leadership chapters 22-23
union shop (closed shop)
All employees are required to join the union and pay dues
Leapfrog Group Initiatives
Growing conglomeration of non-health-care Fortune 500 company leaders committed to modernizing the current health-care system. Based on current research, they have identified four evidence-based standards they believe will provide the greatest impact on reducing medical errors: ■Computerized physician-provider order entry ■Evidence-based hospital referral ■ICU physician staffing ■The use of Leapfrog safe practices scores
Taft-Hartley Act
returned some power to management; resulted in more equal balance of power between unions and management
professionals
have the right to be represented by a union but cannot belong to a union that represents nonprofessionals unless a majority vote for inclusion in the nonprofessional unit
greivance
perception that management has failed in some way to meet the labor agreement
lockout
closing a business by management due to a labor dispute to force employees to accept management terms
managers functioning during union organizing
-Employees have a right to participate in union-organizing under the NLRA, without manager interference. -Nurse managers are legal spokespersons for hospitals with actions closely monitored by the NLRB -Prohibited Managerial Activities: -Threatening employees -Interrogating employees - Promising employee rewards for ceasing unionization - Spying on employees
Why nurses DON'T join unions
-Belief that unions promote welfare state and oppose free enterprise -A need to demonstrate individualism and promote social status -A belief that professionals should not unionize -Identification with the manager's viewpoint is greater than with workers -Fear of employer reprisal even though protected by the National Labor Relations Act -Fear of lost income due to a strike or walkout -The right not to join a union
collective bargaining and nursing hx
-High demand for nurses = healthy national economy and ↑ union activity. -When nursing job vacancies ↓union membership and activity ↓. -In addition, nurses' perceptions of their value to their employers have had an impact on unionization rates. -As of 2017, about 18% of the nation's RNs belonged to unions, compared to 10.5% of the general population across the United States in 2018 (Bureau of Labor Statistics, 2019).
why nurses join unions
-Increase input into decision-making -A feeling of powerlessness -Eliminate favoritism and discrimination -Meet a social need for acceptance -Large groups of employees are less dispensable -Wages are typically higher -Required to in employment agreement -Believe it will improve patient outcomes and quality of care
effective labor managemtn relations
-Labor relations laws concern the rights and duties of unions and employers in their relationship with each other -Managers working with newly formed unions often experience acceptance along a continuum. -Managers must learn to work with unions and develop the art of using unions to assist the organization in building a team effort to meet organizational goals. +This occurs through accommodation or union acceptance, with both management and the union demonstrating mutual working respect
leadership roles
-Self awareness -Accepts others' reasons for seeking unionization -Sensitive to employee needs, reducing unionization -Cooperative when dealing with unions and legislation -Role models fairness/non-discriminatory -Zero tolerance for sexual harassment -Embraces intent of employment laws -Seeks out culturally and ethnically diverse workforce
national labor relations act and the nurse supervisor
-The NLRA establishes certain protections for private sector employees who want to form or join a labor union. -These protections do not extend to nursing supervisors or those who have the authority to hire, fire, promote, assign, discipline, reward, direct, or adjust grievances by use of independent judgment. -Nurses, on average, with < 10% to 15% (equal to about one shift/pay period) of their time as charge nurse are considered staff nurses, while those who work > 15% of their professional time as charge nurses are considered supervisors.
managing functions
-Understands and implements union contracts -Administers policies fairly and consistently -Promotes worker identification with management -Investigates complaints of violations of collective bargaining contracts -Gives subordinates input into organizational decision-making -Alert for discriminatory practices and acts immediately -Ensures licensing regulations are met -Understands and follows labor and employment laws -Ensures a safe work environment -Works closely with human resources regarding legislation issues
hallmarks of effective quality control programs
1. Support from top-level administration 2. Commitment by the organization in terms of fiscal and human resources 3. Quality goals reflect search for excellence rather than minimums 4. Process is ongoing (continuous)
steps to est a union
1.Demonstrate an adequate level of desire among the employees a.At least 30% of employees must sign an interest card b.Most require 60-70% interest before investing in a union venture c.Usually kept top secret from the employer 2.The organization must have an election a.50% + 1 of the petitioned units must vote for unionization b.No representation means voters do not want a union -To get rid of a union (Decertification) 30% of eligible employees in the bargaining unit petition to longer be represented by the union
Kennedy Executive Order 10988 (1962)
Amended the 1935 Wagner Act to allow public employees to join unions
strike
Concerted withholding of labor supply to bring about economic pressure on employers and cause them to grant employee demands
Agency shop (open shop)
Employees are not required to join the union
National Labor Relations Board
Labor board formed to implement the Wagner Act.
union organizing strategies
One-on-one and group meetings Brochures and leaflets Pressure on the hospital corporation through media and community contacts Political pressure of regional legislators and local lawmakers Corporate campaign strategies Activism of local employees Lawsuits Applying pressure by financiers Technology
Audits Frequently Used in Quality Control
Structure—monitor the structure or setting in which patient care occurs Process—measure the process of care or how the care was carried out Outcome—determine what results, if any, followed from specific nursing interventions for patients
quality gap
The difference in performance between top-performing health-care organizations and the national average is called the quality gap
employment legislation
The feeling that the employer is fair encourages team-building that is vital for effective management. The leader must embrace the intent of the labor laws, barring discrimination and providing equal opportunity. Labor Laws Fall into one of 5 Categories 1. Labor standards. These laws establish minimum standards for working conditions regardless of the presence or absence of a union contract. Included in this set are minimum wage, health and safety, and equal pay laws. 2. Labor relations. These laws relate to the rights and duties of unions and employers in their relationship with each other. 3. Equal employment. The laws that deal with employment discrimination were introduced in Chapter 15. 4. Civil and criminal laws. These are statutory and judicial laws that proscribe certain kinds of conduct and establish penalties. 5. Other legislation. Nursing managers have some legal responsibilities that do not generally apply to industrial managers. For instance, licensed personnel are required to have a current, valid license from the state in which they practice. Additionally, most states require that employers of nurses report certain types of substance abuse to the state licensing boards. Confidentiality laws also have a significant impact on health-care organizations.
med concilliation
activity of a third party to help those in a dispute to reach an agreement. no final decision-making power
amendements to wager act
allowed nonprofit organizations to join unions
national labor relations board ruling 1989
allowes nurses to form their own seperate bargaining units
arbitration
final step in a grievance process, involves a third-party reviewer for fact finding final decision-making
quality control
final step in the management process •Activities that are used to evaluate, monitor, or regulate services rendered to consumers •Performance is measured against predetermined standards •Action is taken to correct discrepancies between these standards and actual performance
national labor act/wager act
gave unions many rights in organizing; resulted in rapid union growth
averting unionization
uKnow and care about your employees uEstablish fair and well-communicated personnel policies uUse an effective upward and downward communication uEnsure all managers are well-trained and effective uEstablish a clear procedure for grievances uOffer a competitive compensation plan u uHave an effective performance appraisal system uUse a fair and well communicated system for promotions and transfers uEnsure that job security is based on job performance, adherence to rules and regulations, and availability of work uHave a clear-cut administrative policy on unionization
Total Quality Management (TQM)
•Also referred to as continuous quality improvement (CQI •Based on the premise that the individual is the focal element on which production and service depend •Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving
med errors
•Medical errors continue to be rampant in the health-care system •Ignoring the problem of medical errors, denying their existence, or blaming the individuals involved in the processes does nothing to eliminate the underlying problems •A "just culture" deemphasizes blame and focuses on factors that lead to and cause near misses, medical errors, and adverse events
quality improvement models
•Over the past several decades, the American health-care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI). •The difference between the two concepts is that QA models target currently existing quality; QI models assume that the process is ongoing and continually improving quality •Two models that emphasize the ongoing nature of QI include total quality management (TQM) and the Toyota Production System (TPS).
management controlling functions
•Periodic evaluation of unit philosophy, mission, goals, and objectives •Measurement of individual and group performance against pre-established standards •Auditing of patient goals and outcomes
standards
•Predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced •Each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care •The American Nurses Association has played a key role in developing standards for the nursing profession
clinical practice guidelines
•Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care •Also called standardized clinical guidelines, help formulate critical/clinical pathways •Should reflect evidence-based practice (EBP) -based on cutting-edge research and best practices
six stigma approach
•Sigma is a statistical measurement that reflects how well a product or process is performing. •Higher sigma values indicate better performance. •Historically, the health-care industry has been comfortable striving for three sigma processes in terms of health-care quality, instead of six.
Three Steps of the Quality Control Process
•The standard is determined •Information is collected to determine if the standard has been met •Educational or corrective action is taken if the standard has not been met
union
•an organized group •collective strength/ voice in their workplace •wages, work hours, benefits, workplace health and safety.
collective bargaining
•employees negotiate contracts with their employers to determine their terms of employment, •pay, benefits, hours, leave, job health and safety policies, ways to balance work and family and more.
strategies to prevent med errors
■Better reporting of the errors that do occur ■Reform of the medical liability system ■Other point-of-care strategies -Bar coding -Smart IV pumps -Medication reconciliation -Leapfrog Group Initiatives
Toyota Production System (TPS)
■Customer-focused quality improvement model ■Production system built on the elimination of waste and pursuit of the most efficient production method possible ■Requires a substantial commitment of leadership time and resources ■Quality control in health-care organizations has evolved primarily from external forces -not as a voluntary effort to monitor the quality of services provided.
root cause analysis (critical event analysis)
■Helps identify what, how and why a critical/sentinel event happened ■The End Goal: -to ensure that a preventable negative outcome does not recur 1.determine the problem 2. determine the cause 3. identify effective solutions 4. implement and trak solutions
Centers for Medicare and Medicaid Services (CMS)
■Plays an active role in setting standards for and measuring quality in health care ■Hospital Value-Based Purchasing program. -paid for inpatient acute care services based on the quality of care, not just quantity of the services they provide. -Reductions in payment are possible. -Readmissions Reduction Program penalizes hospitals for high readmission rates with lower Medicare reimbursement overall. (Readmission within 30 days of discharge from the same or another hospital) ■The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. It measures recently discharged patients' perceptions of their hospital experience
quality measurment an organizational mandate JOINT COMMISSION
■The major accrediting body for healthcare in the US ■Imparts External impacts on quality control ■Professional Standards Review Organizations
Benchmarking
■The process of measuring products, practices, or services against best-performing organizations ■Organizations can determine how and why their organization differs and use the exemplars as role models -standard development -performance improvement
outcomes
■growing recognition of the contribution of nursing to patient outcomes ■creates accountability for nurses as professionals and is important in developing nursing as a profession