Employee Voice in Healthcare

This article is a guest post written by David Cook as part of the 2022 Labor Activity in Healthcare Report. David Cook is the Senior Vice President and Chief People Officer at TriHealth. He has spent the bulk of his career involved in the creation and deployment of strategic human resources initiatives.

Employee voice is a principle that has taken on new meaning as labor activity in healthcare rapidly increases. The COVID pandemic brought the healthcare industry into the public’s eyes in a way that hasn’t happened since the last global health crisis, motivating medical researchers  to combine lessons from the past and present to better address the future. The impacts on frontline healthcare workers during crises are always significant, but an important point to remember is the physical and mental health of all healthcare workers affects the quality of patient care. This article explores understanding what is important to today’s healthcare workers, building relationships and trust, and the role a supportive organizational culture plays in the job satisfaction of healthcare workers.  

Do You Know What’s Important to your Employees? 

The difference between the crisis reactions of yesteryear and those in the current healthcare industry is that today’s workers are demanding a voice in the workplace and are connecting the ability to express employee voice to enable better patient care. It isn’t just about more pay or staffing for personal reasons. This is a wider and deeper employee voice needing development. Out of frustration with their working conditions and a belief their employers aren’t concerned with employee health and well-being, all types of healthcare workers are increasingly turning to labor unions to find that voice. They include registered nurses, licensed practical nurses, nursing assistants, medical residents, lab workers, pharmacists, healthcare support occupations like physical therapists, home health aides, nursing home aides, health counselors, and medical facility housekeepers.      

Approximately 4,000 Red Cross workers belong to the Coalition of American Red Cross Unions, comprised of nurses and other health professionals. The labor unions represented are AFSCME, AFT, CWA, IBT, IUOE, SEIU, UAW, UFCW, and USW, indicating one of the ways the varied labor unions are joining forces to attract healthcare workers. Darryl Ford, President of the local union branch USW L254 and a collection technician, said, “Covid proved a lot of things. People are not going to take anything anymore, and just because the Red Cross has that non-profit logo, people are not above it. More people are walking off the job than I’ve seen in 20 years.”      

Like all industries, healthcare organizations are operating in a Resignation Nation with employees who believe their voice is not heard and management is not communicative. As of June 2022, new contract negotiations for the Red Cross employees were stalled. Bobbie Terrell, another Red Cross collection technician and president of AFSCME Local 2691, Darryl Ford, and the union coalition say there is a staffing shortage contributing to the blood supply shortage, employer cuts planned to healthcare plans, and a lack of pay increases. A Red Cross organization spokesman said the hiring rate had increased 50 percent, and a sufficient blood supply was available. Who is right?     

The union representatives claim, “…the Red Cross has not communicated an end to the blood shortage to their workforce” and pointed to flyers soliciting donors for a blood shortage. In March 2022, the Red Cross reached a tentative three-year national contract with the Teamsters two days before a planned strike, but eight local unions needed to vote. The Teamsters represent 1,600 workers. Concessions included annual wage increases of 3 percent, continuation of the current health plan, and a new Paid Family Leave program.   

Employee Voice in Healthcare  

Employee voice in hospitals and medical facilities is a hot topic, and labor unions are leveraging the employee need for a voice to grow membership. Unions are having success recruiting new healthcare workers and are also galvanizing current members in hospitals and nursing homes to take action that includes strikes, protests, and walkouts. At one time, even union employees would not leave their patients and clients at risk, but the story has changed today. Healthcare workers are approached by large and small unions, many of which have nothing to do with healthcare. They encourage employees to walk out to get attention.      

The National Union of Healthcare Workers (NUHW) was formed by members as an independent union. Its website says, “When healthcare workers are not represented by a union, management determines what workers are paid, what benefits workers receive, how many workers will get shifts, who will get them, and who will be laid off. But when healthcare workers come together and form a union, the workers have the collective power to demand a voice in these important issues.”      

Rebecca Kolins Givan, an associate professor of labor studies at Rutgers University, said, “If you ask nurses what they want, they want working conditions where they can provide a high level of care. They don’t want appreciation that is lip service. They don’t want marketing campaigns. They don’t want shiny new buildings.” She also pointed out that organizing can take a while until there is a crisis, and then employees can organize quickly. Voice… it is all about employee voice.     

Room to Grow  

There is a lot of room for growth in union membership in the healthcare industry, making it imperative for employers to give employees a voice as labor activity in healthcare increases. The Bureau of Labor Statistics found that in 2021, 11.7 percent of healthcare practitioners and technical occupations were union members and 8.3 percent of healthcare support occupations were union members. Labor unions and independent unions are mobilizing healthcare workers to a degree not seen in the past. The Hospital Review listed ten hospital-contract agreements and strikes that show the difficulties associated with union negotiations. There are strikes, long negotiating periods, and dozens of negotiating sessions. As labor activity in healthcare accelerates, staying union-free is more challenging even though it benefits employees and the organization.  Just these recent examples demonstrate current labor activity in health care:  

• In June 2022, the Central Oregon Providers Network filed for representation for 300 physicians, nurse practitioners, physician assistants, and other healthcare workers. The reason is to increase provider input into managerial decision-making.  
• In April 2022, the NLRB certified an election in favor of unionizing registered nurses at Longmont United Hospital. “With the backing of the NNU, we will have a powerful collective voice to strengthen patient safety standards, improve infectious disease protocols, win enforceable protections against workplace violence, and secure other standards…” said RN Kris Kloster.   
• In September 2021, 94 percent of RNs at Doctors Hospital of Manteca (part of the Tenet Healthcare system) voted to join the California Nurses Association. “DHM nurses want the voice, protections, and standards their Tenet colleagues at other CNA- and NNU-represented facilities have won through their union.”   
• United Health Professionals of New Mexico, the joint union of the American Federation of Teachers New Mexico, and the International Association of Machinists & Aerospace Workers Lodge #794 filed union authorization cards for recognition of an employee union in May 2022. Lodge #794 President Ashley Long said, “…nearly 500 healthcare workers have a legal voice to advocate and negotiate for improvements in care for their patients and their profession.”   

Intentional Connection: Employee Voice in Healthcare

Developing opportunities for employee voice in healthcare takes a well-planned employee communication system with leadership that is skilled in developing positive employee relations through messaging and feedback.    

There are many ways to approach developing an “employee voice communication system.” It’s not one digital communication channel or random group meetings, or a monthly newsletter. It is a system developed that is based on a strategic plan to ensure all employees are included, embraces a myriad of activities, and develops leaders skilled in utilizing the communication system on a routine basis. Following are some ways to develop employee voice to lower the risk of labor activity in healthcare organizations.    

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Discover Employee Needs and Wants   

Do you know what your employees need and want, or do you think you know? There’s a huge difference. The only way to find out what is important to your employees is to ask them, remembering to maintain the inclusiveness of all employee groups, from RNs to housekeepers. Each group of employees will have different needs that your leaders must recognize and address. Following are some suggestions for discovery.   

• Create meaningful conversations – Meaningful conversations refer to learning something important from employees. It’s more than an offhand “Hi! How are you?” A meaningful conversation has a shared purpose, and your leaders need to have developed skills in areas like active listening and empathy to elicit useful information from employees. Following are some suggestions for initiating meaningful conversations.   
   
• Leadership rounding – In this widely adopted practice used by healthcare leaders to better understand what motivates staff, the administrators, department heads, supervisors, and managers regularly walk around the healthcare facilities and talk directly with staff members about services and care.   
   
• Leaders hold regular 1-on-1 conversations   
   
• Leaders hold regular staff meetings to inform and listen, remembering to give workers on all three shifts opportunities to attend a meeting and share their voice.   
   
• Establish natural feedback opportunities – Supplementing leadership rounds with additional feedback opportunities serves three purposes. First, it ensures all healthcare employees have a voice in some way. Second, communication gives employees a chance to express issues in a positive manner. Third, some feedback opportunities, like town halls, can bring together employees who hold a variety of positions, giving a better picture of the organizational culture.    

If your nurses, lab workers, and housekeepers are all saying that patient care suffers because management doesn’t address staffing issues, the organization’s workplace culture needs improvement, and leadership needs training. Some ways to establish natural feedback opportunities to reduce the need for labor activity in healthcare include the following.      

• Hold employee town halls and forums – Hold virtual and in-person events so that remote employees and other employees unable to attend in person for some reason can still participate, like home healthcare field workers.   
   
• Conduct regular employee surveys, share the results openly, make an action plan based on the feedback, follow through to completion, and the close the loop with employees about how you have taken action on their feedback.   
   
• Have leadership chats - i.e., Coffee with…, Lunch with…, ask the CEO at breakfast…   
  

What’s Your Employee Value Proposition? Reinforcing Who You Say You Are with What You Do    

What is your Employee Value Proposition (EVP)? Did it need to change in light of what was learned during and after the pandemic and in a pro-union national environment? Does it need reinvention or humanizing? Workers today want employers to treat them like people and not employees. Healthcare workers are concerned about issues like reasonable schedules, benefits for all workers, mental health, pay that reflects the personal and work hazards faced each day, safety, and mental well-being in a naturally stressful work environment. Your EVP should be based on a holistic perspective of employees.   

• Leverage your Total Rewards Strategy as the Foundation for your EVP – Your Total Rewards Strategy is a coordinated plan that provides compensation, benefits, recognition, and development opportunities to motivate employees to achieve excellence. If you don’t have one, the top priority is developing one.   
• Leverage conjoint survey techniques to better understand and appreciate your employees’ highest priority needs – conjoint analysis is a type of employee survey used for statistical analysis to gain greater insights into how employees value different aspects of employment. It is more than an employee satisfaction survey, though satisfaction questions are asked. It provides insights into the preferences of employees for employment attributes like compensation and benefits by asking trade-off questions. For example, would RNs prefer a 3 percent wage increase and the addition of a paid family leave benefit or a 5 percent wage increase? Employees can rank preferences in a trade-off question.   
• Develop and execute a communications strategy based on established employee feedback   
• Reinforce leadership commitment to acting on employee feedback through communications     
• Focus on the vital few and align with organizational success   

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Relationships=Trust & Trust=Partnership   

Building trust between employees and leaders is one of the most challenging aspects of developing positive employee relations with high-level employee engagement. This is especially true in the agitated state of the healthcare industry that is spurred on by labor unions. Yet building trust is necessary to minimize the risks of labor activity in healthcare. There are many aspects to trust that include honesty, respect, authenticity, transparency, having a sense of security in communicating perspectives and preferences without fear of retaliation, and believing the other person has your best interests at heart.  Most importantly, building trust has to be sincere!  It should not be something done to avoid a temporary crisis but instead part of your leadership and organization's DNA.   

Trust is critical to positive employee relationship building and a collaborative workforce. A survey of eight Chief Nursing Officers (CNOs) at eight California healthcare organizations on building trust and work relationships found that CNOs believe trust is built by empowering the workforce through confidence in their independent decision-making and abilities and recognizing the feelings, thoughts, and expertise of each other.   

Following are some important keys to building trust in a supportive workplace and thus positive employee relationships.   

• Transparent communications are mandatory.  
    
• Trust-building is a process in which your leaders work to prove their honesty and reliability in addressing employee issues.  
   
• Be who you say you are and admit when you or the organization falls short of your target.  
   
• Remember and address the fact that service recovery applies to your employees and not just your customers/patients.  
    
• Conduct leadership rounds with a purpose!   
    
• Be personable, natural, and sincere, and maintain a positive tone at all times, taking the time to listen and respond.   
    
• Ask questions, take notes, take action and facilitate your employees’ success by ensuring issues raised will be addressed.   
   
• Establish a routine so your presence is expected and welcomed. 
     
• Say what you are going to do, and then confirm you did what they expected.   
   
• Prioritize issues based on risks, urgency, ability to resolve.   
   
• Communicate, Act, Communicate and Repeat – follow up on previous requests and issues while accumulating new ones.   
   

Follow up with:   

• individuals, or    
• With an organizational report that reviews issues brought up and propose solutions, or   
• Identify issues to include in the next leadership round.     

Train Leaders and Employees  

The importance of leadership training in effective employee communication practices and using communication tools and channels is critical to building employee voice in healthcare. Your leaders need to understand how to plan for leadership rounding sessions, identify and document employee issues and develop responses. They also need to understand the relationship of adhering to commitments made to employees to the organization’s ability to stay union-free.  
 
As this discussion pointed out in the beginning, labor unions look most attractive when employees believe a union is the only way to gain a voice in the workplace and to get management to listen. Holistic wellness, employee engagement, and the type of organizational culture are key determinants of the satisfaction of healthcare workers, and common to all the factors is employee voice. Remember, healthcare workers want to provide safe, effective patient care in a positive work environment.  From this perspective, you want to develop a workplace where unions are just not necessary because you give all your employees a voice, and you listen and respond… and most of all, you have a trusting relationship.   

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