(St. Louis, Missouri) July 12, 1999 Nurses from St. John's Mercy Hospital voted to unionize by joining the United Food and Commercial Workers Union. Out of over twelve hundred who voted, 697 voted to unionize while 585 voted against it. The victory was cheered by many healthcare workers in the St. Louis area as it sent a shock wave of tremors across hospital administration systems. Official press response from the hospital said that the vote did not go as they expected.

St. John's Mercy Hospital nurses will be the first group of nurses to unionize in Missouri while nurses and other healthcare workers from other hospitals have now stepped up their movements to join unions. Efforts to unionize nurses and other healthcare workers have been in motion for years as many suffered setbacks due to various reasons. This victory may open up the flood gate of unionization of hospital workers across Missouri and the nation!

Reasons: The seemingly victory for nurses is a disaster for the hospital administration which did not want a third party to negotiate for their employees. Hospital administration understands the system will lose a lot of money to the union in the end! However, the move to unionize by the nurses was in part forced by the hospital administration and the difficult work conditions. Many nurses in various St. Louis hospitals have reported difficult and dangerous working conditions  for them and other healthcare workers. For the most part, the refusal of the hospital administration to listen to employee complaints let alone do something about them might have been the greatest motivator for nurses and other health care workers to seek union representation. "The situation has gotten so bad that many nurses are leaving for other professions and inexperience nurses  are hired to do more dangerous nursing while taking care of patients," said Betty a former nurse. Betty went to work for an insurance company after she was forced to leave the hospital due to what she termed dangerous and unbearable working conditions.

Another factor that could have created great anger among healthcare workers was the lie that was put out as information at a conference of St. Louis  hospitals. About five years ago at a St. Louis healthcare conference, it was announced that hospitals around St. Louis should expect a thirty percent decrease in patient admission creating a lot of surplus beds. Many hospitals accepted this falsehood as truth and consequently utilized the lie as an excuse to start downsizing healthcare workers. Many healthcare workers were over-squeezed and over burden with work as big shots had time to relax, party and received big salary bonuses. Many of the good hospital workers left St. Louis, others went to other professions. Later it was discovered that during the period covering the prediction, patient admissions actually went up and the nursing department including other areas of hospital staffing could not deal with the volume of work. As a result, some hospitals had to utilize non-professionals to do professional work. By 1998 hospitals were declaring staff shortage of healthcare professionals in the St. Louis area.

The latest national report about work place violence indicated that one quarter of all employees are chronically angry because of the stupid decisions made by managers, tension due to heavy work load and anger created by unproductive co-workers.  This is the more reason why corporations should implement employee based solution strategies for work problems.  Based on human nature, the more tension created on the job, the more work place violence is expected. The problem is, many of the business managers or CEOs just don't get it! Because of this, hospitals' management problems may continue and more disasters may be expected.

Problem Created By Nurses: Although the hospital administrations need to be blamed for the current management crisis in hospital care, nurses too have created a lot of problems within the hospital systems. Take the case of the laboratory  versus the nursing department - - -  whatever happens is always the fault of the lab from the nurse's point of view. This misconception has been sold many times to hospital administration that everybody now believes that it is the lab's fault each time patient results are not received on time. But, the same nursing unit refuses to see where nurses played cardinal roles in delaying lab results by ordering test late, sending bad specimens to the lab for analysis and their refusal to allow the lab to re-train their employees.

In one St. Louis hospital, the lab wanted to help retrain the nurses and the unit secretaries on how to order lab tests  and collect specimens correctly. The lab also wanted to  update the nurses about many changes regarding its operation. The nursing division because of arrogance was not receptive to such ideas and consequently, major problems were not solved and the stress level continued to go up. Nurses need to know that they are partly to be blamed for the increase in stress generated due to their lack of co-operation with other hospital departments responsible for patient care.

Setbacks for Hospitals and Nurses: Few people will disagree that nurses and other health care workers need  representation by a third party to negotiate for them since the hospital was not listening. But, they need to consider the cost. Everybody has to pay the union due of at least $50 a pay period and most nurses do not want a pay cut. The union will negotiate for salary increase and better work conditions for employees. Salary may not be a big issue with employees when they seek union representation, the subsequent contract will include a salary increase so the employees will be able to pay the union dues without a pay cut due to unionization. If this doesn't happen now, it will happen later. On the long run, the money for union representation will inadvertently come from the pocket of various hospitals. There is a minimum estimation that for every 1000 employees the union may cost the hospital approximately one million dollars a year after the contract is signed. The sad part is, some hospitals may not survive if many of their employees join the union.

If St. Louis hospitals have listened to me over the years based on my published articles and book, this situation could have been averted. By the time the hospitals make good on the contract demand and salary increase an average hospital may lose close to two million dollars in a year. When I wrote the book, Overcoming the Invisible Crime, I was trying hard to educate hospital administrators about the serious crisis in hospital management hoping the book will be a wakeup call. In the book, I changed the names of all the hospitals because I did not want to expose any institution -- I just wanted to expose problems.

I wrote many articles some of which were circulated by the pro-union movement around St. Louis hospitals. Despite all these, the hospital administration would not listen let alone look at the problems outlined. Later, I went on local radio stations including KMOX and did over 30 radio shows and some television shows across the nation warning healthcare systems about the disaster to come regarding crisis in healthcare management, only very few hospitals made changes. Evidently, the aggressive need to make money over-powered good value judgement. Now, the hospitals have to pay a painful price and some may plunge into financial crisis after the penetration of unions.  However, there is hope only if the hospitals are willing to implement needed changes --- some of them are outlined in this article. Although the issues raised here may not apply to all hospitals, but every hospital administrator can learn something from this article.

Saving Hospitals From Financial Disaster: Hospitals must immediately implement strategies and work hard to re-seduce their employees before they are completely lost to a third party negotiator. If the hospitals had listen to employees, many of the systemic problems could have been solved through "employee to employee" problem solving and resolution strategies. I have suggested solutions in the past articles and publications and those hospitals which have implemented such strategies have improved employee's versus administration's relationship. The following solutions based on problems experienced in various hospitals will help hospital administration improve relationship with employees and in dealing with the core of the problems oblivious to the management. However, the stubbornness of some administrators will open wide the gate for the third part negotiation, and some hospitals may not survive the financial loss!

Both hospital administrators, managers and supervisors should evaluate the following guidelines for not only improving employee and management relationship, but also to improve patient care. This is the time to stop fighting and come to the bargaining table. One thing is important to everybody no matter what side, we do not want our hospital to spin into financial crisis. Many hospitals are just learning to climb into the black after operating at a loss for many years. Hospital administrations must understand that too much of one thing without a balance can create a disaster.

1. Dismantle the Authoritarian Management System and Replace it with a Democratic Manager. An authoritarian manager may belong to the military or still work better in some businesses but it has failed badly in the healthcare system due to different specializations and specifications needed for better patent care. An authoritarian manager does not listen to anybody or cares about what anybody says other than his own boss. He gives orders to be carried out and dishes out punishment for non-compliance. He looks down on employees and refuses to talk to workers except some selected few. An authoritarian manager is a reign of terror!

On the other hand, a democratic leader uses group based knowledge, asks questions, seeks opinions and implement strategies for solutions based on the result of the feedback from employees. In this way the employees become part of the system and do not feel threatened by the overwhelming power of the authoritarian manager.

The authoritarian manager is not only detached from workers, he is also insensitive to people's problems.  Such managers do not believe in the utilization of employees to solve problems. The authoritarian manager was dead wrong in healthcare when decisions supposed to be made by healthcare professionals were being made by non-professionals. This created many dangerous situations for patient care and put the lives of employees at risk. In a computer based hospital operation where many people are computer savvy, it takes few disgruntled workers to dismantle the entire system. Although angry employees can not be averted, but this is the more reason to remove the hostility of an authoritarian manager and be replaced with a friendly democratic one. Violence in the work place causing many work place deaths from angry workers has been associated with the authoritarian style of management.

2.Hospital Administration must Come to the Bargaining Table: A few years ago, I evaluated the trend of healthcare management in many hospitals in St. Louis.  I raised the red flag and wrote many articles about "Hospital management in serious crisis." Few managers listened but many refused and did nothing. I predicted the present crisis in hospital management since 1993 in my book, "Overcoming the Invisible Crime," 352 pages. It was the book which launched Lara Publications company and has since become three large websites operation in addition to producing OUTCRY Magazine. In the book, I discussed serious management problems within many hospitals in St. Louis. I predicted the beginning of the hospital's glorious days and the end in about ten years. I also predicted the Managed Care crisis and sadly declared that many institutions will lose a lot of money once the power to negotiate is taken away from them. We are now entering the final phase of the hospital's management in serious crisis. In the next ten years, as a result of many changes yet to hit healthcare industry, some hospitals may close their doors. This situation could have been averted and some can still be avoided if many guidelines outlined in this article were considered, evaluated and implemented to the levels that were feasible within various hospital departments.

In some of the articles I wrote years ago, I pleaded with hospital management to avoid a disaster by bringing doctors, nurses, lab workers, X-ray techs and other healthcare workers to the discussion table. Doctors will discus what they need at the forum, other departments will discuss what they are able to provide, hospital management will discuss expectations and compromise will be initiated if needed. In this way, everybody will be a part of the implemented strategies to improve healthcare and save the hospital from financial crisis. If many hospitals have implemented these programs by voluntarily coming to the table with healthcare workers, unions will not have the opportunity to force administrations to the bargaining table. However, it is not too late for any hospital, even for those who voted for the union. Hospitals which involve the employees in problem solving intervention by a democratic manager always win the support of the healthcare workers. Even in a situation where a group has unionize, such a group will learn to negotiate with a conscience and not push the hospital into financial crisis.

The bargaining table created by the union will only address particular issues especially increases in salary. But, the bargaining table created by hospital administration will be designed to solve the problems of all areas of the hospital leaving no department behind. For example, doctors will know the cost of ordering many unnecessary STATs at odd hours of the day. Hospital administration will tell the employees how much money is available for a particular project without going bankrupt. Laboratory will discuss their services to the hospital, their limitations and how the nurses can make such work easier with their cooperation. The success of such meetings however is dependent on each group of professionals leaving their egos behind before coming to the meeting.

In some hospitals, the laboratory versus nursing council was implemented to air problems and design resolutions. If this forum is conducted very well, it can be a useful tool to resolve many problems between two departments that are always at odds with each other. All these could have been done without the involvement of a third party, only if the hospital had listened years ago.

3. Non-Professionals Should NEVER be Hired to Preside over or Manage Clinical Departments: The ulterior motive in hiring a non-professional in a particular area is to preclude such manager from listening to professionals in the department. The management wants the departmental heads to listen only to administration's dictation usually by a business manager with no experience   working in those clinical areas. Hire a nurse who has worked on the bedside for years to manage the nurses, not a business manager. One time a hospital put a nurse in charge of the technical supervision of a lab, the result was a disaster!

It is of paramount importance that a person who is heading a department must not only have solid educational background in such area, but must also have years of experience in the same clinical area and be emotionally balanced. As the hospitals go into negotiating phase with employees, an uninformed manager will be unable to represent his or her department at the bargaining table.

Nobody should make a decision over a clinical department except if that person currently works in that area. Each hospital within the network should re-evaluate the directives handed down to them and see if such rule can apply to its hospital. Hospitals are very different and serve different clientele, what works in one hospital may not work in the other even if they are within the same net-work. For example, every major laboratory machine needs a backup just in case the major machine breaks down. Once one of them breaks down, the second is ready and is put to use without question! This was the standard years ago for a rapid response lab dealing with trauma patients. In one of the networks, one uninformed manager removed the access of  the laboratory to a working backup machine and when the main machine broke down, laboratory was unable to turn out tests for hours. In many reputable hospitals running a rapid response laboratory, this is very unacceptable and can be dangerous for the hospital due to lawsuit!

4. Hospitals Must Create a Balance: Hospital management must help to create a balance between their expectations and the needs of the workers. What was lost in the past years between the hospital and the workers is a balance. Hospital wants to run a cost effective business and workers want good working conditions. Hospitals had their ways over the years, they reduced staffing to a point of disaster, cut doctors' salaries and created a group of very dissatisfied healthcare workers. Many destructive decisions were made by departmental heads leading to the present management crisis in hospitals.

Ignoring the needs of the workers may be dangerous to the survival of some hospitals. I believe hospital workers are reasonable people who will understand limitations. It is now up to the administration to educate their workers about the financial status of their system. Open up the books! Let the employees see the annual financial report before they start asking for a $10 per hour raise! Years ago, many hospitals were able to do whatever they wanted because the employees had no power. Now, the time just ran out for such institutions -- the union is knocking at the door!

Hospital administration should urgently evaluate why employees are dissatisfied and immediately implement employee based solution strategies making sure employees are part of the problem solving system. The major reason  why workers are outraged contrary to some opinions is not money, but  conditions of service. Bad working conditions are the major factors why these workers are seeking a third party to negotiate with the hospital administration. What many hospitals may not realize is that, they are at a better position to influence the opinions of their workers than any external force.

5. Hospitals Must Hire Consultants to Evaluate their Present System of Operations: Hospitals must evaluate systems in their institutions to determine how they are effective in meeting the needs of the entire network. Although hospitals have utilized this strategy in the past, the sad part was, they always utilize people that are not informed to administer over specialized clinical departments. There are many qualified healthcare workers with years of experience that can be used as consultants in different areas of the hospital. These workers are more adept in understanding the problems of the hospitals than somebody brought from out of  the state. Just because a particular business strategy works in a particular business does not mean it will work in the healthcare system.

Subsequently to the external consultant's evaluation and recommendations the hospital will now put together the responses from employees as the integral part of problem solving within the institution.

6. Interdepartmental Problem Solving Committee Should Be Set Up Between Some Departments: Fixing many systemic problems within the hospital can make work better for employees. Resolving most of these problems does not need extra expenditure on the part of the hospital as much as it needs a platform to put solutions to work. Anybody who has worked in a hospital knows that a working committee between the lab and the nursing department is badly needed to update, inform, evaluate and resolve problems from time to time. The hospital laboratory and nursing work although differently but are inter-related and sometimes dependent on each other. If the lab does not set the blood, the nurses can not transfuse the patient. If the nurses do not know what is involved in getting blood ready for patient transfusion, the laboratory may be subjected to unnecessary aggravation.

Both the nurses and lab techs have inter-related roles to play in patient care. The lab will sometimes complain that nurses send bad or inadequate samples or failed to order proper tests in the computer while the nursing department is complaining about the slowness in laboratory turnaround time. If both departments work together by setting up an inter-departmental forum, they can both affect better patient care and reduce aggravation. This is also true for other departments like X-ray and the nursing department, pharmacy and the nursing department depending on the areas of problem.

7. Evaluate the Effectiveness of the Computer System from Employees' Feedback: Hospitals have come a long way from the time things were done on written papers to this point where almost everything is done on computer. Hospital administration needs to measure the effectiveness of the system in place from employees' feedback. From experience, an uninformed person might have made a decision about the type of computer to be used and ended up picking the wrong type which may not be user friendly for a particular hospital operation. Other times, a person could have received money under the table from a company which installed the hospital computer system. Everybody in the hospital ended up paying for such error due to the agony created by some computer problems within the system. If a particular computer system is creating problems, dismantle the system and replace it with a more effective hospital computer information system.

8. Hospital Administration Should Stop the Corporate Assassination of Technical Managers: One of the cardinal crime committed within the corporation is the corporate assassination of the middle or technical managers. The administrator in charge of a department gives an order to be carried out. The head of a department tells the supervisors or technical managers to carry out the orders and instruct them to present the information to workers as their (technical managers) own ideas. When trouble starts, the technical managers or supervisors accept the blame and in some situation are fired for carrying out orders as instructed by the administration. This type of corporate irresponsible behavior is called "passing the buck" and innocent managers have been punished severely for the errors committed by the administration.

If an administrator is big enough to dish out orders, such administrator should be big enough to accept the blame. In this respect, minorities have been punished more severely since they become a target everybody loves to hate! Later, the administrator or the departmental head will call a meeting to tell the workers that they have gotten rid of the problem by terminating the job of the supervisor! But the truth is, the technical manager pays for the price of the administrator's errors, and in some situation he can be pursued to his next  job. This type of behavior by the administrative system may motivate the appearance of the gun man in the work place. Many times I have wondered how some "big shots" can go home after damaging an innocent person and still able to sleep comfortable at night! I can't! My conscience will not allow me! As a manager, I did not fit well into this type of abusive administration ---  I was considered a rebel.

9. Administrations Should not Penalize Employees Raising or Solving Problems: Departmental heads sometimes frown on a technical manager who is trying to solve problems using other ways different from the conventional. As a result, the technical manager or supervisor may be punished. Take a case which happened to me few years ago in a St. Louis hospital. It was my policy to prevent supervisors or employees from getting into a shouting match with each other. Our female head of the department who at that time had emotional problems with men said it was fine for women to yell and scream as they wanted! Later, this became the rule in the laboratory and I forbid such behavior on my shift.  When people came yelling at me, if I could not calm them down, I just ignored them and walked out of my office -- this infuriated the head of our   laboratory department.

Few months after I left the hospital, two employees in the lab got into a verbal confrontation which degenerated to the exchange of blows. One of them ended up in jail and the other ended up in surgery with numerous facial fractures, both of them were later terminated. Prior to the time I left the hospital, I warned the pathologists, but they were over powered by the administration. Therefore, the head of the lab was able to do what ever she pleased which later led to the laboratory disaster. After the incident, the same hospital kept the head of the laboratory for many more years!

10. Physicians Need to Work with Hospitals: One of the ways hospitals lose a lot of money is through the ways some doctors practice medicine causing the institution to lose a lot of revenue. STATS have been abused so much in the hospitals representing another major avenue for hospitals to lose money since most hospitals do not charge extra for STATS. Physicians should know about the limitation of each hospitals and not order crazy and unfamiliar tests at odd hours of the day when the hospital has reduced staffing. The greatest annoyance is the three to ten calls a day by the nurse or the unit secretary asking lab techs to figure out what the doctor wrote in his order. The amount of time spent on the telephone and research to figure out physicians' bad handwriting cost the hospital a lot of money per year!

Some people are justifying the cut in physicians' salary since their way of practicing medicine in some situations is draining the healthcare resources. I will rather prefer to bring the physicians to the bargaining table so they can be educated about the problems they have also incurred.

11. Let us Start the Healing Process: Many professionals have been hurt by the crisis is hospital management over the years. The hospitals should be willing to call the professionals who have left to come back. This is the time for the institution to show loyalty to employees in order to raise the employees' awareness and loyalty to the hospital.

It is a time for forgiveness and not a time for professional assassination or corporate decapitation of an employee. When the institution has to take an action against any employee, somebody else should evaluate such decision. In the past, decisions have been made due to perhaps emotions, personal vendetta and in some situation out of hate and prejudice. Although a person loses his or her job, the institution ends up losing a good worker and in some situations cost the hospital a lot of money. Always give the employees options and ways out instead of backing them to a corner in preparation for a corporate decapitation (job termination). 

12. Limit the Work Load of Technical Staff to Improve Quality: Hospital administration should stop running a hospital as an assembly line. It may work for Chrysler Motors but it may eventually destroy the hospital when one person is supposed to do the work of five people. Excessive downsizing has done great disservice to the quality of service in many businesses today leading to long hours of waiting. This is part of the major complaint of nurses, lab techs, pharmacists, X-ray techs etc. Normally, people are proned to make mistakes no matter how perfect the person, but the more pressure to do more work with less staffing increases the chances of errors.

If the margin of errors is very high in a hospital, it opens such a hospital to a big lawsuit on the long run. Hospital workers need opportunity to double check results before sending them out. Even physicians can attest to the fact that hospital laboratories with less staffing tend to send out more erroneous results than the ones that are fully staffed.

It is now up to the administration to determine once again based on feedback from employees how much work load is expected of a nurse or a tech to maintain quality patient care. Do not compare one hospital to another because each has different factors affecting similar situations. Rely on the survey of information from each group of employees in a particular hospital to make decisions. More errors reported by a hospital diminishes the quality of service. Nothing gives a hospital bad publicity and lowers censure than the report of patient's hurt accidentally or dead due to negligence.

13. Bring God Back into Hospitals: The original intention of the hospital was to be a mission of mercy according to the discipleship of Christ. In the past ten years, the mission of mercy has turned to a business for the greedy! It is time we brought back the mission of Christ into hospitals -- it should be a place of healing, not a place to hurt people.

This reminds me of the entry of Jesus into Jerusalem when he entered into the church and saw the "Wall Street" of those days running inside the church. Jesus got mad and chased them out saying, "My father's house is the house of prayers, but ye have turned it into the den of thieves."

I am beginning to experience something very profound about life and finality of man's journey on earth. I am realizing that, it is not the money that you acquired, or the fame that you attained nor the power you seized, but how many hearts you are able to touch with your kindness. Many people who worship money fame and power so much later realize that all these things do not make people happy without spiritual serenity. This is the reason why many people today are reaching out for spirituality. Inside the hospital is the best place to show people during their trying time when they are sick that God is alive! Today, God remains in some hospitals as only a symbol and in others, God has totally vanished.

Remember the words of Christ, "When I was in prison did you come to see me? When I was hungry did you feed me? When I was naked did you cover me up? When I was in sick did you come to visit me?   ..... As long as ye do this to the least of these, ye have done it unto me" ---   Matthew 25: 35 - 36.

I can not write all these issues in this article and I will leave the rest for the hospital seminars. It is important that the employees understand the financial limitation of the hospitals as much as the hospitals need to know the importance of creating a comfortable environment for work. Everybody must come to the bargaining table! If  any hospital administrator still remains stubborn and not want to affect changes, then the door is wide open for the third party negotiation which may cost the institution a lot of money.

The hospital's original intention was to be a mission of mercy to care for the sick, the homeless and to serve as a place for healing, not a place to create more diseases. Today, some hospitals have turned from a mission of mercy to a business for the greedy. May God have mercy on us!

For management seminars, or consultation on how the managers or supervisors should  re-seduce the employees before they are influenced by external factors, please call Lara Publications for Seminar Presentation at 314-653-0467, Fax: 314-653-6543. A copy of the book, Overcoming the Invisible Crime ($19.99) which describes the crisis in hospital management from the autobiography of a former hospital manager may be purchased from www.amazon.com or call the above number and order may be faxed. The quickest way is to order from Lara Publications

Written by 'Yinka Vidal,  author of Overcoming the Invisible Crime, Managing Editor, OUTCRY Magazine.