Unions' role in behavioral health organizations.

The U.S. workforce of the 21st century is expected to face a very different set of opportunities and challenges than faced by previous generations, according to the Workforce Challenges and Opportunities for the 21st Century Forum, hosted by the General Accounting Office (now the Government

These observations certainly apply to the behavioral health and social services field. Within this dynamic change environment, it is reasonable to expect that the nature of the relationships between unions, employees, and human services organizations will be affected as a result. The dynamics of this environment are well known:

* Increasing numbers of people need, and are seeking, assistance.

* The problems people are facing are increasingly complex.

* Keeping current with best-practice advances is a significant training challenge.

* Regulatory requirements are increasing.

* The costs of providing services continue to increase.

* Funding for services is being reduced.

* Recruiting and retaining qualified staff are ever more challenging.

This picture will become more and more grim over time. Given this complex scenario, how will organizations address these issues? And what does this situation portend with regard to organized labor's future role?

Unions and Professionals

Since 1995, the percentage of workers who belong to unions has been trending downward, decreasing from 14.9% in 1995 to 13.2% in 2002. This translated into 16.1 million union members in 2002.

According to an analysis (conducted by the AFL-CIO Department for Professional Employees) of figures from the Department of Labor (DOL) Bureau of Labor Statistics, the union movement is now almost 50% white collar. Like other workers, professionals are forming unions to enhance their professional autonomy, to be involved in making decisions that affect their careers, and for greater professional and personal security. In the healthcare professions, approximately 22% of workers are union members, a higher proportion than the workforce in general.

In the health and behavioral health field, professional practitioners have taken a serious interest in forming their own unions or in pursuing various types of affiliations with existing unions. For example, psychologists employed by the District of Columbia government formed their own bargaining unit affiliated with the American Federation of State, County and Municipal Employees. Psychologists employed by Kaiser Permanente in Denver are represented by the United Food and Commercial Workers. Psychologists employed by Permanente in Southern California are represented by the Service Employees International Union (SEIU). In 1998, the Clinical Social Work Federation (CSWF) voted to form the Clinical Social Work Guild and affiliated with the Office and Professional Employees International Union for a trial period of two years. In 2000, CSWF voted to extend its national affiliation for an additional three years.

For nurses, United American Nurses is the labor arm of the American Nurses Association (ANA). According to ANA, through its Constituent Member State Nurses Association bargaining units, nurses are able to:

* improve wages by negotiating significant pay increases, innovative bonus systems, increases in differential pay, and additional steps on the pay scale;

* expand benefits, including disability coverage and pension plans;

* foster professional growth and development through provisions for in-service training, tuition reimbursement, and educational leave; and

* enhance the quality of patient care through the creation of practice councils, labor management committees, and other special focus groups.

Regarding physicians, the American Medical Association House of Delegates created in November 1999 Physicians for Responsible Negotiation (PRN), a physicians' collective bargaining organization. In March 2000, PRN signed its first contract with physicians employed by the Wellness Plan, a Detroit health management organization; in September 2000, physicians employed with Concentra Managed Care in New Jersey elected PRN as their representative; and in November 2000, about 170 residents and fellows in training with Advocate Lutheran General Hospital in Park Ridge, Illinois, officially elected PRN as their collective bargaining representative. PRN officially teamed up with SEIU in June 2004.

Why Employees Unionize

From an employee perspective, three primary reasons exist for unionizing: poor wages and benefits, poor working conditions, and poor job security. Poor management practices are factors contributing to interest in unions, including practices such as favoritism, inconsistency, lack of predictability, unfair or inconsistent disciplinary practices, poor communication with employees, lack of respect for employees, failure to promote from within, and practices causing the workforce to feel disenfranchised.

These problems are usually a result of a lack of oversight, training, or awareness on the part of the supervisor. The modern manager understands that poor supervisory practices are counterproductive. Supervisors are the most important "management people" in the eyes of employees. The supervisor's actions often can convince employees that there is no need to look outside the organization for help or, conversely, that there is indeed a need to look outside for representation.

Management/Labor Relationships

Most early relationships between an organization's labor and management are strained. This is often because most organizing campaigns are conducted in an adversarial environment in which the union attacks management and management responds in kind. Even after the relationship settles down, it rarely takes on the characteristics of high trust and open communication. Rather, the relationships tend to be marked by a pattern in which both management and labor constantly position themselves to protect their own interests with little attention paid to shared concerns. Management's actions may be met by union reactions such as filing grievances, unfair labor practices claims, or lawsuits. Management typically treats the union as a "foreign body," with the sense that management would like to get rid of the union.

This adversarial relationship continues to stoke strong feelings of mistrust. The actions of one party are automatically viewed as hostile by the other. As a result, the organization is immersed in an internal battle, drawing time, energy, and resources from the real work that needs to get done--and is not done if a strike ensues.

An alternative to this model is seen in those situations in which management and unions specifically have chosen to develop a cooperative, supportive relationship. Instead of viewing each other as the enemy, they relate to one another as allies and valuable resources. A specific and conscious effort is made to develop and maintain high levels of trust and open communication between the two parties. Instead of self-interest bargaining, both promote a win-win problem-solving approach to issues, and a conscious joint decision is made to focus on long-term benefits rather than short-term victories.

Using these labor/management partnerships, organizations and unions can work together to improve both the quality of agencies and employees' work lives. With this model, both sides can make the long-term commitment needed to provide the best value for consumers and payers. An excellent example of this partnership at work occurs when labor and management team up to present a united front in addressing legislative issues--especially those pertaining to funding or regulation. There is a definite common interest to press elected officials for increased funding and keeping cost structures competitive. When employees, the union, and management are all committed to work this issue, they are a substantially more formidable force, increasing the odds for success.

Union/Nonunion Employee Benefits

In terms of employee wages and benefits, the numbers tell the tale. The January 2004 DOL figures show that unionized workers, compared with nonunionized workers, earn more per week ($760 versus $599), are more likely to have a guaranteed (defined benefit) pension (69% versus 49%), more likely to get health benefits (75% versus 49%), more likely to get short-term disability insurance (69% versus 30%), and more likely to get life insurance coverage benefits (82% versus 51%).

Concerning wages more specific to health, behavioral health, and social services, according to the Bureau of Labor Statistics, in 2003 unionized workers in commercial and social services occupations earned $48 versus nonunionized workers earning $650 in median weekly earnings, a 30.46% difference. Workers in the healthcare practitioners and technical occupations category earned $877 if unionized versus $801 if not--a difference of 9.49%.

Union or not, some systematic challenges exist in the field. According to the National Association of State Mental Health Program Directors' Research Institute, 44 state mental health agencies reported that in 2001 they were experiencing shortages of mental health staff. Thirty-seven states identified staff shortages in state hospitals, and 28 identified staff shortages in community mental health programs. In general, states identified shortages across multiple disciplines, including RNs, psychiatrists, social workers, and nurse practitioners.

The very hard nut to crack in the behavioral health and social services field is that employees are poorly compensated relative to those in other fields. They find themselves in this position principally because these organizations are funded inadequately. The end result is that both parties find themselves on the short end of the financial stick.

With limited financial and human resources, executives of behavioral health and social services organizations operate in a climate of scarcity. The ability of an organization to recruit and retain competent staff has a significant bearing on its margin for success. Management can take a number of steps to create a positive work environment and be responsive to employees:

* Carefully screen job applicants and make an effort to fill job openings with qualified employees from within the organization.

* Promote predictability and consistency through use of comprehensive employee handbooks.

* Administer wage and benefit programs on a consistent basis.

* Survey the competition and pay competitive wages and benefits.

* Explain the company's compensation program to employees and why it is attractive and fair, and follow through promptly with announced benefit changes.

* Develop an appropriate affirmative action program and, all other things being equal, recognize seniority.

* Maintain adequate facilities.

* Develop a good two-way (upward as well as downward) communication system.

* Help employees understand how they fit into the "big picture."

If an organization's employees are not represented by a union, then management and staff could find it advantageous to develop a collaborative working relationship that advances both the financial and service delivery goals of the organization. If employees of an organization are represented by a union, then a comparable commitment between management and the union must be made. In either case, if the relationship is contentious and adversarial, the chances of surviving, let alone doing well, are minimal at best. It is therefore incumbent upon all parties to work collaboratively to help ensure the success of an organization in its delivery of services.

SUGGESTED READING

Biggins SL. Assessing & building your organizational HR competencies: Using HR as a strategic partner in human service capacity development. OPEN MINDS 2004;16(2):2-3.

Bridging the Labor-Management Gap. Available at: www.arbitratorwilliams. com.

General Accounting Office. Highlights of a GAO Forum: Workforce Challenges and Opportunities for the 21st Century: Changing Labor Force Dynamics and the Role of Government Policies. GAO-04-845SP. Washington, D.C.: GAO, June 2004. Available at: www.gao. gov/new.items/d04845sp.pdf.

Jenkins J. Using coaching as a management tool: An overview of approaches available to behavioral health & social service organizations. OPEN MINDS 2003; July.

Jess Jamieson, MSW, PhD, is CEO of Compass Health and a member of OPEN MINDS' Advisory Board. This article was adapted from a story that appeared in the October 2004 issue of OPEN MINDS.

To send comments to the author and editors, e-mail jamieson0505@behavioral.net. To order reprints in quantities of 100 or more, call (866) 377-6454.