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Hospital strikes have made headlines. Expect more walkouts in the future.


Healthcare workers will walk to get what they want, and it’s not just about money. Hospitals must focus on building good relationships with their workers.

Over the past year or so, hospitals and unions have clashed over contracts, leading to high-profile strikes.

More than 75,000 Kaiser Permanente workers went on strike in October before the health system and unions agreed on a new contract. (Photo: SEIU-UHW)

More than 75,000 Kaiser Permanente workers went on strike in October before the health system and unions agreed on a new contract. (Photo: SEIU-UHW)

More than 75,000 Kaiser Permanente workers went on strike last month before labor and management agreed to a new contract. Kaiser’s unions called it the largest healthcare worker strike in U.S. history.

Nurses walked off the job at hospitals in Oregon. Thousands of nurses in New York took to picket lines before securing new deals. About 15,000 Minnesota nurses took part in a three-day strike in September 2022, and they threatened a second walkout in December before labor and management agreed on a deal.

Jill Lashay, an attorney with Buchanan Ingersoll & Rooney, says that she expects to see more strikes involving hospitals and health systems.

“I think there's momentum there,” Lashay tells Chief Healthcare Executive®.

“It's proven to be somewhat successful for the unions. And so I think once the union hits upon a successful tool, they will continue using it, as long as it continues to be successful, and I think there have been some successes.”

Workers are pressing their unions to get management to meet their demands, particularly as many say they have been overworked due to short staffing.

Unions also see a favorable environment with a pro-labor Biden administration, Lashay notes.

Healthcare unions are buoyed by the success of labor in other industries, she says. Plus, healthcare unions have an attractive message, since they are taking care of people in need.

“It is really the perfect set of circumstances for the union to exercise its authority,” Lashay says.

Others have projected the possibility of more strikes, or at least more contentious contract battles. In its 2024 outlook for nonprofit hospitals, Moody’s Investors Service projects hospitals are likely to see improved revenue, but they point out the potential for more battles with labor.

“With union activity on the rise nationwide, contract negotiations could become more contentious, resulting in work stoppages and hefty wage increases,” the Moody’s report stated.

Concerns beyond compensation

Health systems and labor unions have struck deals providing substantial raises. Kaiser’s union workers received contracts providing 21% raise over the four years of the pact.

But union leaders have said their concerns go beyond compensation, and labor leaders have said reaching agreements on staffing concessions were critical in reaching deals.

Some unions have pushed for demands on staffing ratios and other measures to bring on more help. Some healthcare workers left their jobs during the COVID-19 pandemic, and some nurses in particular have moved away from bedside hospital roles.

“The unions have recognized they cannot ignore that issue, which is really prominent in everything that's going on in healthcare right now,” Lashay says. “So they're seeking to get involved, to try to figure out a solution with management.”

However, Lashay notes that many hospitals are struggling to fill positions.

“It's not as if hospital systems and long-term care facilities and home care are turning applicants away,” Lashay says. “They can't get them. So, it's very challenging for management to bind itself to ratios that they know they can't meet.”

Building rapport with unions

Hospitals and health systems need to work collaboratively with unions on contracts, and send the message that they have similar goals in trying to maintain a good organization and take care of workers, she says.

To that end, hospitals may want to open their books with labor and give them a look at their finances before engaging in collective bargaining, so unions understand that there isn’t “a bottomless pit of revenue available for increased wages,” Lashay says.

Hospital leaders should have discussions with unions, including those within the local members who will be running negotiations for workers, ahead of actual contract talks to discuss issues such as revenues and challenges in hiring.

“Well-run organizations that have good labor management relations, have these kinds of conversations consistently in labor management meetings, and they can kind of talk through what the challenges are before getting to that next round of collective bargaining when the contracts do expire,” Lashay says. “And so my recommendation is, if you don't have that kind of rapport, that you try to develop that.”

Getting deals done

Healthcare executives need to choose negotiators who can be strong but aren’t hostile with unions.

Negotiators with the wrong style or temperament “can create a rift between labor and management,” Lashay says.

When asked about the right qualities in leading labor negotiations, she stresses that leaders need to see contract talks as one part of what will be a continuing relationship.

“You need to have somebody who knows how to get to yes, and doesn't look at every issue as a hill to die on, someone who really has clarity and can recognize that there are certain issues that management has to stand on and cannot concede, and then others that can be resolved through some creative and collaborative work with the union,” Lashay says.

Hospital leaders need to recognize that they will have to bargain with unions and aren’t going to be able to run roughshod in negotiations.

“If you’ve got a C-suite that is well-educated and willing to be open minded about creative solutions, you can avoid problems,” she says.

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