CHL
Supervision Continuing Education (SCE)
SELF-STUDY PLANS

Supervisory Continuing Education (SCE) lessons provide members with ongoing education focusing on supervisory or management issues. These lessons are designed for CHL re-certification, but can be of value to any CRCST in a management or supervisory role.

You can use these lessons as an in-service with your staff, or visit www.iahcsmm.org for online grading at a nominal fee ($5 per single lesson plan, or bundled packages are available for quantities of 6 lessons for $25 (save $5) or 12 lessons for $50 (save $10) for greater savings).

Each lesson plan graded online with a passing score of 70% or higher is worth one point (contact hour). You can use these points toward either your re-certification of CRCST (12 points) or CHL (6 points), but you can not use them for both.

Mailed submissions to IAHCSMM will not be graded and will not be granted a point value (paper/pencil grading of the SCE Lesson Plans is not available through IAHCSMM or Purdue University; IAHCSMM accepts only online subscriptions of the SCE Lesson Plans).

Lesson Plan CHL 304
Central Service Managers in Unionized Facilities: Part II
[Reprinted from Communiqué: November/December 2007]

In Part I of this two-part series we explored reasons why some employees want to join a union, provided a brief history of unions, and discussed basics of the unionization process. In this concluding article, we’ll take a close look at the collective bargaining process and contract administration.

The Collective Bargaining Process

A 1974 amendment to the National Labor Relations Act allowed employees of non-profit hospitals to join unions.1 While total union membership has been decreasing in the United States, there has been some expansion of the collective bargaining process in healthcare facilities in some communities.

Collective bargaining involves the negotiation and administration of written agreements between union and administrative officials. A traditional view of the contract negotiation process is one of union and facility representatives attempting to win concessions in an “I win, you lose” strategy. This approach is used, for example, when a union attempts to bargain for increased compensation packages at a time when the facility cannot afford it. Unfortunately, concessions negotiated during “good” economic times are not usually given up during periods when the facility is confronted with challenges, and then financial and personnel-related problems can arise.

Contemporary collective bargaining approaches attempt to focus on each party’s interests rather than “positions” that must be defended. The premise that a healthcare organization must be able to survive to benefit both parties can become a foundation upon which labor and administrators can work to achieve mutual interests.

Significant time and effort is required to negotiate agreements, and they commonly span a several-year period. Both parties will be very interested about compensation rates and the facility’s current and projected financial position. Details about the current contract must be assessed, and issues of concern must be considered by both parties in advance of the negotiation process.

In the first article of this series, we discussed the Wagner Act which requires employers to bargain in good faith about three mandatory issues: wages, hours and employment terms/conditions. Additionally, grievance procedures are addressed in almost all labor contracts. Bargaining issues are generally one of two types: mandatory items include those about which labor and management must negotiate if either party desires to do so including wages, working hours and benefits. Permissible items are those which can be negotiated if labor and administrators agree to do so. Example: union veto power over departmental work schedules.

Employee unions are concerned about current and future compensation for their employees. They often negotiate cost of living adjustments that tie wage increases to changes in consumer purchasing power. Other typical union concerns relate to employee benefits including retirement, paid holidays and working conditions. Unions typically negotiate for employer payment of all or most employee insurance costs. Job security is another typical collective bargaining priority, and seniority is integral to this discussion. A wide range of other union-initiated issues is often considered. These include working hours and overtime pay policies, agreements about rest periods, differential pay for employees working on different shifts, and the use of part-time and temporary employees.

What happens if the union and management negotiators cannot agree about one or more contract clauses? One typically thinks about strikes and, unfortunately, these do occur, and they can cause significant disruption to facility operations and patients. Other legal labor actions that unions can use to deal with labor disputes include picketing, boycotts and work slowdowns.

Typical union agreements contain clauses addressing the following issues:

• Recognition of union
• Wages and benefits
• Vacation and holidays
• Working conditions
• Lay offs
• Management rights
• Working hours
• Employee seniority
• Arbitration
• Union renewal clause

Three conflict resolution tactics may be used when negotiations cannot be completed:

• Voluntary arbitration. An action in which both parties submit a dispute to an external, disinterested third party for binding or non-binding resolution after the presentation of evidence and discussion.
• Compulsory arbitration. An action in which an arbitrator is appointed by the government to make a binding decision upon the parties negotiating the contract.
• Mediation. A non-binding structured process in which a third party assists management and union negotiators to reach an agreement. Advice, not a final, mandated decision results.

Contract Administration

After union and healthcare organization representatives agree to contract provisions, the contract is ratified (approved) by the union members. Then communication and coordination efforts are required to assure that it is understood by all parties. Even if changes are relatively minor, significant communication, training and education, and meetings may be necessary so both parties understand all contractual terms. Changes involving work rules and hours, for example, can involve significant details that require careful explanation.

The union steward represents union employees, and Central Service managers represent the organization’s interests. They must both consider each other’s rights to work together cooperatively. If approved by the union steward, an employee may attempt to resolve a complaint through a formal grievance process that often includes the following steps, if resolution is not forthcoming at an earlier step:

Step 1 – The union steward and affected employee meet with the Central Service supervisor or manager.

Step 2 – The employee, union steward and chief steward meet with the Central Service supervisor or manager and the organization’s labor relations (human resources) specialist.

Step 3 – The employee, steward, and union grievance committee meet with the facility’s labor relations (human resources) and other top-level personnel.

Step 4 – Representatives of the national union or other top union officials meet with top-level administrators and/or attorneys representing the facility.

If the “Step 4” grievance resolution procedure is unsuccessful, a final step will likely be arbitration. Note: in small organizations, the grievance process described above is often abbreviated.

The labor agreement should effectively spell out both the facility’s and employees’ rights. This is important because they directly impact what Central Service managers can and cannot do. Those negotiating labor agreements and participating in grievance procedures should, respectively, assure that contractual terms are properly worded and understood. Some of the numerous rights that managers should never “negotiate away” include:

Terms and conditions for employee performance reviews.

• The ability to develop schedules that manage overtime.
• Employee assignment, re-assignment and promotion decisions.
• Use of tests to assess employment qualifications.
• Length of probationary periods.
• Expected on-job conduct.
• Discretion to administer work rules, policies, standard operating proced ures, and performance standards.
• Modification of job description tasks.
• Implementation of tactics to increase productivity.
• Decisions about staff members qualified for specific positions, merit increases and promotions.
• Property reorganization including the closure of departments or facilities (in multi-unit organizations).

Basic administrative rights are very important, and these topics should be addressed during employee orientation sessions.

• Union agreements affect other aspects of employee relations that should be addressed during orientation including:
• Employees’ rights and responsibilities.
• Managers and supervisors’ rights and responsibilities.
• Relations with supervisors and union stewards.
• Union contract provisions and company policies.
• Discipline and reprimands.
• Grievance procedures.
• Employment termination.
• Union dues and dues collection

Many employee and administrative rights and responsibilities do not differ significantly between unionized operations and their non-unionized counterparts. For example, all Central Service employees in all facilities are expected to come to work when scheduled and perform their job tasks appropriately. The basic policies and procedures that relate to all (most) employees should be addressed during orientation, and they should be administered equitably and consistently in all healthcare organizations regardless of union affiliation.

What are examples of how work differs in unionized Central Service departments? The differences begin with job assignments. In a unionized workforce, job tasks may be assigned based on seniority (length of employment in the position), not necessarily on skill and ability. Preferential shifts and days off may also be based on seniority. Union employees can only perform work tasks defined in their job descriptions, and they cannot do non-union work. Likewise, only union-member employees can perform specified work tasks.

Challenges can result when there is an overlapping of tasks in two or more job descriptions. Consider, for example, the assembly of instrument trays. Preparing an instrument set is a primary task of Central Service Technicians. However, surgical scrub technicians and nurses may also perform this task when, for example, they are preparing an instrument set to be flash sterilized. If this task is not listed in the applicable job descriptions, staff members in operating room environments may not be able to prepare an instrument tray. Union members have the right to have a union representative present when these matters are discussed, and when disciplinary conferences are conducted.
While the future is unknown, economic and/or organizational changes may increase the interest of healthcare employees in union membership. If this occurs, Central Service managers and supervisors with human resources responsibilities will be challenged to manage according to the labor agreement while addressing the needs of the patients being served.

Endnote:
A brief history of the unionization movement was presented in the first article in this two-part series.