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: Quote 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.