5 Issues Affecting Hospital Employment

Kevin Troutman, JD, chair of the national healthcare practice at Fisher & Phillips, discusses five issues affecting hospital employment over the next few years.  

1. Efforts to unionize hospital workers.
States that have traditionally been union-free should expect to see more efforts by unions to unionize hospital workers, Mr. Troutman says. As hospitals across the country struggle with ongoing strikes and union negotiations, Mr. Troutman recommends facilities speak with their employees about the reality of a unionized facility. "For those who want to remain union-free, they need to demonstrate to their employees why a union is unnecessary," he says. "Unions effectively insert a third party between the hospital and its employees, so it takes longer to get things. It's a more bureaucratic structure and a more adversarial structure, and those are not really conducive." For example, he says in a unionized environment, if an employee has a concern, he or she must go through a union representative and consult the union contract rather than speaking directly to a supervisor. For some hospitals and employees, unionizing works, but Mr. Troutman recommends that hospitals at least address the issue before unionizing starts to let employees know the facility's stance. 

2. Aging workforce. As the workforce ages and subsequently retires, hospitals will have to deal with shortages of key personnel, Mr. Troutman says. "That means they're going to have to increasingly deal with immigration laws to recruit from out of the country, and it also means they're probably going to face more requests for alternative work schedules as opposed to the traditional 40-hour week," he says. He adds that hospitals may see more age discrimination claims related to termination, as well as more requests for accommodations from employees with disabilities.

In order to deal with the aging workforce — meaning both the shortage of providers and the policies necessary to deal with older employees — hospitals will have to plan on strengthening recruitment and policy work, Mr. Troutman says. "If the average age of your nursing staff is 48, you've got to think about bringing in people to make up for those nurses retiring and cutting back," he says. He says hospitals should also plan on accommodating disabled employees who can still perform the essential functions of the job, a process that can be time-consuming and expensive because of the individual nature of a disability.

In order to prevent problems, Mr. Troutman says hospitals should make sure job descriptions are accurate and up-to-date.

3. Privacy issues arising from social media
. In addition to traditional privacy issues, hospitals are now faced with thousands of employees using social media to communicate with the world — and possibly divulge confidential hospital information or violate employee or patient privacy rights. In June 2010, five nurses were fired from Tri-City Medical Center in Oceanside, Calif., for allegedly discussing patient cases on Facebook. In July, an Oakwood Hospital employee was fired for posting comments about a shooting suspect and shooting victim on Facebook, allegedly violating HIPAA. "As technology changes and we see more use of Facebook, Twitter and other social media, patient and employee privacy issues are going to be more important," Mr. Troutman says. "Patients and employees may be raising more complaints that their privacy has been invaded."

He says potential privacy violations necessitate education and enforcement from hospital administration. "I think because technology is so readily available, people sometimes use it without thinking," he says. "It's important that hospitals train employees to respond to a violation when they see it. If someone sticks something on Facebook or Twitter and the hospital doesn't address it, it only makes the problem more difficult to fix later."

4. Need to maintain a high-performance workforce.
As hospitals struggle to stay financially viable in the face of lower reimbursements and economic strife, a high-performing workforce is absolutely essential to maintaining efficiency and profitability. "Hospitals are going to have to deal with things like poor performers," Mr. Troutman says. In past years, hospitals might have been able to overlook poor performers because their effect on the hospital's finances was negligible. But when every dollar matters and cost-savings is applied to every hospital process, poor performers can cause a significant drain on hospital funds. He says hospitals should put policies in place to address performance problems early on, which can also help in the event of claims of discrimination of wrongful termination.

"They just can't afford to have an employee who's not pulling his or her weight," Mr. Troutman says. "They're going to have to educate employees about regulatory changes and cost-containment efforts so employees understand what role they play in that process."

5. Increasing whistleblower claims. According to Mr. Troutman, hospitals will have to protect their interests by establishing and publicizing different ways employees can report misconduct. Without established policies for reporting, hospitals can find themselves involved in whistleblower claims, particularly from employees who have been terminated from the facility. "The scenario I typically encounter — not always the case, but about 90 percent of the time — is an employee who's having a performance problem, who's been written up or warned or terminated, will say they questioned a billing practice or complained, and that's the reason they were terminated," Mr. Troutman says.

Mr. Troutman says hospitals can often avoid whistleblower claims by setting up methods for employees to report inappropriate conduct. Mr. Troutman says these methods might include an 800-number or a confidential hotline. "The policies should also state that the hospital wants employees to report suspected wrongdoing, and there will be no retaliation for these reports," he says.

Read more on hospital employment:

-Physicians Rethink Traditional Practice, Consider Hospital Employment in Increasing Numbers

-California's Salinas Valley Memorial Announces Layoff of 120 Workers

-6 Essential Strategies for Physician Integration

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