Navigating Patient Safety: Opportunities and Challenges in Labor-Management Relations

1. The struggle continues: Opportunities and challenges in joint labor-management patient safety initiatives Rick Brooks, Director United Nurses & Allied Professionals

2. Overview of presentation • UNAP & RI Hospital • 15-year history of labor relations • The adversarial years • The peace dividend • The current environment • Fighting for patient safety – then & now

3. The players • United Nurses & Allied Professionals • Rhode Island Hospital

4. The history • 1993 – The organizing of RI Hospital • A culture of mistrust • Health insurance hikes, merit raises, staffing shortages • “Maids with manners” • Largest organizing victory in RI history

5. 1994-2003: The adversarial years • RI Hospital approach • Deskilling • Downsizing (layoffs & attrition) • Vacancies, short staffing, travelers, MOT • UNAP approach • Continual safe staffing campaigns • Workplace, contractual, and legislative battles • Job actions, strike votes, confrontation

6. 2003 – ?: The “peace dividend” • Successful negotiations in 2003 • Focus on recruitment & retention • Early negotiations in 2005, 2007 • Significant economic gains (union and hospital)

7. 2003 – ?: The “peace dividend” • Joint initiatives • Self-insured health plan • Safe patient handling • Education Trust • CEU programs • Stepping Up (Career ladder program)

8. The current environment • Increased financial pressures • Medicare cutbacks • State budget cuts • Commercial insurance – uninsured, high deductibles, etc • Competition from out-of-state and for-profit hospitals

9. The current environment • Increased regulatory pressures • Institute of Medicine • Wrong-site surgeries • Reporting & disclosure: patient outcomes & satisfaction • Pay for performance • HospitalCompare.gov

10. The current environment • RI Hospital’s “Magnet Journey” Magnet hospitals…lead the way with outstanding quality and professionalism and create a culture of excellence that attracts and retains highly skilled nurses who provide exemplary professional practice, create new knowledge, and impact quality outcomes. American Nurses Credentialing Center

11. The current environment • Unique opportunity for collaboration? • Improve patient safety • Increase patient satisfaction • Increase RN satisfaction

12. The Key to Nurse Unionism • Paul and Darlene Clark • Nurses join unions “to have a voice in patient care and nursing practice decisions” • For many, this has meant battling unsafe staffing, floating, and mandatory overtime

13. UNAP - United for Quality Care • Mobilizing members around patient safety • Grievances and labor-management meetings • Petitions, unsafe staffing forms & mandatory OT forms • Rallies & street theatre • informational picket lines & strike votes • Billboards, buttons & bumper stickers • TV and radio ads • Meetings with regulators and inspectors, • Op-eds, editorials & exposes • …even sky writing

14. UNAP - United for Quality Care • Real victories in the workplace • Successful fights to stop deskilling and downsizing • Strict limits and financial penalties for mandatory overtime • Effective restrictions on floating • Staffing & quality committees • Recruitment & retention improvements

15. UNAP - United for Quality Care • And at the legislature • Public disclosure of staffing levels • Safe patient handling • Prohibition of mandatory overtime

16. The next frontier • Is there life after mandatory OT? • The fight for safe staffing is forever • How else do we “empower nurses to have a voice in patient care and nursing practice decisions?” (Clark & Clark) • When we say “patient safety” do we mean “working conditions?”

17. The next frontier • Management’s patient safety agenda • Responding to pressure from regulators and payors • Focus on measurable quality indicators • E.g., pressure ulcers, patient falls, HAI, VAP, UTIs, medical errors, never events, readmissions, length of stay, pain control… • And patient satisfaction scores

18. The next frontier • Do unions want a seat at the patient safety agenda? • Does management want us there? • UNAP Convention resolution & op-ed • Management reaction • Can we be effective without partnering?

19. The next frontier • Barriers to partnership • For management • Lack of trust • Loss of authority • Fear of “infiltration” • For union • Lack of trust • Lack of interest • Lack of expertise • Lack of time & resources • Political risks

20. The next frontier • Recommendations for unions • Be pro-active around patient safety issues • Connect patient safety goals to member goals • Pursue non-traditional bargaining(not a mandatory subject of bargaining) • Obtain Union seats on patient safety committees • Establish enforceable right to information, education, release time, union caucuses, etc • Keep committees connected to Union leaders and members

21. The next frontier • Recommendations for employers • Encourage Union participation • Ask Union to designate committee members • Provide adequate paid time and training • Respect Union agenda and political realities • Connect patient safety goals to employee goals