Unions can conjure images of bruising public battles that have inflicted long-lasting damage to the reputations of hospitals across the country. So when the union that waged an eight-year campaign against Connecticut's Yale-New Haven Hospital characterizes itself as a hospital ally, many executives might respond with a skeptical chuckle.But the Service Employees International Union contends it is not an enemy to hospitals. The union considers the healthcare industry ripe for growth; in the next few months the organization's healthcare division will announce a new name for itself as part of a marketing campaign it developed with the Studer Group, an executive coaching firm that works with hospitals and health systems, that will emphasize the union's close ties to hospital management. "We are the healthcare workers union," says Dennis Rivera, president of the SEIU's healthcare division. "But we want to be a different, modern union that works with our employers."That might be hard for some executives to believe considering the SEIU's use of political muscle, lawsuits and a media blitz to impede Yale-New Haven's construction of a $430 million cancer center in an effort to unionize the hospital's employees. The parties finally reached an accord on the cancer center in March 2006, but in December the union called off an employee election after an independent arbitrator ruled the hospital had threatened employees and spread misinformation to keep them from organizing. Rivera describes the ongoing conflict as "very tragic" and calls it a failure on the part of hospital management and union leaders to find common ground. "We learned that we need to work harder to convince management that we are not evil incarnate," he says. "We are not here to cause problems for them."With approximately 800,000 member healthcare workers, the SEIU will likely need some compelling marketing efforts to convince hospital leaders that the days of the corporate campaign are fading. The battle of Yale-New Haven is an example of how unions have used corporate campaigns to persuade management to allow unionizing efforts. Some unions pressure hospital leaders into signing neutrality agreements that limit management's ability to discuss unionization with employees. Another union tactic is card-check elections, in which the normal union election process is bypassed once 50 percent of the workers sign authorization cards.But the SEIU's claim to be an ally of hospital management is more than mere rhetoric, says Kenneth E. Raske, president of the Greater New York Hospital Association. The union has had a longstanding presence in New York hospitals and shares its organizing experience and political clout to help hospitals lobby lawmakers. The partnership recently resulted in expanded health coverage and government investment in healthcare IT spending, says Raske. "The truth is, it is not a slogan," he says. "They really are a friend to hospital management. We've worked in a collegial way toward common policy objectives." The harmony between the union and New York hospitals notwithstanding, many executives are less than enthusiastic about SEIU's national growth ambitions. As a general rule, the SEIU and other unions are targeting regions that tend to be union-friendly and where they have an existing presence in other industries, says James D. Bentley, Ph.D., senior vice president of strategic policy planning for the American Hospital Association. Hospitals on the coasts and around the Great Lakes can anticipate heightened union activity. For example, the SEIU has begun looking at Boston's major academic hospitals, most of which are not unionized. So far the hospitals have resisted and for the most part are not speaking publicly about the union's efforts. But one executive, Paul Levy, president and chief executive officer of Beth Israel Deaconess Medical Center, told employees in an e-mail that he would not agree to modify the normal union organizing procedure under the National Labor Relations Act.Levy said the SEIU has conducted telephone surveys of some hospital employees and submitted Freedom of Information Act requests about several of Beth Israel's research projects. "These activities are entirely legal, although you might wonder, as we do, what relevance our peer-reviewed research has to a union organizing process," he wrote.Levy warned his staff about the effects that union corporate campaigns have had on other hospitals. "The object of these attacks seems to be to denigrate the reputation of the hospitals and to put pressure on volunteer boards of trustees and management to agree to the unions' organizing terms," he said. "We hope and trust that the SEIU will not use these tactics in Boston."In some cases, by the time a CEO learns that a union has targeted his or her hospital, it could be too late, says Bentley. "Long before you learn that the SEIU or any other union has you in focus, you need to be thinking about how your organization maintains positive relations with employees and the community," he says. "The task is made more difficult if you wait until a union has decided you're vulnerable-because the union has done its research and might know more about your vulnerabilities than you do."Rick Johnson is senior managing editor of HealthLeaders Online News. He may be reached at firstname.lastname@example.org.