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PubMed1990

Physician unions: any doctor can join, but who can bargain collectively?

Employees in the health care industry, including physicians, have recently taken more interest in unions and collective bargaining. At the present time the health care industry is approximately 20 percent unionized. Labor leaders believe that existing conditions are fertile ground for significant union activity that has been on a recent upswing after a decline during the early 1980s. While current attention is being drawn to the shortage of and increased union organizational activities by nurses, physicians may not be far behind. It is conceivable that by the year 2000 the majority of physicians in the United States will work in full-time salaried positions. In addition, the antitrust laws that currently restrain independent physicians from collective bargaining are being challenged and are likely to change as more physicians become salaried and begin to resemble other professional employee groups. The ruling determining that interns and residents are students rather than hospital employees is also certain to be challenged and changed, especially as pressures on the National Labor Relations Board (NLRB) are brought by house staff union organizations. After a 1987 ruling that the NLRB had been improperly interpreting the 1974 amendments to the Taft-Hartley Act, the NLRB was ordered to exercise its rule-making power in defining bargaining units for health care workers in acute care hospitals. Physicians would then be one of eight occupations defined as a separate health care bargaining unit.

American Hospital Association↗

PubMed2001

Coverage of smoking cessation treatment by union health and welfare funds.

OBJECTIVES: This study determined the level of insurance coverage for smoking cessation treatment and factors associated with coverage among health and welfare funds affiliated with a large labor union. METHODS: A self-administered written survey was mailed to fund and union officials. Analyses were conducted by chi2 tests. RESULTS: Twenty-nine percent of funds provided coverage for some type of smoking cessation treatment, with the odds of coverage significantly increased among funds whose administrators reported having received members' requests for smoking cessation treatment in the past year (odds ratio = 4.9, P = .05). CONCLUSIONS: Coverage for smoking cessation services is low, comparable to coverage offered by other health insurers. Interventions with union members and fund officials are needed to provide union members with access to affordable and effective smoking cessation treatments.

Administrative Personnel↗

PubMed1976

Organizational systems for change offer an alternative to unions.

Hospital management must begin to face the implications of unionization more directly. Certain current practices of most hospitals tend to increase vulnerability to unionization; they must be evaluated and modified. Strategies and programs for modernizing personel practices, for developing better employee information systems, and for training and developing managers need to be developed in order to effectively inhibit the intervention of labor unions.

Career Mobility↗

PubMed1999

Effective employee relations in reengineered organizations.

The degree to which a healthcare organization can effectively respond to changes that are brought about by managed care is often the result of how well the organization engages the workforce in the changes. The goal of a process-centered healthcare organization is to deliver service that is truly patient-centered. Successful organizations understand that the actualization of this goal begins with the decision to engage in an employee-guided approach to reengineering. This article describes issues of effective employee relations in the postreengineering era. Strategies for dealing effectively with labor unions or for preventing unionization are also discussed.

Attitude of Health Personnel↗

PubMedDate not supplied

Trends in hospital unionization and a predictive model for unionizing success.

Between 1976 and 1980, the average annual increase in hospital expenses was 12.7%. Wages for employees accounted for approximately one-half of this increase. Because employee wages have such a great effect on hospital costs, it is important to study those factors that could curtail management's control over these expenses. One such factor is the establishment of labor unions. This study outlines the structural factors that encourage union activity, as well as the factors that contribute to its success. Variables studied include: the types of employees in the bargaining unit; the total number of employees in the bargaining unit; the number of hospitals in the same city; the control of the hospital and the presence of a profit motive; the number of beds in the hospital; the occupancy level of the hospital; and the region of the country in which the hospital is located.

Data Collection↗

PubMed1999

Physician unionization: a threat to integration?

Physicians, primarily those salaried by hospitals and health systems, are increasingly turning to labor unions to help them in their frustration over what they see as eroding clinical autonomy as well as diminishing compensation. Significantly, non-salaried physicians are also looking to the concept of collective bargaining as a tool in their negotiations with health insurers. The pro-labor doctors may get some of what they're looking for in the coming months and years, with a combination of economic and political forces driving the nascent trend forward regionally and nationwide. But victory won't come without a struggle and some major legal and regulatory hassles. And what will physician unionization mean for integrated health systems and other large healthcare organizations? Plenty, say industry observers and those in the trenches.

American Medical Association↗

PubMedDate not supplied

Professional nurses in unions: working together pays off.

Professionalism versus unionization of nurses is often posited as a dichotomy of mutually exclusive choices. Many US nurses are alienated from militancy and activism because they are viewed as unprofessional. This stance weakens nurses' ability to organize coalitions, to increase their power bases, and to advocate for both nurses and clients. This article examines how nurses worked together in a labor union to realize professional gains. Ethnography, including participant observation and ethnographic interviews, was the method used to study unionized registered nurses (RNs) in a 60-bed, private, not-for-profit psychiatric hospital in rural southern New England. The union nurses' position as workers in a gendered profession was analyzed. Nurses' union involvement, solidarity, and working conditions were considered in the context of a patriarchal and authoritarian hospital setting. Collaborative decision making and an innovative conflict resolution strategy allowed nurses to voice professional concerns. Unionization allowed RNs to collectively mobilize as a legitimate ideological force in the hospital culture and to enhance their professional status. Their ability to resolve conflicts and to implement change within this context were evaluated.

Attitude of Health Personnel↗

PubMedDate not supplied

[Politicization of the age problem--the dispute over industrial pension funds in the Ruhr district on the eve of the 1st World War].

The heterogeneous experience of older industrial workers on the job, in the labor market, and in their families prevented the development of a consciousness recognizing old age as a political problem. Industrial social policies for old age or disability appeared earlier than state programs and continued to play an important role even after the start of social insurance in Germany. The low public pensions and the increasingly uncertain family support of the elderly made supplementary private benefits very attractive. Before 1914, however, in the debate between labor unions and business about the rigid rules of private pension funds and their use for social control, the problems of aging workers became highly politicized. Drawing upon examples from Krupp and Gutehoffnungshütte, the article emphasizes that these industrial social policies were aimed at maintaining a division between mobile and permanently employed workers as well as limiting the influence of the labor movement.

Adult↗

PubMed2005

Hospital charity care and billing practices: the labor movement pans for gold.

Labor unions and legislators are accusing some hospitals of discriminatory billing practices, overbilling the poor, and using humiliating collection practices. The authors focus on the unions targeting healthcare, the litigation, and how these unions are using these issues to advance organizing. Healthcare executives need to empower their employees with information on how money is spent at their organizations to further the organization's mission, vision, and values.

Hospitalization↗

PubMedDate not supplied

The United Farm Workers clinic in Delano, Calif.: a study of the rural poor.

Data on the utilization of services and morbidity were obtained for 1972 from the Rodrigo Terronez Memorial Clinic in Delano, Calif., a health care facility operated without government funds, which was established to serve the rural poor, specifically farmworkers and their dependents. There were 23,141 patient visits in the study year. The average number of physician visits per patient 3.4; 65 percent of the visits were by appointment, 9 percent were after hours, and 1 percent resulted in hospitalization. Only 0.2 percent constituted true emergencies. Ninety-nine percent of the prescriptions written at the clinic were from a 190-item drug formulary developed by the staff physicians. The data on the clinic are roughly comparable with those from other urban rural comprehensive health centers. The Terronez Clinic, however, differed significantly from most of these other centers in its orientation. It served as an organizing tool for a labor union trying to mobilize agricultural workers in the area so they would act together to improve their living conditions.

Adolescent↗

PubMed2004

Reducing occupation-based disparities related to tobacco: roles for occupational health and organized labor.

BACKGROUND: Persistent and growing occupation-based disparities related to tobacco pose a serious public health challenge. Tobacco exacts a disproportionate toll on individuals employed in working class occupations, due to higher prevalence of smoking and exposure to secondhand smoke among these workers compared to others. METHODS: We provide an overview of recent advances that may help to reduce these disparities, including research findings on a successful social contextual intervention model that integrates smoking cessation and occupational health and safety, and a new national effort to link labor unions and tobacco control organizations around their shared interest in reducing tobacco's threat to workers' health. CONCLUSIONS: Implications of these efforts for future research and action are discussed.

Health Priorities↗

PubMed2002

A critique of social capital.

This article critiques the concepts of communitarianism and social capital as used in the United States and in Europe. For the United States, the author focuses on Robert Putnam's understanding of both concepts, showing that the apolitical analysis of the Progressive Era, of the progressive developments in Northern Italy, and of the situation of labor unions in the United States is not only insufficient but wrong. The critique also includes the difference between U.S. communitarianism and its European versions, Christian democracy and New Labour, and the limitations of both approaches. The uses and misuses of these concepts in the political debate are discussed.

Capitalism↗

PubMed1993

Bush's and Clinton's fat cats.

As the 1992 presidential race went into full swing, Republican and Democratic fundraisers were busy soliciting $100,000 donations from corporations, labor unions and wealthy individuals. This kind of money is supposedly illegal in presidential campaigns, but both parties have found a way to launder it: by channeling it through their state affiliates and calling it "soft money." Whatever its name, it is compromising the integrity of the system.

Economics↗

PubMed1991

Reviving the action research model: combining case and cause with dislocated workers.

Action research, a model combining research with activist goals and microlevel and macrolevel social work practice, has received little recent attention in the social work literature. This article reports on an action research project conducted by a major labor union and a university department of social work to assist dislocated workers in New England. A partnership of union-trained peer counselors and social work faculty and students combined a research study with providing direct service to displaced workers, assisting in an organizing project, and developing a policy agenda to assist low-income workers. The author suggests that an action research model can be used by social workers in a wide variety of settings and under different practice auspices.

Humans↗

PubMed2006

Results of a union-based smoking cessation intervention for apprentice iron workers (United States).

OBJECTIVE: Blue-collar workers are more likely to smoke, smoke more heavily, and have less success in quitting compared to white-collar workers, and this occupational gap is growing over time. Effective smoking cessation interventions among blue-collar workers are needed to address growing class-based disparities. METHODS: We used a pre-post study design to test feasibility and effect size of a smoking cessation trial in a union apprenticeship training program for iron workers (n = 337). The 4-month intervention drew upon a health promotion-health protection model for smoking cessation among blue-collar workers. We conducted pairwise analyses to assess pre-post intervention differences in 7-day point prevalence smoking abstinence measured 1 month after intervention was completed. Additional secondary outcomes, including smoking frequency, intensity, intention and self-efficacy to quit, were also assessed. RESULTS: Baseline smoking prevalence was 41%. We observed a 19.4% post-intervention quit rate among baseline smokers. There were statistically significant positive changes pre- and post-intervention in intention to quit smoking, self-efficacy to quit, and a reduction in the number of days smoked. Participation in pro-active intervention components was associated with a three-fold (OR = 3.0, 1.15, 7.83) increase in the likelihood of quitting. Overall, participation in intervention components was low. CONCLUSIONS: Labor union apprenticeship programs represent a promising venue for smoking cessation interventions, particularly those that draw upon a health promotion-health protection model.

Adult↗

PubMed1980

A historical and socioeconomic analysis of occupational safety and health in India.

Workers in poor countries of the so-called Third World are more likely to be affected by the dangers of high technology than their counterparts in wealthier countries. Owing to their lack of education, most workers in the "developing" world are unaware of the hazards of their occupations. Moreover, their general backwardness in sanitation and nutrition and climatic proneness of their geographic region to epidemics cause diseases contracted from the work environment to be aggravated. occupational diseases are often misconstrued as diseases resulting from the general environment. Since unemployment in underdeveloped countries is of a very high order, workers are prepared to accept any job, irrespective of the dangers involved. Labor is cheap and easily replaceable, so employers see no need for improving occupational safety and health. Labor unions are mostly controlled by full-time politicians who consider health a political issue, especially when their party controls the country's government. The seriousness of all these factors is heightened by the existing socioeconomic order in poor countries, in which national medievalism and multinational modernism play a crucial role. In order to understand the prevailing socioeconomic order, one has to analyze the social structures of poor countries in the context of today's world economic structure. India is taken as an example of a "developing" country where all the above-mentioned factors and many others are in operation: backwardness of the worker; poor nutrition; lack of concern for public health; proneness to epidemics; and indifference on the part of employers, politicians, and unions toward occupational health; high unemployment, control of the local economy by multinational corporations; and control of the mass media by feudalistic vested interests. This article attempts to analyze the occupational health and safety issue in India from a historical perspective, and stresses the vital need of structural changes in various fields so that workers can have a safe and healthy working environment.

Accidents, Occupational↗

PubMed1986

Initiation of academic health administration education in Israel.

This article describes the historical and political context of the evolution of health care management in Israel, including the role of the Ministry of Health and various national advisory committees, and the influence exerted by labor unions attempting to control the management work force. Reasons for the lack of professional identification among health care managers and the problems faced by universities initiating programs in health administration are examined. The author goes on to describe efforts by Ben Gurion University and other institutions to implement management education programs for health administration and the effects these programs may have on the quality of health administration and its status as a profession in Israel.

Delivery of Health Care↗

PubMed2003

Prostate cancer risk in California farm workers.

Previous studies have evaluated prostate cancer in farm-working populations and most, although not all, have found an elevated risk of this cancer in farmers and farm workers. Specific occupational risk factors have not been identified. A nested case-control study of prostate cancer was conducted within a large cohort of a predominantly Hispanic labor union in California, the United Farm Workers of America. By conducting an electronic record linkage between a roster of the union members and the California Cancer Registry for the years 1988 through 1999, newly diagnosed cases of prostate cancer were identified within the union. Age-matched controls were randomly selected from the remainder of the cancer-free cohort. Risk for prostate cancer was examined by examining the type of crops and commodities cultivated by the farm workers as well as by the date of first union activity and duration of union affiliation. In addition, the risk of prostate cancer was evaluated in association with use of several pesticides recorded by the California Department of Pesticide Regulation. Between 1988 and 1999, 222 newly diagnosed prostate cancer cases were identified for analysis and 1110 age-matched controls were selected. The risk of prostate cancer was not associated with patterns of employment in any crop/commodity. Increasing duration of union affiliation was associated with decreasing prostate cancer risk. Although risk was not associated with total pounds of pesticides applied in the years and counties where farm workers were employed, risk was increased with specific chemicals, including simazine, lindane, and heptachlor, and suggestive increases were observed with dichlorvos and methyl bromide. We concluded that Hispanic farm workers with relatively high levels of exposure to organochlorine pesticides (lindane and hepatachlor), organophosphate pesticides (dichlorvos), fumigants (methyl bromide), or triazine herbicides (simazine) experienced elevated risk of prostate cancer compared to workers with lower levels of exposure.

Aged↗