Are Unions Killing Healthcare? Should We Fire Them or Add More?

MP900341718Unions helped improve working conditions in the mid-19th century industrial revolution.  But what have they done for PATIENTS lately?

Unions did great things for manufacturing, but have they done ANYTHING to improve service?

In a publicly funded healthcare system, does it make ANY sense to have unions?  Don’t government jobs already have good salaries and benefits?

Have unions improved anything for patients?

Have they increased efficiency?

Customer service?

Quality?

Innovation?

Choice?

Do unions improve anything other than salaries and benefits for their MEMBERS?  Are unions all about protecting seniority instead of promoting skill?  Are all unions the same, or do some care about something other than themselves?

Jeffrey Simpson writes in ‘Chronic Condition‘, that governments can’t “…break union rules that make surgeries happen to fit the convenience of providers instead of patients…” (p. 41).

In a world of evidence-based decision making, is there any proof that unions add value for patients? 

Unions drive up wages and create MANY extra layers of bureaucracy in hospitals just to manage union issues.  A platoon of nurse leadership and human resources staff spend hours managing unions.  Not employees . . . unions.  Would the public support the extra costs of dealing with unions? 

Increased wages, increased hospital costs, patient access decreased…

We need reform based on patient need.

We need to measure outcomes and hold unions accountable.  We need to look at the total cost of unions to healthcare and have them find efficiencies.  We need to examine the impact unions have on patient mortality and morbidity due to unions refusing care unless wages go up or work effort goes down.

Unions exist for themselves.  Unions do not exist for patients.  This has to change.

Should we empower hospitals to get rid of unions or expand them?  Do you have evidence showing that unions benefit patient access to care, quality, and customer service?  Please leave a comment by clicking Leave a Reply or # of Replies below.  Thank you!

Patient Flow into Buckets or Patient Flow into a Funnel?

bucketsNurses and doctors think patients belong in buckets.

Not literal buckets; buckets of care: primary care bucket, emergency medicine bucket, inpatient bucket…

How do we know providers believe in a bucket concept of care?

They tell patients they’re in the wrong bucket!

They tell patients to get out of the bucket!

They tell patients to go to a different bucket next time they need care.

Hilton hotels suggests staff should be empowered to handle ANY issue that arises for guests during their stay.

What happens in healthcare?

Sorry, ma’am.  You’ll have to go somewhere else for that.

Sorry, sir.  I don’t have time to discuss that with you.  The ED isn’t the place for that kind of problem.

Subtitle:  And don’t come back next time!

Funnel of Care

Patients should seek care where THEY choose.  How they choose and how we can help them make a great choice will be discussed in another post.  For now, once patients present with a concern – no matter where they present – we should be prepared to help to whatever extent we can.  Sending them away with a dismissive, “This isn’t an emergency” is unacceptable.

The funnel starts where patients choose to access care.  The funnel continues to more and more specialized care until patients get what they need.

With bucket-thinking, we expect patients to make their own clinical judgment.  Then, we berate them for poor clinical judgment:

“Why didn’t you go see the family-doc/walk-in-clinic/anywhere-else?”

But without clear, available access, patients are forced to attend the ED.  EDs refer patients to their family docs for follow-up far more than family doctors refer to the ED.  Referral patterns have reversed.  We could make the ED a referral only facility like an ICU – no entry without a referral letter.  Family Docs and clinics would need advanced access, longer office hours, basic resuscitation equipment…

System issues force patients to seek care wherever they can get it.  It’s our job to help them when they get there; not send them away.

What do you think?  Would you want your family to be sent away from the ED?  Is that safe?  Is it good customer service?  Click Leave a Reply or # of Replies below.