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PubMed2002

Managing the healthcare workforce: cost reduction or innovation.

Labour costs are the largest proportion of total costs in the health industry in developed countries and are a target in health sectory reform. The Kennett government in Victoria introduced policies based on competition and cost reduction and the decentralisation of industrial relations through enterprise bargaining. These policies directly impacted on the health workforce leading to work intensification, labour shortages and poor morale. The Bracks government has since returned to centralisation. This paper argues that it is time for a more innovative approach to health workforce management based on recognising staff as an asset rather than a cost.

Capitalism↗
PubMed1991

Special report on labor and employment. Supreme Court upholds NLRB bargaining units rule.

Providers should expect the number of union organizing campaigns to rise quickly in the wake of the Supreme Court's decision in AHA v. NLRB. Despite this increased activity, providers that offer good working conditions and maintain open lines of communication between employees and management, and that understand their legal rights in connection with such situations, will be much more likely to be effective in responding to union organizing activities.

American Hospital Association↗
PubMed1983

Bargaining for concessions: what information must the employer provide?

Employers faced with the current bleak economic situation increasingly are demanding concessions from the unions representing their employees. Unions faced with such demands are fighting back by requesting confidential information from their employers concerning the need for concessions. In recent years, the scope of the information to which a union may be entitled has been expanded greatly. This article examines recent decisions and suggests some alternatives for avoiding disclosure of information to the union.

Collective Bargaining↗
PubMed1988

Structure as a causal factor in nurses' strikes.

Nurses employed in Alberta's hospitals have earned a reputation of militancy as a result of four province-wide strikes in the 11-year period 1977-1988. Based on a case study of the first three strikes, the principal causes of the labour disputes are discussed: namely, union ideology, economic factors and inherent constraints in the structure of bargaining in the public sector. Interorganizational relationships of the three main players, the United Nurses of Alberta, the Alberta Hospital Association and the provincial government have been contributing factors in all three strikes. Although issues in the disputes were primarily economic, demands associated with the needs of working women, and demands that threatened the traditional prerogatives of management were at the heart of every impasse.

Alberta↗
PubMed1995

Best practice and enterprise bargaining.

The Australian Council of Trade Unions (ACTU) and its affiliated health unions have strongly supported and actively participated in the Federal Government Best Practice in Health initiative over the past two years. We believe the initiative has been an important vehicle in fostering the development of the Best Practice approach in this vital sector of the economy. Healthcare expenditure in this country runs to some $34.3 billion (1992/93 figures) annually, financed by a mix of Commonwealth, State and private sources and constituting approximately 9% of GDP. Hospital expenditure alone absorbs just over a third of the total at $11.8 billion (1990/91). At the same time, we have developed one of the most accessible and equitable healthcare systems in the world and an increasing source of valuable export dollars. The Australian trade union movement, like others in the community, recognizes that real cost constraints exist on governments in healthcare as elsewhere. Those constraints can lead to a variety of responses, such as to withdraw money from the system, combined with total reorganization of financing through the introduction of casemix and hospital reorganization, to see whether the system survives. The alternative is one epitomized by a Best Practice type approach. It is these types of approaches and their relationships with enterprise bargaining on which I intend to focus. However, I hasten to add that the issue of context is all important. Whilst it may be possible to create a microcosm of Best Practice change in a particular healthcare setting, it is unlikely to be maintained. The interface with the socio-ecomonic and political context cannot be avoided and it is this context which will determine the continuing success of Best Practice initiatives--whether in health or elsewhere.

Australia↗
PubMed1985

NLRB's St. Francis decision signals broader-based bargaining units.

The number of potentially appropriate bargaining units in a hospital has been sharply reduced by the National Labor Relations Board's recent St. Francis decision. Following a series of rejections by the U.S. Courts of Appeals, the NLRB has abandoned its previous position and adopted new standards that it believes are more in keeping with Congress' directive to prevent the proliferation of bargaining units in the health care industry. The new standards require that there be unusually sharp differences between the wages, hours, working conditions, etc., of employees requesting a separate bargaining unit and those in an overall professional or nonprofessional unit. As a result, hospital bargaining units will become much more broadly based. The St. Francis decision does not, however, invalidate previous NLRB certification or relieve a hospital of established bargaining obligations. To establish the appropriateness of broader based units, employers can ensure that employees in such a proposed unit are covered by a centrally administered wage and salary program with common wage scales, labor grades, pay increments, and job performance evaluation standards. Functional integration, continuing education and training, job transfers, shared facilities and activities, and centralized personnel policies and procedures are also areas in which employees' mutuality of interest can be established, thereby supporting the creation or maintenance of broad units.

Collective Bargaining↗
PubMed1978

Health care institution labor law: case law developments, 1974-78.

This Article examines the key National Labor Relations Board and federal court interpretations of the much-heralded 1974 Health Care Institution Amendments to the National Labor Relations Act. It analyzes NLRB decisions that have resulted in a proliferation of separate employee bargaining units at health care facilities, and that have applied the strike notice provisions of the NLRA to labor disputes involving building trade employees engaged in construction at operating health care facilities. In addition, the Article examines the Board's decision to decline jurisdiction over employee unions representing interns and residents, and summarizes both the special NLRB rules designed to apply to union solicitation of employees at health care facilities and the conflicting circuit court decisions that have modified the Board's specialized solicitation rules.

Collective Bargaining↗
PubMed1997

Trade unions and local bargaining in the NHS.

Examines some effects of NHS Trusts moving away at varying speeds from complex national arrangements for determining terms and conditions towards local bargaining. Notes that while there has been some research into the extent and nature of this decentralization, the impact on trade unions has largely been ignored. This research suggests that, far from marginalizing stewards, senior managers have involved them in joint discussions. Although there has not been a renewal of local trade unionism, there has not been a decline, as membership has held up. Moreover, stewards have coped remarkably well with their enhanced roles, even though faced with the increasing and conflicting demands of their work and their union duties, compounded by problems in obtaining time off work because of lack of cover.

Collective Bargaining↗
PubMed2001

An analysis of physician antitrust exemption legislation: adjusting the balance of power.

Current antitrust law restricts physicians from joining together to collectively negotiate. However, such activities may be approved by state laws under the so-called state action immunity doctrine and by federal legislation under an explicit antitrust exemption. In 1999, Texas became the first state to pass physician antitrust exemption legislation allowing physicians, under certain defined circumstances, to collectively negotiate fees with health plans. Last year, similar legislation was introduced in the US Congress, in 18 state legislatures, and in the District of Columbia. This legislation was passed only in the District of Columbia where its implementation was blocked by the city's financial control board. Nonetheless, legislation permitting physicians to collectively negotiate fees with managed care plans has been introduced in 10 state legislatures this year, and there is continued interest in introducing similar legislation in the US Congress. This analysis examines the basic features of this legislation and its potential impact on the balance of power between physicians and managed care plans.

Antitrust Laws↗