adult↗
PubMedDate not supplied

Is there a physician union in your future?

Physician unions are in the news. Patient management and patient care decisions are increasingly being taken out of the hands of physicians and put into the hands of "The Suits." To take their case for a return to physician-driven patient care to the people, some physicians are joining unions. Some are even collectively bargaining for salary and other issues that are historically more closely associated with unions. The simple fact is that physician unions exist and the number of physicians joining them is expected to increase. What are the pros and cons of unionization? What motivates physicians to join unions, and what potential negative and positive factors are associated with physician unionization? This article reviews the pros and cons and the issues related to physician unions, for physicians attempting to answer the question, "Is there a union in my future?"

Collective Bargaining↗
PubMed1999

Physician unionization efforts gain momentum, support.

Physicians increasingly are assuming the status of employees in healthcare organizations. Physicians also are seeing restrictions imposed on their practices by healthcare organizations seeking to control costs of care delivery. These trends have led a growing number of physicians to attempt to organize into unions. Obstacles to physician unionization efforts have included Federal antitrust laws that prohibit physicians from organizing, as well as physician reluctance to engage in organized activities they see as antithetical to their professional duties (e.g., strikes). In addition, physicians' attempts to unionize frequently have failed due to provisions of the National Labor Relations Act, which authorize collective bargaining only among individuals designated as "employees." Physicians seeking to form unions often are thwarted by the argument that they are not employees, but rather students, independent contractors, or supervisors, and therefore not entitled to protection under the act. Nonetheless, a number of recent developments, such as the American Medical Association's decision to endorse unionization by physicians and the National Labor Relations Board's decision that attending physicians should be regarded as employees, not supervisors, are creating a climate more conducive to physician unionization in the United States.

Antitrust Laws↗
PubMed1993

Reinstatement of the sexual harasser: the conflict between federal labor law and Title VII.

Greater numbers of employers are adopting and vigorously enforcing policies prohibiting sexual harassment in the workplace. Discipline, including possible termination of employment, often is prescribed for the violation of such policies. When employees are represented by a union and covered by a collective bargaining agreement, final decisions relating to discipline often are made by arbitrators pursuant to the agreement's grievance and arbitration procedure. For a variety of reasons, arbitrators may decide that a lesser form of discipline than that imposed by the employer is warranted for acts of sexual harassment. Such arbitration awards present a substantial conflict between two compelling public policies--the public policy favoring the private resolution of workplace disputes and the public policy against sexual harassment. This article will address the several federal courts of appeals' decisions that have attempted to resolve this conflict.

Collective Bargaining↗
PubMed1975

Unionization, strikes, threatened strikes, and hospitals--the view from hospital management.

The history of union organizing efforts in the hospital field is discussed in this article, along with the factors judged necessary for successful union organizing. The role played by labor legislation in the unionization of hospital workers is shown, and the influences of the National Labor Relations Act, the Taft-Hartley amendments, and labor legislation at the local level are described. Management has largely resisted unionization because of the social nature of hospitals. Competitive market forces do not confront the not-for-profit hospitals, which are dependent upon third-party reimbursement. While strikes are an integral and essential part of collective bargaining in industry, they are, in fact, detrimental to hospitals because of these institutions' concern with human life. Despite laws and assurances from labor leaders that strikes will not occur, strikes have been used as a method for resolving disputes, through they are basically inconsistent with the economic characteristics and objectives of the hospital. The authors conclude that arbitration awards should be made by arbitrators appointed from outside of the local region of the hospital involved, ant that, because of the catastrophic effect of strikes upon patients as well as employees, arbitration awards should be required, should be binding upon both parties, and should be federally enforced.

Attitude↗
PubMed1982

Union activity in hospitals: past, present, and future.

Between 1970 and 1980, the percentage of hospitals with one or more collective bargaining contracts increased from 15.7 percent to 27.4 percent. A substantial amount of variation exists in the extent of unionism on the basis of hospital ownership, bed size, and location. Employees are more likely to organize when hospitals in the State are regulated by a mandatory rate-setting program. Unions raise hospital employee's wages--a modal estimate for RNs is about 6 percent; the corresponding figure for nonprofessional employees is about 10 percent. Growth of union activity in hospitals has generally not been a major contributor to hospital wage inflation, and less than 10 percent of the increase in real (relative to the Consumer Price Index) spending for hospital care that occurred during the 1970s can be attributed to union growth. We project that between 45 and 50 percent of all hospitals will have at least one union by 1990.

Collective Bargaining↗
PubMed2004

Public health sector unions and deregulation in Europe.

Deregulation and liberalization of health services take several forms in Europe: public-private partnerships; contracting out of services; and corporatization of health care institutions. The impact on health workers includes changes in terms and conditions of employment, breakup of collective bargaining agreements, and often more stressful working conditions. The author examines four types of trade union responses to deregulation. National health trade union action has used campaigning, awareness raising, and judicial review. Health workers' unions in alliance with other trade unions have taken part in wider campaigns against privatization and in promoting public services. Health workers' unions joining with social movements have become involved in wider alliances that link with broader public policy issues such as poverty reduction and urban/regional regeneration. European-wide action, seen through the work of the European Federation of Public Service Unions, has concentrated on the development of an alternative health policy, and the promotion of social dialogue at a European level. Trade unions must adopt a range of approaches to challenge the effects of deregulation. Increasingly, trade union members need to be aware of how to take action at both the national and European levels.

Collective Bargaining↗
PubMed1979

Physicians' changing attitudes about striking.

Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation.

Attitude of Health Personnel↗
PubMed1986

Workplace health and safety: report from Canada.

This article represents a critical analysis of the major policy responses to workplace health and safety in Canada. It examines the deficiencies inherent in the legislative development of Joint Health and Safety Committees in most Canadian jurisdictions, the limitations regarding standard-setting of worker exposure to contaminants, and disincentive for employers to positively improve the workplace because of Workers Compensation legislation. Collective bargaining agreements in Canada have had only limited positive effects, while the ultimate legal sanction of criminal prosecution by the regulatory agencies has weakened enforcement and compliance of existing regulations. There has never been a successful criminal prosecution of an employer in Canada, even for multiple deaths. The article suggests the following four reasons for this "underdevelopment" of occupational health and safety in Canada: the concealment of the dimension of the incidence of industrial disease based on Workers Compensation Board statistics; the application of an incorrect theory of causation of both industrial disease and injury by both managers and government administrators of occupational health and safety programs; the resistance of both senior and middle managers against increased worker participation in both work organization and job design questions; and the general "moral underdevelopment," rather than ignorance, of managers in favoring economic considerations or values at the expense of worker health and safety. In light of the magnitude of the problem and the deficiencies of existing policy approaches, the author proposes the need for greater workplace democratization of production and industry as a necessary and sufficient reform of workplace health and safety.

Accident Prevention↗
PubMedDate not supplied

The ABCs of labor management.

Today, many healthcare facilities co-exist with unions, a fact that makes collective bargaining agreements (CBAs) important. Considered by many employees to be their bible, a CBA is a contract written for a certain period of time and negotiated with the employer by union representatives and designated company employees. CBAs follow existing laws. Guidelines called "due process" must be followed in employee discipline situations. Overlooking even one of these guidelines can provide a loophole if a legal dispute should arise. An organizational chart is a representation of a department's chain of command. It presents a clear picture of how the department is run and is useful for employees who wish to make use of an open-door policy. An informal hearing is a meeting between an employee and the employer to make the employee aware of an existing problem. No disciplinary action is taken, but may be at a later date, if the problem continues. In a formal grievance discussion, the employee is made aware of an existing problem and discussion centers around resolving the issue. Under the Weingarten decision, an employee can refuse submit to an investigatory interview without union representation, if the employee reasonably believes disciplinary action will be taken. "Just cause," considered the basis for disciplinary actions, must contain basic elements and the necessary documentation to be valid. Without just cause, an attorney for the employee may find a technicality or loophhole in any ensuing hearing, civil action or arbitration. Managers must know a great deal about labor-related law. Sooner or later, many will face an employee situation where knowledge of the due process guidelines will be useful.

Awareness↗
PubMed1999

Factors affecting bargaining outcomes between pharmacies and insurers.

OBJECTIVE: To model the bargaining power of pharmacies and insurers in price negotiations and test whether it varies with characteristics of the pharmacy, insurer, and pharmacy market. DATA SOURCES/STUDY SETTING: Data from four sources. Pharmacy/insurer transactions were taken from Medstat's universe of 6.8 million pharmacy claims in their 1994 Marketscan database. Sources Informatics, Inc. supplied a three-digit zip code-level summary database containing pharmacy payments and self-reported costs for retail (cash-paying) customers for the top 200 pharmaceutical products by prescription size in 1994. The National Council of Prescription Drug Programs supplied their 1994 pharmacy database. Zip code-level socioeconomic and commercial information was taken from Bureau of the Census' 1990 Summary Tape File 3B and 1994 Zip Code Business Patterns database. STUDY DESIGN: The provider/insurer bargaining model first employed in Brooks, Dor, and Wong (1997, 1998) was adapted to the circumstances surrounding pharmacy and insurer bargaining. DATA COLLECTION/EXTRACTION METHODS: The units of observation in this study were single Medstat claims for each unique insurer/pharmacy combination in the database for selected pharmaceutical products. The four products selected varied in the conditions they treat, whether they are used to treat chronic or acute conditions, and by their sales volume. Used in the analysis were 9,758 Zantac, 2,681 Humulin, 3,437 Mevacor, and 1,860 Dilantin observations. PRINCIPAL FINDINGS: We find statistically significant variation in pharmacy bargaining power. Pharmacy bargaining power varies significantly across markets, insurers, and pharmacy types. With respect to market structure, pharmacy bargaining power is negatively related to pharmacies per capita and pharmacies per employer and positively related to pharmacy concentration at higher concentration levels. In addition, the higher the percentage of independent pharmacies in an area, the lower the pharmacy bargaining power. With respect to socioeconomic conditions, pharmacy bargaining power is higher in areas with lower per capita income and higher rates of public assistance. CONCLUSIONS: The bargaining power of pharmacies in contract negotiations with insurers varies considerably with exogenous factors. Local area pharmacy ownership concentration enhances pharmacy bargaining. As a result, anti-trust law prohibiting the collective bargaining of independent pharmacies with insurers leaves independents at a disadvantage with respect to chains.

Commerce↗
PubMedDate not supplied

Avoiding the high cost of a strike.

Matthew Goodfellow's article on strategies for avoiding disturbances in labor relations follow on the heels of an injunction won by the American Hospital Association this April. It had sued the National Labor Relations Board (NLRB) to halt implementation of new rules concerning health care union bargaining units. The NLRB proposed rules that would have established eight collective bargaining units in acute care hospitals. As this dispute works its way through the legal channels, FAHS Review will report in-depth. But here, now, is sound advice from an individual and his institution's research in the often delicate art of managing highly skilled, well educated medical professionals.

Costs and Cost Analysis↗
PubMed2004

Public sector reform and demand for human resources for health (HRH).

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector.Fiscal reform results in pressure to measure the staff outputs of the health sector. Financial decentralisation often leads to hospitals becoming "corporatised" institutions, operating with business principles but remaining in the public sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts.Decentralisation of budgets and administrative functions can affect the health sector, often in negative ways, by reducing resources available and confusing lines of accountability for health workers. Governance and regulation of health care, when delivered by both public and private providers, require new systems of regulation.The increase in private sector provision has led health workers to move to the private sector. For those remaining in the public sector, there are often worsening working conditions, a lack of employment security and dismantling of collective bargaining agreements.Human resource development is gradually being recognised as crucial to future reforms and the formulation of health policy. New information systems at local and regional level will be needed to collect data on human resources. New employment arrangements, strengthening organisational culture, training and continuing education will also be needed.

Journal Article↗
PubMed1992

Nurse Education Tomorrow Conference 1991. An examination of selected current student nurse issues.

Clinical teaching has become increasingly complex and difficult for nursing instructors. Pressures for public accountability in nursing education and patient care, economic stresses, marked changes in the nursing curricula, and the growth of collective bargaining units have all complicated the task of educating student nurses. Traditional issues focusing on teaching strategies, academic and clinical evaluation concerns have been extensively researched. What are the current issues facing nurse educators? Our project aimed to identify some current student nurse issues in selected nursing programmes. Using a convenience sample, data were collected from the chairmen of nursing education in selected agencies. Analysis following the Fox and Diamond framework (1965) revealed recurring issues relating to mature students, stress and the clinical environment, and the mentor needs are a few of the issues discussed in this paper.

Education, Nursing↗
PubMed2007

Negotiation of mutualism: rhizobia and legumes.

The evolution and persistence of biological cooperation have been an important puzzle in evolutionary theory. Here, we suggest a new approach based on bargaining theory to tackle the question. We present a mechanistic model for negotiation of benefits between a nitrogen-fixing nodule and a legume plant. To that end, we first derive growth rates for the nodule and plant from metabolic models of each as a function of material fluxes between them. We use these growth rates as pay-off functions in the negotiation process, which is analogous to collective bargaining between a firm and a workers' union. Our model predicts that negotiations lead to the Nash bargaining solution, maximizing the product of players' pay-offs. This work introduces elements of cooperative game theory into the field of mutualistic interactions. In the discussion of the paper, we argue for the benefits of such an approach in studying the question of biological cooperation.

Biological Evolution↗
PubMed2004

Factors which influence physicians to join labor unions.

As members of a fiercely independent and individualistic profession, physicians have historically resisted the lure of organizing into collectives and have steadfastly maintained their autonomy. With the advent of managed care, the conditions of work have been altered and many of the assumptions guiding unions and collective bargaining have taken on renewed interest. Proponents of organizing physicians argue that unions can act as representative agents for health care providers to negotiate effectively with managed care organizations (MCO), insurance companies and government for conditions of work to help make their practice of medicine better for patients. Many physicians who previously rejected the notion of unions have reconsidered their entrenched positions and are beginning to weigh the costs and benefits associated with union membership.

Attitude of Health Personnel↗