**Best Practices**

**at**

**Minnesota Hospitals**

Gretchen Weismann

Center for Urban and Regional Policy

Northeastern University

In 1984 nurses and representatives from the Minnesota Nurses Association
and hospital administrators in Twin Cities hospitals instituted joint
labor-management practices in an effort to avoid costly labor strikes
and improve the hospitals' work environment. With the support of the
regional Federal Mediation and Conciliation Service, these cooperative
practices evolved into a structured relationship based on interest-based
bargaining, representative committees, and shared labor objectives.
Several steps in the development of the joint labor-management
relationship at HealthEast Care System, Children's Hospital St. Paul,
and Woodwinds Health Campus illustrate the best practices in this case
study.

-   **Establishment of joint Labor-Management Committees**

After a city wide nursing strike in 1984, hospital administrators and
nurses from Children\'s Hospital St. Paul invited the Federal Mediation
Service to help them develop more cooperative mechanisms that could
prevent another costly work stoppage. To improve the labor-management
climate, FMCS helped establish joint-labor management committees and
subsequently trained committee members in problem solving techniques,
communication, and team building. In 1990 during a turbulent time of
hospital closures and mergers, HealthEast began implementing joint
labor-management committees with nurses from the Minnesota Nurses
Association as a way to minimize the likelihood of a strike.

The new labor-management committees are seen as an extension of, and not
a replacement for, collective bargaining. By contract, joint
labor-management committees have some ability to enforce solutions that
are a product of the committee process. However, business decisions are
the exclusive purview of hospital management.

> The joint labor-management committees include:

-   *Staffing and Advisory Committee*- issues include nursing schedules
    on unit, time off, compensation, holiday pay, overtime.

-   *Care Delivery Committee*- issues include RN and LPN
    responsibilities, nursing care, practice, and procedure.

-   *System Labor-Management Committee --* Labor-management relations
    and training. Other committees report back to this committee on
    consensus issues.

-   *Health and Safety Committee-* Workplace safety issues for RNs

In order to facilitate hospital-wide participation in cooperative
labor-management practices, committee members\' employ several
communication techniques including:

-   *Joint communiqués* -- Newsletters co-authored by labor and
    management which describe the progress of negotiations for all
    employees that help to minimize the environment of secrecy and
    animosity surrounding traditional bargaining

-   *Notebook of Meetings* -- On their own initiative, co-chairs of the
    labor-management committees keep all meeting notes and committee
    decisions filed for easy reference.

-   *Voice Mail* - MNA co-chairs are easily accessible through their
    hospital voice mail, which is maintained for the purpose of
    facilitating committee communication.

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-   **Interest Based Bargaining for Contract Negotiations**

Surrounded by an environment of union collaboration and through
discussions between labor leaders at other hospitals and the nurses
union, the MNA decided to use Interest Based-Bargaining (IBB) for their
1995 contract negotiations. These negotiations were extremely complex
because the hospitals were negotiating a multi-employer contract with
more than 35 different hospital groups. In addition, the IBB process
required a greater commitment of time and energy both to learn and to
employ. FMCS commissioners were called upon as both trainers and
mediators during the implementation of IBB processes for contract
negotiations.

Participants involved in the process felt that IBB principles allowed
them to interact in a less adversarial environment and to develop
alternative approaches to long standing labor-management disagreements.
Nursing members of the MNA negotiating team also felt empowered by the
ability to communicate first hand experience and were vocal in
recommending that IBB processes be continued on the hospitals\' floors.

-   **Utilization of IBB problem solving techniques in hospital policy
    making committees**

During the contract negotiations in 1995, several outstanding issues
were included in *Action Plans* and remanded to labor-management
committees. In addition, the MNA contract at both Children\'s Hospitals
and Clinics St. Paul and HealthEast Care Systems dictated that existing
labor-management committees should adopt IBB problem solving techniques.
To demonstrate their commitment to IBB-based joint labor-management
committees, the hospitals gave offices and voice mail to RNs serving as
MNA co-chairs and agreed to pay for the time they spent on committee
activities.

With adequate training, MNA nurses felt that IBB skills would improve
and formalize the cooperation between hospital administrators and nurses
and help to manage outstanding Action Plans. To that end, FMCS
facilitators worked together with labor and management committee members
to build upon the lessons learned during the frenetic bargaining
episodes. The institutionalization of the relationship was realized
through an FMCS sponsored training manual followed by a series of work
sheets and sessions developed by the nurse representatives of the MNA.

**IBB Committee Techniques include:**

-   *Planning* -- establishing goals and structure for the process,
    assigning tasks.

-   *Brainstorming* -- non-critical elaboration of ideas; documenting
    all alternative solutions.

-   *Consensus Decision Making* -- team building, full participation,
    and active listening.

-   *Problem Solving* -- multi-step process of identifying problems and
    coming up with mutually agreeable solutions.

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-   **Establishment of a temporary joint labor management committee for
    Woodwinds Hospital**

The joint partnership between the hospitals and the MNA and the adoption
of IBB techniques and skills learned though the development of joint
committees allowed the hospitals to negotiate a pro-active, cooperative
labor-management relationship in a newly built hospital system in a
suburb of the Twin Cities. Even before the new Woodwinds Health Campus
was opened, the MNA was invited to participate in a discussion about the
future of the health care facility and the work environment. A working
group of nurses and administrators from HealthEast and Children\'s
(co-owners of Woodwinds) as well as an FMCS commissioner met for nearly
a year around issues from comprehensive patient care and hospital room
size to overtime pay.

-   **Contract documents including a Letter of Understanding and
    Transition Agreements between the MNA and the management at
    Woodwinds hospital.**

One of the primary concerns MNA nurses expressed during contract
negotiations in 1995 was job security. At the same time that all twin
cities hospitals were confronting a nursing shortage, hospitals were
continuing to merge and fold. Anxious to leave their current positions
for a new hospital - Woodwinds - with an uncertain labor future, while
at the same time committed to charting a new course in both patient care
and labor relations, the bargaining committee was able to forge a
compromise on job security.

> The ***Letter of Understanding*** signed by management and MNA
> representatives from both Children's and HealthEast during contract
> negotiations stated that administrators, nurses, and the MNA staff
> would continue to work together on the development of labor
> relationships at Woodwinds and that nurses from both hospitals would
> be given preferential hiring status. To carry out the intent of the
> Letter of Understanding, the hospitals formed the Labor-Management
> Steering Committee.
>
> The ***Transition Agreement*** specified the hospital's MNA and RN
> labor policies for a contract facility and a non-contract facility. In
> the event that nurses chose not to accept the MNA, RNs were given 7
> days to decide to return to their parent hospitals with preferential
> hiring status -- RNs would receive their jobs, or a comparable job if
> that position was not available. During the 90 days between the
> opening of the new hospital and the MNA card count, RNs that
> transitioned to Woodwinds could retain their benefits at their parent
> hospital, so as not to lose seniority should they choose to return.