Impassioned stares at a crystal ball.
Closer to home, respondents were asked whether unionization was likely to change in their own labs in the next 10 years. These answers were very different; 90% believed the situation would remain the same. Among these respondents, 73% work in nonunion labs and 17% in union labs. Increased unionization in their own labs was anticipated by only 8%, while 3% of respondents predicted a decrease.
Opinions were mixed regarding potential effects of the recent U.S. Supreme Court decision expanding the number of worker groups permitted to bargain independently with unions (see "How wide will the Supreme Court ruling open the door to unions?," page 37).
Asked whether they had "strong concerns" about unionization, 45% of respondents said they did. They forcefully stated their beliefs, shared throughout this two-part article.
* Past effects. Whether unions have helped laboratorians overall is doubtful or unknown by most respondents. Only 18% discerned improvements (Figure I). People employed in union labs were far more likely to express a positive view than those in nonunion labs (48% vs. 14%, respectively).
* Future effects. Will unions help laboratorians in the future? The prevailing opinion was thumbs down. More than half of respondents (55%) said they would not, while 19% said they would--nearly the same breakdown as regarding past effects of unions. Respondents employed by union labs were about twice as likely to believe future unionization would help laboratorians overall than were those in nonunion labs (35% vs. 17%, respectively), again suggesting that personal experience with unions puts them in a better light.
Also of note is that 26% of panelists said they were unsure about future effects of unions. That leaves at least one-fourth of all respondents willing to wait and see-a large enough group to give union organizers a foothold.
* Why unions would help. Asked how unionization might help or fail to help laboratorians in the future, panelists named potential effects covering a vast array of related issues. Gaining professional recognition and thus bargaining power and the ear of currently uninterested management was cited frequently among those who foresaw improvements through unions. A new cohesion and strength in numbers would unite lab workers, many say.
One panelist yearned for more control over working conditions, now under the sway of administration and the medical and nursing staffs. Yet even when a union is present, a strong administration may hold the power. "Laboratory workers, through altruism or timidity, are trampled by management without the help of the unions," writes a clinical chemistry supervisor at a "grossly underfunded county facility" in California. "Management tries hard to break the unions by a variety of low blows."
Panelists who seemed to be smarting from bad personal experiences thought unions might keep administrators on their toes. Unions "would help job security in that adequate documentation would be necessary before a termination, especially important for workers close to retirement," says an administrative/technical director at a small, nonunionized not-for-profit Florida hospital. "It could also require that safety and professional practices were employed and adhered to." An angry respondent who shall remain anonymous says, "For years our hospital lab has had a bunch of idiots in management. A union would not tolerate this and employees would have someone to go to."
The point raised most often, however, is salaries and pay scales, particularly in comparison with those of other health care workers. "In a hospital where RNs and technical workers have a union," says an assistant department head in a large urban not-for-profit hospital with numerous unions, including in the lab, "other groups not unionized may fall behind in salaries because they lack representation."
The lab director of an independent lab in suburban Rhode Island says, "For many years, pathologists and other physicians have reaped the fruit of laboratorians' labors and have bestowed a pittance back to us. Let them do their own testing if they feel that we are being paid and treated equitably at present."
Says a former technologist and lab director who is now in his third year of medical school, "Our pathologist fired everyone and sent all blood samples to a reference lab for two weeks until he hired new technologists, because we wanted to unionize." Would unions necessarily right such wrongs? Yes, asserts the future physician, who has worked in both Texas and Illinois: "I believe unionization will give us a chance of being recognized as professionals in health care. Technologists are considered equal to janitorial service in the hospital. There is no respect for our profession even though we have five years of college work plus advanced degrees."
* Who is professional. The word "professionalism" arises often in panelists' comments, notes Linda Bielitzki, J.D., legal liaison to the clinical laboratories at Rush-Presbyterian-St. Luke's Medical Center, Chicago, and a former medical technician. "Individual sentiments expressed concern that professionalism will be diminished" by unions, says Bielitzki, who reviewed the survey findings before publication. The problem could be greatly exacerbated by CLIA '88, she adds, which does not distinguish technologist from technician, grouping both as "testing personnel."
"With the stroke of a pen," Bielitzki says, "the Government is dismantling the profession of medical technology." Economic pressures could induce many hospital administrators to let workers with less education and training operate sophisticated instruments. If unions adopted certain new approaches, making clear efforts to preserve that distinction, she says, technologists might welcome them as a last recourse in salvaging their title.
That they can now organize with other professionals to create a unit of their own might be an additional impetus, she says. "If they find the unions willing, unions will proliferate and be successful," she concludes. If unions continue to concentrate on money, however, "they will make only small strides."
Some respondents see unionization as a quick fix for problems endemic in health care today. "With increased demands to keep costs down," says a chemistry supervisor at a North Dakota hospital, "employees are given increased stress in the form of salary freezes, cuts in benefits, longer hours, and less staff. Unions could keep some rein on all this."
Reluctantly, some furstrated laboratorians are revising their previously negative opinions of unions. A microbiology supervisor at a nonunionized midsize not-for-profit hospital in North Carolina is of two minds. He blames many of the ills now besetting laboratorians on the absence of a nationally recognized licensing agency and on the lack of unification of lab personnel nationwide. "In general," he writes, "I believe that unions act primarily for their own interests and ultimately would result in increased hospital costs. I do not want unionization, but unions may help to unify our cause." Says a chief technologist in a small Washington hospital that is not unionized, "I dislike the confrontational methods the unions in Seattle used, but I felt that overall conditions and benefits improved."
"Personally, I am anti-union," states a medical technologist at a small Texas hospital, "but several years ago, pressure was put on me to accept altered hours, call, benefits, etc. A union would never have allowed the situation to arise, much less happen. Today I think unions will spread to labs, yet I feel one has an alliance with Satan when joining one."
* Other factors. More than one thoughtful respondent recognizes that not all unions are alike. A better situation "will depend upon the union. The union must be structured so there is a win-win situation and individuals do not give up professionalism," says one panelist. Unions will help lab workers, says another, "as long as patient care, not political issues, remains the main focus."
Observes an ancillary outreach manager at a Michigan satellite lab who was once burned, "The one union I was forced to belong to in the past did not understand the medical field and therefore kept the laboratorians' wages and benefits artificially low in comparison to those of other departments and other hospitals in the area."
Institution size is another consideration, says a chief technologist at a small rural hospital in Montana who believes unions will help laboratorians overall: "Bigger medical facilities have a better chance for unionization to impact regulatory agencies for larger reimbursements. Small rural hospitals are already straining [so hard] from excessive regulations that only the most efficient will continue to be financially viable."
* Why unions wouldn't help. Remarkably, many of the same themes crop up among the comments of respondents who think unionization will not help laboratorians overall. Panelists are offended at the thought of being grouped with blue-collar workers such as laundry personnel. They say unions would reduce professionalism, decrease laboratorians' professional image, worsen relations with administration, hinder management's ability to respond to changing conditions, undermine productivity, and exhaust dollars that would otherwise be available for continuing education, retraining, and myriad other uses. A likely drop in the quality of patient care was mentioned by numerous worried panelists. They say unionization "compartnermentalizes laboratory functions," "establishes highly adversarial relationships," and "polarizes" groups that should be working as a team.
Salary gains, many respondents insist, would be drained by union dues, strikes, and increased distancing from management. Panelists remark that potential gains in salaries would have to come from somewhere; one result would be to force more layoffs, exacerbating the stress on those who remained. (Others says union rules would prevent layoffs, protecting employees with seniority.) "Until I went through the [union organizing process as a manager, I was pro-union," says a Massachusetts lab manager who is no longer sure. Having to deal with what one can and can't say and the alienation that results was awful."
"Only inept, inefficient laboratorians will benefit," asserts the lab manager of a small rural not-for-profit hospital in Texas, echoing many others. "Performance, product quality, and personal pride will decline with unionization. Having been a union member (non-health care related), I have experienced first hand the effects of prolonged strikes. Strike subsidies do not begin to cover basic needs and are short lived. 'Benefits' gained are seldom enough to offset losses incurred during the strike. Union negotiators are often well paid and do not suffer the financial devastation of the picket walkers. My opinion of any union is that they have long outlived their usefulness." That unions were once imperative for oppressed workers but are now obsolete was reflected in the comments of a good many panelists.
"One strike can wipe out a salary increase pretty fast," adds a microbiology supervisor at an independent lab in California. "A striking lab is a send-out lab," comments an administrative technologist at a large medical center in Pennsylvania. "All you need is a phlebotomist and delivery people."
A single union represents all employees at the Pennsylvania respondent's VA facility. "Since President Reagan leveled the air traffic controllers and their union, our union has no teeth," he says. "Very few people actually belong and the majority of those who do have union jobs."
This statement, from an assistant lab director at a large not-for-profit hospital in Kentucky, represents the long view: "Hospitals must control expenses to stay in operation. I believe that unions cannot contribute anything to helping reduce the high costs of health care, which must be addressed by the Government and physicians."
Objections that smack of the 1930s arise, including concerns that unions "do not benefit the employee, only the union." MLO panelists cited old-time images: confrontations, "coercion and strong-arm tactics," "ties to organized crime," "allegations of corruption," and stolen pension funds.
The MLO survey reveals that lab supervisors, managers, and directors still don't know what they should about unions, says management consultant and MLO contributing editor Annamarie Barros, M.A., CLS, CLDir(NCA). "That these comments came from management makes them even more frightening because they're the ones who should know about unions," she observes. "Laboratory employees don't understand the mechanics of unionism. They get emotional. They're afraid to learn."
Many respondents insist that laboratorians can negotiate with administration on their own, Barros noted after reading the survey results, yet they don't seem to notice that this has historically not been done. Nor, on the whole, have pathologists, or even lab managers, stood up for lab employees.
Denial, Barros says, is the prevailing mood. Lab workers call her to say, "We're having a union election tomorrow. How do we keep them out?" The time to ask, says Barros, is when a union is distributing leaflets in the parking lot, which they usually won't do without a prior demonstration of interest.
Managers should explain to their staffs how unions operate, Barros urges. A one-hour lecture can cover the basics. The stakes are high: Once unions enter the lab, they become strong competitors for membership dollars with professional associations as employees opt for the organization that will obtain the highest pay rates, she points out.
* Why employees join unions. Respondents were asked to name their own impressions of primary reasons clinical lab employees join unions. Salary improvement topped the lsit at 51%. Making management listen was cited by 15%; ineffective supervisors or lab manager by 15%; and job protection and security by 12%.
Less pressing reasons were recognition of professional accomplishments, named number one by 3% of respondents; symbiotic needs and belonging to a group, by 1%; and opprotunities for rewarding union jobs (committees, representatives), by less than 1%. Other causes were noted by 3%.
* Drawbacks of unions. A list of potential drawbacks to unions was provided in the MLO questionnaire. Three out of four (75%) respondents, whether unionized or not, checked "protection of incompetent employees." More than half said unions encourage petty grievances (58%), introduce the threat of a strike (52%), and reduce professionalism (52%).
Other disadvantages: Unions provide advancement or promotion through seniority rather than skill or merit (47%), reduce efficiency (39%), and increase paperwork (35%). Eight percent gave other reasons; 2% did not reply. (Multiple responses were accepted.) It is interesting to note that respondents working in nonunion labs were more than twice as likely as union laboratorians to identify the threat of strikes as a drawback of unions (56% vs. 25%, respectively).
Major differences arose between those in union and nonunion labs. The former group was more likely to disagree that unionism and professionalism don't mix (48% vs. 24%); that concern for professionalism has curbed or contained the unionization of labs (32% vs. 15%); and that unions focus more strongly on individual cases than on underlying problems (29% vs. 14%).
On the other hand, more respondents in union than in nonunion labs disagreed that unions promote safety (59% vs. 45%). Respondents in union labs were more likely than those in others to agree that unions are necessary to compensate for management's dificiencies (43% vs. 24%).
* Effects of more unions. Panelists were asked whether they agreed or disagreed with a list of six statements about potential effects of increased lab unionization. More than half of respondents (55%) agreed that it would increase salaries; almost one-thired (31%) disagreed. A majority disagreed that having more unions would improve working conditions for women (60%) or for minorities (58%).
Opinions were more evenly split concerning unions' likelihood of increasing fringe benefits (47% said yes, 36% said no); requiring equitable treatment of workers (44% yes, 37% no); and improving the conditions of laboratorians with less formal education than others (36% yes, 42% no).
For all the questions in this section, 15% to 24% of respondents stated no opinion. In each case, some 4.5 to 8 times more yea-sayers "agreed" than "strongly agreed" and nay-syaers "disagreed" than "strongly disagreed."
Almost half of all respondents (48%) said the prevailing attitude toward unionization among clinical lab professionals had not changed in the past decade. One in four (25%) believed attitudes had changed. Those in union labs were more likely to see a change than were those in nonunion labs (34% vs. 24% of the two groups). Another 28% were unsure.
Those who claimed to have noted such a change were asked to comment. While reactions were mixed, a majority saw greater acceptance. The lab director of a group practice lab in Florida cites "more concern by rank-and-file employees for their financial needs to be met. Unresponsive attitudes from some hospital administrations reinforce this problem." Says a lab manager of a nonunionized California HMO, "Unions are being seen as a necessary evil--not preferred but needed to bring about safety and salary changes."
Other models are being observed closely. "Laboratorians have watched the effectiveness of the nursing unions in drastically increasing salaries, usually beyond those of MTs with more education," says the chief medical technologist at a small Michigan hospital. The connection isn't lost on a lab manager at a large proprietary hospital in Oregon whose staff has received no salary increase in eight years while the same institution's unionized nurses' pay has risen.
"Increasing consideration has been given to unionization as a cure for perceived mismanagement," suggests the lab manager of a midsize not-for-profit hospital in suburban Illinois that has no unions. "The perception has developed from the misuse of many forms of communication available to management, such as evaluations, discipline--and talking." An immunology/virology section manager at a large not-for-profit Illinois hospital with a non-union lab expresses a common opinion: "If management doesn't respond to salary demands, MTs are more likely to consider unions."
Says a Michigan education coordinator, "People are more vocal about their concerns, and they want change. They no longer buy into the myth that being 'professional' precludes expecting recognition and compensation. There are professionals who are unionized without loss of their image. I think this makes laboratorians more receptive to investigating the possibility of unionization." A supervisor at a group practice lab in Connecticut agrees: "The old idea that only blue-collar workers are unionized has gone by the board."
Some believe intrinsic aspects of laboratory work make certain improvements impossible. A lab director at a group practice lab in Indiana, for example, who does not look kindly on unions, reports a general "realization that unionization will not improve the work. Lab work requires overtime, call, and additional duties. Unionization cannot control this."
* Keeping unions out. Administrators make three chief errors in failing to prevent unionization, a recent study by an independent group found.  First, they assume raising pay and benefits will bar unions from employees' thoughts. Second, they expect to learn how employees feel about unionization simply by interviewing supervisors, who for many reasons may fail to see or report the tru situation. Third, they do not understand what really chafes their employees. (The study, conducted by University Research Center, Inc., of Chicago with the cooperation of the National Labor Relations Board, analyzed 427 NLRB elections, including 46 at hospitals, between January 1988 and January 1991.)
A two-way communication system is the most effective weapon against unionization in hospitals, the study claims. By encouraging a regular exchange of information, hospital administrators learn that day-to-day annoyances such as inadequate ventilation and ineffective in-service programs can add up to a vote for a union card.
The importance of paying attention to small irritations is borne out by SEIU spokesman Ray Abernathy, who told MLO that in the past year he has personally been involved in three major hospital campaigns in which the revocation of parking privileges was a cutting issue. "It infuriates people," he said.
Preventing or soothing such friction is the point of a two-way communication system. "Unless hospital administrators have a system that permits employees to express honest and critical opinions, reacts to their grievances, and provides modern supervisory training," the University Research Center study asserts, "union organizing campaigns will succeed by capitalizing on the absence of such a system." A thorough overhaul of existing communication techniques is often the only answer, the study concludes: "Any hospital management that believes it can continue its old labor relations policies may have a rude awakening. Avoiding unionization now is the one sure way of avoiding a strike later."
Many panelists are aware of the crying need to enhance communication between administration and staff. They cite multiple abuses that laboratorians no longer wish to abide. Articles on how to prevent unionization have appeared for years, including in the pages of MLO. [2-5]
"Unionization will not disappear," says a chief medical technologist at a midsize Arizona hospital, "and should not be thought of as an infection or disease needing eradication. Managers and administrators must take the steps to be actively involved in supporting our staff in ways that allow for growth and job enrichment whenever possible. When we stop listening to and involving our staff in decisions that directly affect their work, we risk unionization and its impact on departmental operations."
One measure that has bloomed quickly in the lab after a late start is total quality management, which includes employees in decision making. "Many of the reasons that drove people to unions before may be gone" when TQM is implemented, says Linda Bielitzki of Rush-Presbyterian-St. Luke's, where the first step in TQM was to make internal customers--that is, employees--happy. Shortages drive employers to TQM, which is proliferating, Bielitzki says; "It's self-serving, so it will continue to spread."
"Some administrators in the know," confides a medical technologist at a small proprietary hospital in Utah, "realize that a better working environment is the best detriment to unionization." Whether administrators share that knowledge with each other and promulgate it in their own institutions may well sway the vote, yea or nay: Shall union buttons proliferate on the lapels of lab coats in clinical laboratories across the country?
 Goodfellow, M. Study shows ways to win, avoid union elections. Healthcare Financial Management 45:48-56, September 1991.
 Adams, C.D., and Bevis, L. How to make a union unnecessary. MLO 13(3): 85-93, March 1981.
 Barros, A. Will unions solve the lab staffing problem? (Viewpoint). MLO 20(12): 17, Decembr 1988.
 Long, F.R. Safeguarding your union-free status. MLO 18(5): 57-60, May 1986.
 Mantey, C.W. The union threat: What supervisors need to know. MLO 10(3): 40-42, March 1978.
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|Title Annotation:||includes related article on labor law; The State of the Unions in the Clinical Laboratory, part II|
|Author:||Barman, Marcia Ringel|
|Publication:||Medical Laboratory Observer|
|Article Type:||Cover Story|
|Date:||Jan 1, 1992|
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