Collective Bargaining in Not-for-Profit Hospitals: A Model and Its Implications for the Likelihood of Strikes

Abstract

The number of strikes by hospital employees has increased substantially in the past decade and has become a matter of public interest and concern. Approximately 25 percent of U.S. hospitals already collectively bargain with their employees, and union organizing efforts may well increase that percentage [9]. Naturally, as hospital services are often of an essential nature, their disruption by strikes may endanger patient safety or lead to extreme inconvenience. As this type of activity increases, public resentment and reaction, with the possibility of public sector intervention, are likely to increase as well. The development of useful policies in this area requires an understanding of the motivations of and the limitations placed on the bargaining participants and the manner in which they are manifested in the bargaining process. Prior to the 1960s very little collective bargaining occurred in hospitals [10]. The literature on hospital collective bargaining is even more recent and, in large part due to this, it has been primarily descriptive in nature. The literature on collective bargaining models has been confined mainly to private industrial strikes [1; 3; 4; 5; 6; 8; 12; 13; 14]. This is true even though the health sector now consumes slightly in excess of 10 percent of GNP and hospital collective bargaining has been dominated by economic issues [2]. Thus, the purpose of this paper it to develop a conceptual framework capable of analyzing collective bargaining and strike activities in not-for-profit hospitals. The model, designed to incorporate the self interests of the bargaining parties as well as the limitations imposed on them by their constituents, will be developed in the next section. Following this, the implications of the model will be derived and discussed, as well as the predicted impacts of several exogenous variables on the likelihood of hospital strikes.