An analysis of hospital union election activity: 1985-1987--by hospital ownership, size, and system, and employee organization and bargaining-unit size

During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.     

Decertification elections in health care: some recent evidence

This article examines union decertification elections conducted by the National Labor Relations Board between January 1999 and February 2002 in hospitals and nursing and residential care facilities. Employees petitioned 92% of all decertification elections. Service Employees International Union was involved in nearly 43% of all decertification elections and won 57%. Forty-three percent of all decertification elections involved bargaining units with 50 employees or less. Unions lost 66% of decertification elections in departments, but won 75% in bargaining units consisting of both professional and clerical employees. The union win rate in non-right-to-work states was 52% compared with 37% in right-to-work states.     

A profile of hospital union election activity, 1985--1994 NLRB rulemaking and results in right-to-work states

The authors present union election results in non-governmental, short-term hospitals for the 10-year period 1985--1994. The authors include profiles for the periods before (1985--1989) and after (1990--1994) the National Labor Relations Board (NLRB) rulemaking. When comparing the period data, they found that the impact of rulemaking was a reduction in mean bargaining unit size, an increase in the absolute number of elections in hospitals, and an increase in the percentage of union wins. Their examination of hospital union election results in right-to-work (RTW) versus non-RTW states revealed that unions did not aggressively try to organize workers in non-RTW states and, when they did, they were not very successful. When the authors examined only initial recognition elections during the periods before and after rulemaking, as well as the whole 10 years, regression analysis identified three variables significantly related to union wins: the 1989 NLRB rule change, bargaining unit size, and employee participation rates.     

Hospital union election activity, 1974-85.

This study, using National Labor Relations Board data and American Hospital Association data, reports on the status of union election activity in the hospital industry for a 65-month period, January 1980-May 1985, and contrasts it with earlier data for a similar 65-month time period (1974-79). Together these data provide a comprehensive overview of union election activity in non-Federal, nongovernment hospitals since the passage of the 1974 Nonprofit Hospital Amendments to the Taft-Hartley Act. The study analyzes union, election, hospital, and environmental characteristics. Comparisons over the two time periods show that, while union victory rates in hospital elections have remained constant, the total number of elections has declined dramatically in the hospital industry.     

Labor relations strategies and tactics in hospital elections

This article explores various labor relations strategies and tactics used by hospitals in union elections. Union avoidance and union substitution were the two most widely used, with union avoidance being the best way to fight unions. Regardless of the strategy used, unions won a majority of the elections, most often using a neutral or accommodative strategy. Some widely used management tactics during an election included: hiring a labor lawyer, using a consultant known for breaking unions,and prohibiting distribution of union literature in non-working areas of hospitals.     

Calendar of Meetings

The authors present union election results in non-governmental, short-term hospitals for the 10-year period 1985-1994. The authors include profiles for the periods before (1985-1989) and after (1990-1994) the National Labor Relations Board (NLRB) rulemaking. When comparing the period data, they found that the impact of rulemaking was a reduction in mean bargaining unit size, an increase in the absolute number of elections in hospitals, and an increase in the percentage of union wins. Their examination of hospital union election results in right-to-work (RTW) versus non-RTW states revealed that unions did not aggressively try to organize workers in non-RTW states and, when they did, they were not very successful. When the authors examined only initial recognition elections during the periods before and after rulemaking, as well as the whole 10 years, regression analysis identified three variables significantly related to union wins: the 1989 NLRB rule change, bargaining unit size, and employee participation rates.     

The impact of union elections on human resources management practices in hospitals

The purpose of this article is to explore top management's perceptions of how various human resources management (HRM) practices changed in hospitals (n = 101) after union elections. Significant increases in many HRM practices that are believed to lead to competitive advantage through human resources were reported in firms in which unions lost elections but not in firms where unions were certified.     

Bargaining unit rules having little effect on hospital union activity

The number of hospital union elections rose only slightly between 1990 and 1991, suggesting that the National Labor Relations Board's new hospital bargaining unit rules haven't had much impact on hospital organizing efforts. NLRB data appear to contradict the dire predictions of many hospitals and labor attorneys who said expanded bargaining unit categories would lead to unbridled union organizing efforts.     

Union certification elections in nursing care facilities

This empirical study examines 387 union certification elections conducted by the National Labor Relations Board in nursing care facilities (North American Industry Classification System 623) from January 1999 to December 2001. Unions won 60% of the elections. Service Employees International Union was involved in 42% of the elections. Bargaining unit size significantly impacted union victory. Unions had a better probability of winning elections in the northeast and midwest than in the south. Unlike other industries, American Federation of Labor-Congress of Industrial Organizations affiliated unions did not suffer a big labor image in nursing care facilities. Implications for union organizers and administrators of nursing care facilities are discussed.     

Risk-adjusted infection rates in surgery: a model for outcome measurement in hospitals developing new quality improvement programmes

Assessment of healthcare quality is a major challenge in countries such as Hungary where there is limited experience with measurement of patient outcomes. We sought to develop the capacity for valid outcome measurement in Hungarian hospitals using surgical site infection (SSI) surveillance as a model and to identify areas for improvement by comparing SSI rates in Hungarian hospitals to benchmarks published by the United States Centers for Disease Control and Prevention's National Nosocomial Infection Surveillance (NNIS) System. We surveyed the incidence of SSI among 5126 patients undergoing 6006 procedures in 20 public hospitals in Hungary during 1996 using the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) protocol, a protocol consistent with the methods used by the NNIS System. Cholecystectomy, herniorrhaphy, appendectomy, and open reduction of fracture--four of the five most commonly performed procedures in Hungary in 1996--comprised 85% of the procedures analysed. Cumulative SSI rates for herniorrhaphy and appendectomy were comparable to NNIS System benchmarks. Cumulative SSI rates for cholecystectomy were significantly higher in Hungarian hospitals among risk categories that included open procedures. Nearly half of the hospitals had SSI rates for cholecystectomy that were high outliers (>90% percentile) compared to NNIS System benchmarks. Cumulative SSI rates for open reduction of fracture and mastectomy were significantly higher in Hungarian hospitals due to high rates in a few hospitals. The duration of surgery for all procedure types was substantially shorter in Hungarian hospitals compared with NNIS System hospitals. Future work should focus on optimizing prevention strategies for patients undergoing cholecystectomy, open reduction of fracture, and mastectomy. The effect of the utilization of open vs. laparoscopic cholecystectomy, short procedure duration, and procedure volume on SSI rates should be evaluated further. This programme expanded the capacity of Hungarian hospitals to perform surgical site infection surveillance and can serve as a model for hospitals in other countries with limited experience with outcome measurement.     

Variation in management of community-acquired pneumonia requiring admission to Alberta,Canada hospitals

Previous studies have shown small area variation in the rate of admission to hospital for patients with community-acquired pneumonia. We determined the rates of admission and length of stay for patients with community-acquired pneumonia in Alberta and the factors influencing admission rates and length of stay. Using hospital abstracts, hospital admissions for community-acquired pneumonia from 1 April 1994 to 31 March 1999 were compared. We classified Alberta hospitals according to geographical regions, by the number of beds, and by number of community-acquired pneumonia cases. There were 12,000 annual hospital discharges for community-acquired pneumonia costing over $40 million per year. The overall in-hospital mortality rate was 12% and the 1 year mortality rate was 26%. Compared with rural hospitals, regional and metropolitan hospitals admitted patients with greater severity of illness as demonstrated by greater in-hospital mortality, cost per case and comorbidity. Age-sex adjusted hospital discharge rates were significantly below the provincial average in both urban regions. Hospital discharge rates for residents in all rural regions and 4 of 5 regions with a regional hospital were significantly higher than the provincial average. After adjusting for comorbidity, the relative risk for a longer length of stay was 22% greater in regional hospitals and about 30% greater in urban hospitals compared to rural hospitals. Seasonal variation in the admission rate was evident, with higher rates in the winter of each year. We conclude that rural hospitals would be likely to benefit from a protocol to help with the admission decision and urban hospitals from a programme to reduce length of stay.     

双赢理论与公立医院的公益性建设分析

"双赢"的本义就是指对博弈双方都有利的行为和结果,"双赢"观念的建立,为现代竞争带来了新的策略和思路。在市场经济的大背景下,公立医院的公益性与经营性的矛盾冲突在所难免,如何在公立医院公益性建设中运用双赢理论缓解其矛盾并创造出新的利益对于深化公立医院改革具有十分重要的意义。     

Volume thresholds and hospital characteristics in the United States

Procedure volume has been used as a proxy for quality and recommended as a basis for hospital referrals. We studied the volume, mortality, and associated hospital and staffing characteristics of ten complex procedures in U.S. hospitals using the 2000 HCUP Nationwide Inpatient Sample. Although the majority of patients had their procedures performed in high-volume hospitals, for seven procedures, more than three-fourths of hospitals would be considered low-volume. Unadjusted mortality rates were significantly higher at low-volume hospitals for five procedures. Low-volume hospitals also tended to have lower mean numbers of residents and RNs. However, for two procedures, low-volume hospitals had RN and resident staffing equal to or higher than those of high-volume hospitals, and the unadjusted mortality rates were no different.     

A profile of U.S. hospital mergers

According to Modern Healthcare's Annual Report on Mergers and Acquisitions the number of hospital mergers has declined significantly since the Balanced Budget Act of 1997. This study evaluated market characteristics, organizational factors and the operational performance of these hospitals prior to merger. We found that merged hospitals were more likely to be located in markets with higher per capital income and higher HMO penetration. Merged hospitals were larger in size and had greater clinical complexity as measured by increased services. Finally, we found that merged hospitals had higher occupancy rates, lower return on assets (ROA), and older facilities. From a managerial perspective, merged hospitals display many of the characteristics of an organization in financial distress. From a policy standpoint, the decline in hospital mergers subsequent to the Balanced Budget Act of 1997 may affect the long-term survivability of many U.S. hospitals.     

Consequences of hospital financial distress

This study identifies a group of financially distressed hospitals and tracks them over time to identify the consequences of their financial distress and the factors that may precipitate different events. Of 2,547 that supplied complete financial data to the American Hospital Association for the period 1983-1985, a total of 340 community hospitals met our definition for distress. The most striking finding is that 91.2 percent of hospitals that were distressed in 1983-1985 survived through the end of 1990. Distressed hospitals also had significantly higher rates of system acquisition and merger, as well as higher rates of system divesture. Growing competition in a market appeared to be a major factor in the closure of a distressed hospital. The results of this study suggest that financially distressed hospitals have a remarkable resiliency that allows them to continue operation without dramatic change. This may be good news to local community officials concerned about maintaining financially weakened hospitals. Alternatively, it may be bad news if poor financial performance is a signal of unneeded capacity.     

A look at the central issues surrounding joint consultation

Over the past 30 years the value of staff consultative committees has been challenged by unions and managers alike. Authors argue that the revival of interest in staff consultative committees will be accelerated if elections to staff-sides are carried out on a union rather than professional group basis.     

Surveillance of work-related musculoskeletal injuries among union carpenters

Combined data sources, including union administrative records and workers' compensation claims, were used to construct event histories for a dynamic cohort of union carpenters from Washington State during the period 1989–1992. Person-time at risk and the events of interest were stratified by age, sex, time in the union, and predominant type of carpentry work. Poisson regression techniques were used to identify subgroups at greatest risk of filing claims for a variety of musculoskeletal disorders defined by ANSI codes for body part injured and injury nature. Distinguishing different kinds of musculoskeletal disorders, even crudely with ANSI codes, led to different conclusions about the effects of the explanatory variables. Among older workers, the rates of fractures of the foot were higher, while rates of contusions of the hand and foot were lower. Women had higher rates of sprain/strains and nerve conditions of the wrist/forearm. Higher rates of injuries to the axial skeleton were seen among carpenters who did predominantly light commercial and drywall work, while piledrivers had lower rates of these injuries. Drywall workers had higher rates of sprains to the ankle/lower leg. Workers who were members of the union as long as four years had lower risks for the vast majority of musculoskeletal disorders studied. Similar patterns were seen for more serious claims that resulted in paid lost time from work. Am. J. Ind. Med. 32:629–640, 1997. © 1997 Wiley-Liss, Inc.     

全国细菌耐药监测网2014-2019年不同等级医院细菌耐药监测报告

目的 研究2014-2019年全国不同等级医院细菌耐药情况.方法 从2014-2019年全国细菌耐药监测报告中提取不同等级医院的相关数据,分析三级医院及二级医院数据变迁,并进行比较.结果 2014-2019年,全部医院检出革兰阳性菌位于前五位的依次为金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、肺炎链球菌和屎肠球菌.与三级医...     

Patient Safety Outcomes in Small Urban and Small Rural Hospitals

Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes.
Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was restricted to hospitals with fewer than 100 beds. Out of 292 hospitals in the sample, 185 were rural hospitals and 107 were urban hospitals. AHRQ Patient Safety Indicators (PSI) were used to examine 9 common patient safety outcomes at these hospitals. The unit of analysis was the patient. Associations between hospital location and patient and hospital characteristics were determined using 1-way analysis of variance (ANOVA) and Pearson chi-square test. Multivariable analysis using generalized estimating equation regression models assessed the relationship between hospital location and PSIs.
Results: Most of the observed rates for the 9 PSIs were higher (indicating worse outcomes) for small urban hospitals than for small rural hospitals. In the multivariable analyses, after adjusting for important patient and hospital characteristics, many of these differences disappeared, except for decubitus ulcer. Small urban hospitals had significantly higher odds for decubitus ulcer than small rural hospitals.
Conclusion: These results deviate from findings in the literature that urban-rural differences in patient safety rates exist. This study highlights the importance of understanding the factors that differ between small urban and small rural hospitals while developing hospital-relevant patient safety interventions at these hospitals.     

Programmatic factors related to smallpox vaccine uptake by healthcare workers and others.

We surveyed program coordinators at 106 hospitals and health departments that participated in the National Smallpox Vaccination Program to ascertain how program-level factors affected the rate of smallpox vaccine uptake by staff. In a fully adjusted multivariate model, health departments achieved significantly higher vaccination rates than did hospitals, as did facilities that invited fewer employees to be vaccinated.