Long-term care is a labor-intensive industry. The National Nursing Home Survey (DHHS 1977) noted that 59.7% of a facility's operating costs are labor costs. Of that total, 32.6% represents nursing payroll. Labor is by far the largest cost in operating long-term care facilities.
Long-term health care administrators face a crucial challenge in creating a work environment where employees recognize that their individual interests and those of their employer are the same and can best be achieved through mutual cooperation. No combination of management styles, philosophies, or progressive labor relations programs will be effective if employees lack this perception. If employees believe their interests differ from those of their employer, they may turn to a third party to fulfill their needs.
Employers have sound business reasons for embarking upon a planned union-free strategy. A union-free strategy means a well-planned, positive approach to the employer-employee relationship. Union-free should not be considered a negative term or an antiunion approach. It is far more than simply not having a union. It means taking the initiative in implementing an active pro-employee program. It means acting, rather than reacting to employee dissatisfaction. It means establishing a positive approach toward labor relations. This approach fosters employee support through fair policies that encourage mutual employer-employee cooperation and establishes management's credibility through effective communication. It stresses shared goals, joint problem solving, positive leadership and direction, participative management, and a perception of mutual respect. These positive values advance the interests of both the health care employer and the employee. Employees who do not want union representation are the by-product of this approach.
Health care administrators have often not adopted a pro-active strategy, but merely waited until they faced full-blown union organizing efforts and then mounted an acrimonious, defensive campaign in response. Such an approach is purely negative and focuses solely on the "dangers" of unionism. In some cases, this type of campaign may be sufficient to keep a facility nonunion, but in others it will be too little, too late. If the facility merely reacts to union organizing efforts and does not implement a pro-active strategy, the core problems and perceptions that allowed the union inroads in the first place will remain, even if the facility wins the first round. Engaging in union prevention through a defensive posture constitutes too narrow a perspective. This lactic just delays but does not solve the problem. Union organizing efforts will surely be repealed, and the facility will again experience the turmoil of an organizing campaign. An integrated union-free strategy is a far more preferable and lasting approach. Positive, pro-employee measures result in a cohesive work force that has no need for or interest in a union.
Pro-employee labor relations programs also reduce the likelihood that employees will initiate employment-related litigation because they understand the work philosophy of the facility and know where they stand in relation to the work rules, supervision, and disciplinary system. Additionally, should an employee initiate litigation, a facility that has a pro-employee program greatly enhances its chances of successfully defending against a lawsuit or administrative action because it has implemented mechanisms for identifying troubled employees and has instituted fair disciplinary systems that thoroughly document all actions taken against employees.
Health care administrators can lay the cornerstone of this pro-active approach to the employee relations environment by the following strategy.
Facility Work Philosophy -- Communicate a statement of the health care facility work philosophy, emphasizing organizational goals, objectives, and a commitment to positive employee relations. This sets the tone and direction for positive changes. For example, if a facility's primary commitment is to create a family environment while providing high-quality patient care in an extremely competitive industry, this commitment needs to be clearly stated in the facility's employee work philosophy.
Employee Opinion Survey -- Conduct a confidential employee opinion survey to ascertain employee attitudes toward job duties working conditions, the skills of supervisors and managers, communications, pay, benefits, opportunities for advancement, personnel policies and procedures, and job security. The survey serves a dual purpose. First, it provides employees with a direct and anonymous channel of communication to top management. They know that they can communicate frankly with management without fear of reprisal. Second, it furnishes management with an accurate, continuing profile of employee attitudes on which to base policy decisions. For example, items dealing with communications might include "my supervisor asks for my opinion," or "management keeps us well informed about matters that affect us." Employees would then decide the degree to which they agree or disagree with the statement. Items asking for employees' written opinion or comments might include "the thing 1 like most about working here is ... " or "some things our management should know are..." Feedback sessions regarding the results are necessary and encourage direct and positive dialogue with employees on critical issues. Once management has gained insight into issues that employees consider important, it can then respond and thus demonstrate that it is truly listening.
Employee Profile -- Develop a profile of the type of worker the facility should actively seek for employment. An employee profile greatly increases the likelihood that a facility will hire applicants who will be useful, efficient workers and reduces the chances of hiring persons who will be disaffected and troublesome. The development of an employee profile begins with a thorough analysis of the employer's current work force. The work force analysis must determine the precise skills required at the facility and examine the attitudes employees must possess to foster a positive work environment. In addition, it will be necessary to analyze the labor market to measure the availability of desirable employees.
Once the profile has been developed, management will be in a position to prepare an employee selection system. The selection system will ensure that the facility hires only applicants who have the right combination skills and attitudes for the particular work, environment. As part of the selection system, management should develop questions and model answers to help employment interviewers determine whether an applicant possesses the desired profile characteristics.
Because they require supervisors to respond to a series of questions about employees, audits compel supervisors lo become more aware of the employees who they supervise and to take an interest in them. Additionally, audits ask supervisors to give what they believe is the employees' view of working conditions in the facility. It is important to remember that supervisors themselves are sometimes only recently removed from being hourly employees and are likely to have a good perspective on the hourly work force. Personnel audits serve as a barometer for determining how well the employees are adapting to the pro-employee method of operation. The audit might include the following questions:
Involvement Systems -- Institute systems that encourage employee involvement in the decision-making process. Employees will understand and are more likely to support decisions in which they play a role. Employees who see themselves as a genuine part of the health care facility, rather than just cogs in a wheel, will be more productive, efficient, caring, and loyal. Informal involvement systems might include meetings with small groups of workers to listen to employees' needs and perceptions. Formal involvement systems include the use of such techniques as quality circles or employee membership on committees dealing with work rules, safety, discipline, and so forth. The important point is that management must listen to what is on the minds of employees and let employees know that management cares about them and their jobs.
Long-term health care administrators face a crucial employee challenge. That challenge is to create a work environment in which employees and employers recognize that their interests are the same and that their goals can best be achieved through mutual cooperation. By implementing an integrated union-free strategy, the prudent health care employer can meet that challenge.