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Labor-management partnerships have demonstrated their potential to support superior performance in healthcare, as in other settings, through the adoption of high performance work practices.235 Yet labor-management partnerships remain the exception in American labor relations and are hard to sustain.

There is universal agreement that along with expanding access, healthcare reform will have to address quality and cost problems. There is also a growing consensus that addressing these problems requires a coordinated, engaged workforce and labor-management relations that support coordination as well as engagement. To date, however, no proposal for healthcare reform has included a coherent workforce and labor-management relations strategy. Healthcare labor relations currently mirror the pattern found in the rest of the U.S. economy, with adversarial labor-management relations being the norm and efforts to build partnerships the exception. Data from a representative national sample of labor-management relationships show that less than 10 percent are engaged in comprehensive efforts to transform relationships at the workplace. However, those who follow this path report higher levels of innovation in bargaining and greater implementation of high performance work practices.236 In this chapter we will consider several prominent partnership efforts in healthcare and contrast them with the more adversarial norm.


One longstanding example of a labor-management partnership was initiated by Service Employees International Union (SEIU) Local 1199 and a multiemployer association, the New York League of Voluntary Hospitals and Nursing Homes. Those organizations created a formal partnership in 1997 called the Labor Management Project. The project formally covers over 125,000 SEIU members working in dozens of nonprofit hospitals and nursing homes that are members of the league. The Labor Management Project is a cooperative relationship aimed at improving patient care, helping workers retain their employment if hospitals close, protecting and increasing public funding for the healthcare system, and achieving union-building goals.

Labor-management partnership activities take a variety of forms within the project, depending on the interests and readiness of management and union leaders in each participating organization. In some organizations, the focus has been on improving labor relations through the use of tools such as interest-based problem-solving skills. Other organizations have gone much further by expanding opportunities for workers to improve the quality and safety of patient care, patient satisfaction scores, and the quality of jobs. In some cases, unions such as the Committee of Interns and Residents and the New York State Nurses Association have joined in partnership activities. The results so far have been largely positive. At five medical centers in New York City, partnerships have resulted in increased patient satisfaction, increased employee satisfaction, reduced grievance rates, and cost savings.237


Allina Health System in Minnesota and SEIU Local 115 recently signed a partnership agreement after a larger multiemployer and multiunion effort proved ...

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