Confessions of a Hospital Administrator: It's Not a Problem Until it Blows Up Big
When a hospital gets into a labor dispute with its nurses, it has failed well ahead of the negotiations.
At a healthcare conference earlier this year where I was reporting for a client, I met a few of the senior managers at Allina Health from Minneapolis. They were nice folks and were realizing some cutting-edge technology accomplishments. So, when they got into a protracted labor dispute with their nursing union later in 2016, I wondered: How does such a forward-thinking technology organization get into a nasty contract dispute that resulted in 4,000 nurses striking for a combined 44 days?
In the end, Allina agreed to one of the key demands of the nurses: to provide around-the-clock security in their five ER locations. As one nurse said in a StarTribune article:
Announcing the vote results at 9:45 p.m. Thursday, nurse Angela Becchetti said she wished Allina would have arrived at concessions in this contract, such as 24-hour security in all five emergency rooms, earlier.
“This never should have happened — the hard feelings, the strike, none of it,” said Becchetti, a member of the bargaining team for the Minnesota Nurses Association."
As a former hospital administrator who negotiated several times with both nurses and other unions, I learned this truth: there is never enough money to fix a problem until something goes wrong. Then money cannot be spent fast enough.
I used to make rounds in the hospital (including ER) on second and third shifts at least a few times a month. I know hospitals can be dangerous to staff and patients at night after administrators have gone home.
I've had to respond to everything from a gun-wielding intruder forcing the night supervisor to unload the pain meds out of the Pyxis machines, to a multiple shooting in the ER, to a crazy, wandering ER patient placing occult symbols on sleeping inpatients, to public urination in the parking lot.
Some of these incidents happened with good security in place. In some hospitals, I put off-duty police officers in place to provide security in the ER where there was none. What I eventually learned that prevention is not only good for safety, but it conveyed to staff that I cared about them.
Then, when it came time to negotiate a new contract and I needed something from the unions as the administrator, they were more likely to give me the benefit of the doubt. This was especially true if I presented my problem and asked the union what their suggestions were for solving my problem.
This is an age-old negotiating truth: before you ask someone for anything, you must first establish a relationship based on mutual trust and appreciation.
Something I learned from the nursing and professional union reps where I worked for nearly five years at Washington hospital is that union members want the same thing that hospital administrators want: a safe, well-run hospital staffed by caring and competent staff who are fairly treated. On my last day in that position when I walked two rows of employees who lined up to wish me goodbye, the last person to shake my hand was one of those union leaders.
He and the nursing union leader had worked with me over the past four years to redesign the hospital culture from the bottom, up. The results were the hospital achieved patient satisfaction, medical staff satisfaction, quality and outcomes success never before achieved. Not surprisingly, the payor mix and finances also improved significantly.
That handshake represented an important lesson for me: be fair and take care of your staff.
ServantLeader is a retired hospital administrator who now works as a freelance reporter on healthcare and healthcare policy for several publications and sites. He is also published widely on several sites and in publications about craft beer. He is the author of the hospital novel "Medical Necessity".
John W Mitchell is a retired hospital administrator, freelance writer and author of the novel "Medical Necessity". He is published widely at several health care and craft beer sites and in publications.
Joined: May '11; Posts: 41; Likes: 219
Retired Hospital Servant Leader Adminstrator; from US
Specialty: 25 year(s) of experience in Administrator inspired by nursesJan 3, '17John,
I have yet to see a hospital or any business not invite the Union wolf through its door by consistently acting in bad faith as in "l'm the boss like it or leave it or go home."
The figurehead CEOs doing the bidding of the lawyers and gentry in the boardroom all at the behest of Wall Street's demand for constantly higher profits run the show since most religious organizations threw in the towel long ago.
Let's not delude ourselves and engage in blowing smoke up each other's hindquarters.
Hospitals are the most heavily government subsidized corporations next to for-profit education. No masters of the universe there.
Making a profit to pay the bills and keep the lights on no one begrudges but you know probably more than most that as nursing is the single most costly sunk outlay any hospital makes to run any given operation, capital dictates that the day of the inexhaustible nurse robot can't be too far off in the future; and I'm sure sans Union so no love lost or given I suppose to the hapless patients
Now as far as retroactivly spending money to provide protection to staff in dangerous emergency departments, since when did they get dangerous? Wouldn't that money have been better spent painting the entrance way mauve or whatever is the latest consultant recommended color?Last edit by Buyer beware on Jan 3, '17 : Reason: wJan 3, '17The strike did not center around security, it primarily centered around their healthcare plans. The nurses did not want the same plan as every other Allina employee, they wanted their own much better plan.
In reality the strike was not even for the healthcare plan, it was political. The system could not cave in easily less they lose their ability to efficiently negotiate in the future and the union had to push for much the same reason but added on a bunch of other requests with the full expectation to lose them.Jan 3, '17Very nice article. I just want to point out a major difference.... As licensed professionals, we have much more to lose than Hospital Administrators. We must always abide by our Nurse Practice Act, even in the fact of vague and arbitrary staff cuts, supply shortages, and seemingly inane policies. Our first loyalty must be to our profession, not our employer.
In my experience, Administrators just don't get this. They readily prioritize non-clinical preferences and don't bother to review nursing professional requirements before making new rules. - true example: "flexing" staff for low census leaving only one RN in the department -- forcing the RN to violate practice standards by inappropriately delegating nursing tasks to other staff. When push comes to shove, we know that it's better to lose a job than lose a license. Organizations that do not ensure operational alignment with nursing standards will never have our trust.Jan 3, '17Thanks for the article. Agree that "big" problems for nurses can sometimes blow up in "administration's" faces. Appreciate the view from the other side.Jan 4, '17Thank you for the article - I think you point to something that gets forgotten easily in nowadays healthcare driven by finances:
1. There is still a human being on the other side that counts and not just the $$$ and surveys - which is equally important for nurses and patients and
2. Mutual respect and the willingness to find solutions, to listen to the other side and to realize that there is only so much you can push the other side.
You sound like the good old fashioned administrator who is mostly interested in making the work place a good experience and place for everybody - humanity first.Jan 11, '17Thank you for this clarification Asystole, it was remiss of me to mention the disagreement around the health benefits. Your point about positioning is also well taken. This is what happens when leaders do not know how to create an inspired workplace. This is because the only thing the leaders know how to do is govern by confrontation.Jan 11, '17Great point HouTX. I agree that administrators don't think about nursing licenses. This is why it's always a good idea to ask the frontline people who do the work for a solution to a problem. This, as opposed, to administration coming up with the answer themselves because they've been taught to be an effective leader, all the solutions to problems have to be their solutions. The foundation of the LEAN process and Shared Governance advocates hands-on solutions by staff doing the work.Jan 11, '17Buyer Beware - I have never been happier at work in a hospital as when I was successful being a Servant Leader. Every metric that matters to hospital boards got better - often world-class. I loved getting up and going to work in the morning and so did everyone else. My job was much easier because we were a team - and the team was inspired. This resulted in the hospital achieving patient satisfaction in the top 15 percent of hospitals in the country. It was the best five years of my career.Jan 14, '17Thank you servant leader... I live and work in that state of allina though not for them. I wish our admin would round on the off shifts and see the ED examples you gave. Have to be real careful what I post here...
having healthcare and a good plan is important. Allina rn's fought hard and still lost most of this plan. Generally, it was known as better than most and desirable. There are few perks in nursing anymore and that one was worth fighting for. Given the money spent on replacement rn's and all other costs, we'd all love to hear if the sr admin. thought it was worth it to create distrust and a bad vibe, but won't.
the quarter bets are on to see whether the CEO retains her job in 2016 or not.
i think trust helps some with the union at least when dealing with small issues, but all bets go out the door when the strike comes.Jan 15, '17Your experience is the manifestation of the difference between command-and-control leaders and servant leaders. Unfortunately, servant leadership is the exception, rather than the rule. A pity, as my experience is that servant leadership is the easiest, most effective way to be in charge, with no strikes necessary. A hospital board gets the results they pay their admin team to achieve.
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