People help patients. Organizations, governments, unions and associations may or may not help patients.
Nick Nanos, Canadian public opinion pollster, lectured that the public holds very high opinions of healthcare workers as individual providers – as nurses, therapists, physicians, etc. – but not so high opinions as members of a particular union, association, organization or party.
I published a post yesterday about how unions do not help patients; people help patients. Regrettably, union members missed the point and read it as being anti-provider, as though union = provider. I took it down.
We need to debate whether the labour movement helps patients. Columnist Jeffery Simpson in his book Chronic Condition takes aim at nurse and physician organizations:
“Nor can they [hospitals] break union rules that make surgeries happen to fit the convenience of providers instead of patients…A system that boasts brilliant surgeons…accomplished staff, wonderfully furnished facilities but uses them only a fraction of the available time in the face of unmet demand is a system straitjacketed by ideology.” p. 41
“The health-care system, being largely public, suffers from something called Baumol’s cost disease, named after the economist who demonstrated that wage growth eclipses productivity improvement in the public sector.” p. 214
We need to ask and learn how to debate:
- Do powerful nurse unions and physician organizations help patients?
- Should healthcare providers ever go on strike?
- How much do union generated activities (grievances, etc.) cost?
- Do raises delivered by arbitration cause lay-offs and decreased access to care?
- Do unions and organizations foster the right attitudes for patient care, or the opposite?
- Are leaders in public organizations free to implement change or are they ‘straitjacketed by ideology‘?
We need to have adult conversations about what prevents patients from getting the care they need. We need to learn how to separate ideas from our personal identities. We need people who can discuss big ideas without attaching themselves or their local workplace to the discussion. If we continue to let personal outrage control Medicare, we will never innovate.
Medicare desperately needs innovation on the big ideas and people courageous enough to engage them. It would be helpful coming from people working on the inside. How about you?
Please leave a comment! I cannot post comments from deleted posts (gone with the post!) as some have requested. I love to hear from folks who see things differently. Looking forward to reading your comment!
(photocredit: thewinanews.com)
Shawn, I wanted to commend you on all of your interesting, thought provoking posts.
Yes, your post yesterday may have provoked some strong reactions but it is exactly what is needed now to bring about real change in our system.
Your current post, while less direct, does address the same basic concepts.
One of your readers was upset that you were attacking unions, I would put it to you that the Ontario Medical Association, as a physician organization, behaves really very much in the same way. Even more so since they have brought in the Rand formula for Association dues. I would be interested in hearing your own views on this as a District Director of the OMA.
It is perhaps wishing for too much to think that the political, medical and other organizational leaders might actually collaborate to bring about real change in putting patient care first and foremost.
I will continue to read with interest your future posts.
Ken Lai
Thanks so much for taking the time to read and comment, Ken! I really appreciate the encouragement.
I agree; if the OMA looks and acts exactly like a union, we should call it. Having said that, the OMA only spends 30% of its annual budget on negotiations in a negotiation year. It spends far more on member services, patient advocacy, health promotion, health policy, leadership development, student support, practice management, legal advice, physician health, workplace support, and so much more.
Some long-time members wish the OMA acted more like a union. I do not believe patients or the healthcare system would benefit if that happened.
As for Rand, personally, I believe we should offer such great value to members that Rand isn’t needed. Having disgruntled members forced to pay dues works against us overall, I believe. Last time council debated it, they supported Rand. As such, I support the wisdom of council. Perhaps, it’s time to debate it again?
It’s really great to have you read and comment! I hope you are well.
Best Regards,
Shawn
PS Sure was great to hear from you again! Seems like just yesterday when we worked together, but it’s been years. Hope to see you again soon…
You should not be bullied to takedown posts. We live in a country that values freedom of speech and opinion. I did not read your post like that at all and I disagree with your decision to take it down.
Thank you, Scott. I struggled with the decision. A group of people decided to whip things up as though it were an attack on one provider group. The post was about whether or not the labour movement improved things for patients.
I asked whether unions promoted the open, compassionate, flexible, patient-before-self attitude needed in healthcare, or a disdainful, scoffing, circumspect attitude? I suggested the latter.
In the end, the message got lost in emotion and personal outrage so I took it down. I didn’t want it used as fodder to justify a distorted description of reality.
Was the message off-base, over-the-top or uncivil? Or did it strike too close to the mark? This current post garnered 1/4 the number of views… At least people are reading!
Thanks again for reading and commenting and disagreeing with me….I love it!
Best
Shawn
I think we all feel we are giving good care with the patient at hand, and generally are. As you keep stressing however, the unseen patient wannabe is getting no care. Labour organizations, whether professional or “blue collar”, are necessarily focused on their members and maintenance of the organization rather than on the product. Membership in these organizations is typically a requisite of the position and is not a criticism of the worker. Doing union business on company time however is a conflict of interest, and should be grounds for dismissal.
Thanks so much for commenting. I’m happy you highlighted that the organization is different from the worker.
Union business on company time is rampant. In fact, many hospitals now just pay union reps to do union business on the hospital’s dime!
Sure appreciate you taking time to read and comment. Thanks!
Shawn