China, India, and Brazil are gaining ground in their ability to make the latest medical technology innovations, and may surpass developed countries in innovative healthcare delivery over the next decade, according to a PcW report published this week.
PwC's Medical Technology Innovation Scorecard: The race for global leadershipfound thatgrowth in these emerging market economies isattracting innovation resources and activity, allowing these countries to take the lead in developing a new generation of small, faster, more affordable medical devices.
"A confluence of social, demographic, economic and technology changes is altering the dynamics of the medical technology field," said PwC analyst Mike Swanick. "As a result, ecosystems that promote medical technology innovation – with supportive elements such as access to financing, scientific knowledge and patient interaction – are being established around the world, These changes are creating opportunities for companies – and entire nations – that are able to adapt to a rapidly evolving environment."
The PwC report assessed the capacity of nine countries to adapt to the changing nature of innovation: Brazil, China, France, Germany, India, Israel, Japan, the United Kingdom and the United States.
While there has been anecdotal evidence that the center of innovation is moving away from the United States, PwC says its report quantifies five factors, using 86 different metrics, to evaluate how well each nation promotes the advance of innovation, looking at the past five years and projecting change over the next decade to 2020.
The Innovation Scorecard ranks the overall capacity of each country on a scale of 1 to 9 with 9 being the highest score. A top-line view of the report finding reveals:
The U.S. currently holds its position as the global leader in medical technology innovation, and because of decades of innovation dominance, it continues to show the greatest capacity for medical technology innovation. The U.S. currently has a total score of 7.1.
The scores of the other developed nations (United Kingdom, Germany, Japan, and France) fall in a band of 4.8 to 5.4. Germany and the United Kingdom demonstrate the strongest support for innovation, and Japan the weakest.
Israel ranks near the level of the European nations, a reflection of its strong capacity to foster innovation.
China, with its economic growth engine, scores 3.4, ranking it higher than India and Brazil, each of which scored 2.7.
Looking to the future, the United States is expected to continue to lead in medical technology innovation, but also will lose ground to other countries during the next decade. The innovation scorecard also projects relative declines for Japan, Israel, France, the UK and Germany. By contrast, China, India and Brazil are likely to see gains during the coming decade.
China, which has shown the largest improvement in its medical technology innovation capacity during the past five years, is expected to continue to outpace other countries and reach near parity with the developed nations of Europe by 2020, PwC said.
PwC analyst Simon Friend said that if developed counties do not step up investment in innovation, over the next decade new markets will surpass developed countries in innovative healthcare delivery. "Stimuli for new technologies [are] being built through the education system and we will see businesses focusing on new markets for new ideas and expanding sales bases," Friend said.
The innovation scorecard examined where each of the nine countries evaluated stands in relation to five "pillars" that make the United States a leader in medical technology innovation: Financial incentives such as reimbursements for adoption of new technologies; resources for innovation, such as academic medical centers; a supportive regulatory system; demanding and price-insensitive patients; and a supportive investment community of venture capitalists and other investors, PwC said.
The scorecard showed that the innovation ecosystem itself is changing as the nature of medical technology innovation evolves. Some of this transformation is being driven by changes in the United States, such as more expensive, less-predictable regulatory approvals, an increased focus on value and cost-effective solutions in healthcare and increasingly international investments in research and development.
Other dynamics are the result of changes abroad, including increasing investment in local academic medical centers; investment in research programs; the return of foreign-educated scientists and doctors to their homelands; advancement of mobile health technologies that expand access to care; and a focus on the lean, frugal and reverse innovation necessary to deliver faster, better, cheaper and more effective healthcare solutions in these markets, PwC says.
As a result, medical technology companies increasingly are seeking clinical data, new-product registration and first revenue in markets outside the United States that are becoming more attractive and supportive of new innovation. Medical technology innovators already are going first to market in Europe and, by 2020, likely will move into emerging countries before entering the United States, PwC says.
Despite the size of the markets in China, India and Brazil, their global leadership in medical technology innovation is not preordained. Factors related to intellectual property protection, difficulty of doing business in some emerging countries and weak local supplier networks could make these markets less attractive, despite their size, and could hinder these nations' efforts to assume innovation leadership. PwC said.
Mountain State Blue Cross Blue Shield announced Tuesday that it has changed its name to Highmark Blue Cross Blue Shield West Virginia to reflect its 12-year affiliation with Pennsylvania-based Highmark Inc.
The affiliation started in 1999 and became permanent in 2004. The new name is the only change planned for the company, and services, member benefits, programs, and other offerings will remain the same. The new website will be highmarkbcbswv.com , the Parkersburg, WV-based company announced.
"After a partnership spanning more than a decade, we have decided that our name should reflect Highmark's commitment to West Virginia," said Fred Earley, president of Highmark Blue Cross Blue Shield West Virginia.
Earley said Highmark already provides support for technology, regulatory compliance, financial and investment services and human resources. "As we continue with our preparations and planning for healthcare reform, we felt that it was time to rebrand," he said. "We want our customers to know that only our name is different, and nothing will change in regards to their benefits and services. This change has always been a part of the affiliation plan, and everyone involved felt the timing was right to make the announcement as the New Year begins. "
Kenneth Melani, MD, president/CEO of Pittsburgh-based Highmark, called the name change "the next important step in our successful business partnership, and underscores how important this region is to our company."
Highmark covers 4.7 million people, and Highmark Blue Cross Blue Shield West Virginia provides or administers coverage to more than 500,000 people.
Half of "non-elderly" Americans under the age of 65 — 129 million people—might have a pre-existing medical condition such as high blood pressure or arthritis that could deny them healthcare coverage if the Affordable Care Act is repealed, according to a Health and Human Services report issued Tuesday.
"The Affordable Care Act is stopping insurance companies from discriminating against Americans with pre-existing conditions and is giving us all more freedom and control over our healthcare decisions," HHS Secretary Kathleen Sebelius said in a statement accompanying the report.
"The new law is already helping to free Americans from the fear that an insurer will drop, limit, or cap their coverage when they need it most. And Americans living with pre-existing conditions are being freed from discrimination in order to get the health coverage they need," Sebelius said.
The HHS report comes as majority House Republicans in the newly convened 112th Congress launch their attempt to repeal the healthcare reforms enacted last year by Democrats. By midday Tuesday, House GOP leaders had not responded to the report.
The health insurance lobby, however, disputed the findings.
"We have long agreed that the individual insurance market needs to be reformed, but this report significantly exaggerates the number of people whose coverage is impacted by pre-existing conditions," said Robert Zirkelbach, spokesman for America's Health Insurance Plans.
Zirkelbach said the report fails to note that most Americans get their healthcare coverage from their employers. That coverage does not take into account pre-existing conditions. In addition, he said that nine in 10 people who apply for coverage in the individual market are offered a policy, and that "many others" are eligible for public plans such as Medicaid.
The House vote is viewed largely as a symbolic gesture by Republicans, who made repeal of the healthcare reforms a central issue of the November election that won them the House majority. Democrats remain in control of the Senate, however, and have said they will not consider repeal. In addition, President Obama has threatened to veto any repeal bill in the unlikely chance that it reaches his desk.
The HHS report said that anywhere from 50 million to 129 million (19% to 50%) of Americans under age 65 have some type of pre-existing condition, including heart disease, cancer, asthma, high blood pressure, and arthritis. Americans between ages 55 and 64 are at particular risk, with 48% to 86% of people in that age bracket living with a pre-existing condition. In addition, the report projected that 15% to 30% of people under age 65 in good health today are likely to develop a pre-existing condition over the next eight years. As many as 25 million people under age 65 with a pre-existing condition are uninsured, HHS said.
Before the Affordable Care Act, Sebelius said that insurance companies in most states could deny individual coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that 36% of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance for these reasons.
Although most of the provisions of the Affordable Care Act don't take effect until 2014, several already are in place. For example, insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents' coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition, HHS said.
Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan, which provides private insurance to those locked out of the insurance market because of a pre-existing condition. The PCIP program serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a pre-existing condition, HHS said.
Community Health Systems, Inc. on Friday said it would back a full slate of 10 nominees for the Tenet Healthcare Corp. board of directors at the rival hospital company’s annual meeting this fall in an attempt to oust the current board, which in December rejected CHS’s $3.3 billion unsolicited takeover offer.
CHS Chairman/CEO/President Wayne T. Smith said the action was necessary because the current Tenet board refuses to discuss what he has called a generous acquisition offer that would benefit Tenet shareholders.
“By just saying no to our 40% premium offer, installing a poison pill with a 4.9% trigger, and delaying the 2011 Annual Meeting for six months -- instead of entering good-faith discussions with us -- Tenet’s highly paid board has clearly demonstrated its entrenchment,” Smith said. “Tenet shareholders deserve better. Accordingly, we have today taken the first step in running a full slate of 10 highly qualified independent directors to replace the existing Tenet board. If elected, these directors will act in the best interest of Tenet’s shareholders and carefully evaluate the value-creation opportunity represented by the CHS offer.”
On Nov. 12, 2010, CHS made an unsolicited offer to buy Tenet for $6 per share, including $5 per share in cash and $1 per share in CHS common stock. CHS said at the time that the offer was a premium of 40% over Tenet’s unaffected stock price. The offer was rejected by Tenet’s board on Dec. 6, and CHS made public the details of the offer on Dec. 9.
Tenet issued a statement Friday defending its rejection of the CHS offer, and noting that the company’s board had “delivered strong growth for more than five years.”
“We believe that Community Health has nominated its slate of director candidates only to advance its goal of acquiring Tenet at an inadequate price. We are confident that the continued execution of our strategic plan will deliver significantly more value to our stockholders than Community Health’s inadequate proposal,” Tenet said in a written statement.
“We firmly believe that Tenet’s stockholders – not Community Health – deserve to benefit from this growth. Tenet’s Board and management team will continue to act in the best interests of all its stockholders, and remain focused on executing our core business plan and capitalizing on Tenet’s leading position in healthcare services,” Tenet said.
Tenet delayed its 2011 annual meeting for six months, until Nov. 3, and its entire board is up for reelection.
CHS said its nominees are:
Thomas Boudreau, 59, who most recently was executive vice president, law and strategy of Express Scripts, Inc. and previously served as senior vice president and general counsel of Express Scripts.
Duke K. Bristow, 53, an economist at the Marshall School of Business at the University of Southern California, and a specialist in corporate governance and finance.
John E. Hornbeak, 63, is an executive in residence in the Department of Healthcare Administration at Trinity University, and was president/CEO of the Methodist Healthcare System of San Antonio, TX.
Curtis S. Lane, 53, a healthcare mergers and acquisitions banker, and senior managing director of MTS Health Partners, LP, a merchant bank providing advisory and investment services to healthcare organizations.
Doug E. Linton, 63, a self-employed consultant through DEL International, LLC, a pharmaceutical channel management consulting company.
Peter H. Rothschild, 55, managing member of Daroth Capital LLC.
John A. Sedor, 66, is president, director/CEO of CPEX Pharmaceuticals, Inc.
Steven J. Shulman, 59, a senior advisor to Warburg Pincus and is an operating partner at Water Street Healthcare Partners and Tower Three Partners. Previously, he was chairman/CEO of Magellan Health Services.
Daniel S. Van Riper, 70, CPA, an independent financial consultant.
David J. Wenstrup, 46, a consultant with Clinton Climate Initiative.
Alternate candidates are:
James O. Egan, 62, non-executive chair of PHH Corp. Previously, he was managing director, Global Private Equity at Investcorp International, Inc.
Jon Rotenstreich, 67, managing partner of RF Partners, a financial advisory and investment firm, and a founding principal of Bayer Properties Inc., a real estate development company.
Gary M. Stein, 60, a principal at the Stein Consultancy, LLC. He served as president/CEO and director of Touro Infirmary Health System, and chairman of the Metropolitan Hospital Council of Greater New Orleans.
Larry Yost, 72, former chairman/CEO of ArvinMeritor, Inc., an automotive supplier.
Community Health is located in Franklin, TN, and is the largest publicly traded hospital company in the U.S., with 126 hospitals in 29 states and 19,400 licensed beds. It also says it is a leading operator of non-urban and mid-size market general acute care hospitals.
Based in Dallas, Tenet owns 49 acute care hospitals in 11 states, 64 outpatient centers and has 57,000 employees.
Healthcare is a complicated business, and it won't get any simpler with the advent of sweeping federal healthcare reforms that include complicated new standards for care, quality and reimbursement.
And, however much electronic medical recordsmay improve care and efficiency, there is a steep learning curve for these complex systems. Most of these adjustments are done on the job, under duress, while dealing with anxious patients, creating no small amount of stress for healthcare workers. Physicians' staff at off-site offices are particularly vulnerable to these stresses because they perceive that they don't enjoy the same support or access to help that is available for staff inside hospital walls.
With that in mind Broward General Medical Center in Fort Lauderdale, FL, created "Broward General University." The free program of eight, once-a-month, midday classes for up to 40 office managers of affiliated physicians at the hospital was started last year and designed to enhance their knowledge of healthcare reforms and provide a variety of strategies for other daily issues.
Maybe they should call it Reform U.
"We wanted to have a program to reach out to our physicians' office staff," says Anthea Greaves, Physician Services and Medical Staff Coordinator at North Broward Hospital District. "The healthcare reforms and the medical records becoming electronic, those are some huge changes happening in the healthcare industry that are going to impact physician practices We wanted to give back to our physicians on staff by allowing their office managers and staff to be trained on various issues, whether it be claims and collections or learning how to motivate staff."
Topics for the 2011 Physician Office Staff Education Series, which runs from March through October, include managing stress in the office, difficult patients, patient access, insurance verification, hospital scheduling, claims and collections, motivating staff, marketing and advertising, negotiating contracts with insurance carriers, and case management.
There are also hands-on training and networking opportunities, and a chance to speak with guest instructors. "We are offering practices strategies on how to deal with claims and collections, negotiating contracts with different insurance carriers," Greaves says.
"We did a survey of the last participants of the first series and one of the popular topics that came up was stress and difficult patients, along with patient access and marketing ideas for the practice," she says. "The industry has changed where physicians are left on their own in a private practice where they don't necessarily have the tools to market the practice and bring in the business."
This is a great idea, and a remarkable and cost-effective way to promote engagement with physicians and their staff. With so much going on inside the hospital walls, it would be easy to forget about the critical role that physicians' office managers and staff play in coordinating care. Courses such as these not only provide practical solutions-based training on specific issues, they also provide a valuable outlet for office managers to build professional relationships and socialize with colleagues. Perhaps most importantly, these classes send a strong message that BGMC values its physician partners and their staff.
Nine months after pleading guilty, Guidant LLC was formally convicted and sentenced this week in St. Paul, MN, for failing to report to the federal government life-threatening defects in the medical device maker's implantable cadrioverter defibrillators.
U.S. District Judge Donovan W. Frank ordered Guidant, a wholly-owned subsidiary of Boston Scientific Corp., to pay more than $296 million in criminal fines and forfeiture, and to submit to three-years of supervised probation.
The Justice Department brought criminal charges against Guidant for failing to notify the Food and Drug Administration about short-circuiting failures in three models of its implantable cardioverter defibrillators: the Ventak Prizm 2 DR (Model 1861) and the Contak Renewal (Models H135 and H155). Guidant's Cardiac Rhythm Management division, which produced the defibrillators, is headquartered in Arden Hills, MN.
Guidant was charged in federal court last February, and pleaded guilty in April.
The surgically implanted defibrillators monitor electrical activity in a patient's heart for deadly arrhythmias, and deliver an electric shock to the heart to return the heartbeat to normal rhythm. If they fail, a person can die within minutes.
"FDA always works closely with companies to support compliance with standards that prevent serious safety problems from occurring," said Margaret Hamburg, MD, commissioner of Food and Drugs. "However, as today's sentence demonstrates, when companies fail to comply, we will use our enforcement tools to ensure the safety and efficacy of the medical products that Americans rely on every day."
Federal prosecutors said Guidant hid information from the FDA and medical professionals about the device failures. In June 2005, the company finally went public with information it had known for 10 months, and only after three deaths had occurred.
The Justice Department's sentencing memorandum said Guidant continued to implant hundreds of defective Renewal devices, even after the company stopped shipping them from the factory because of the health risk.
Prosecutors said Guidant developed a strategy to mitigate the health risk while not raising FDA suspicions about the problem. This strategy included the company advising its sales reps to tell physicians that "nothing was broken" with the Renewal, and falsely telling the FDA that changes it proposed to the device to correct the electrical short-circuiting "were not being done to correct device flaws that threaten patient safety" but were rather "to improve process throughout." Under the sentence handed down Wednesday, Guidant will forfeit $42 million and pay a criminal fine of $253 million.
Guidant was sentenced to three years of probation, submit quarterly reports to the U.S. Probation Office, and allow regular, unannounced inspections of its records. The court also required Guidant to notify its employees and shareholders of its criminal conviction.
In a written statement, Guidant said, "The DOJ's investigation began prior to Boston Scientific's 2006 acquisition of Guidant, as did the alleged conduct and product sales. The Company no longer sells the products involved in the investigation."
Signature Hospital Corp. CEO Charles Miller said Wednesday he would retire on Jan. 31, as the Houston-based company announced plans to sell its three hospitals and wind down operations by the end of 2011.
"Our decision follows months of careful deliberation on the future of our hospitals and the Company," said Signature CFO Steve Peterson.
Founded in 2005, privately held Signature owns and operates: St. Joseph's Hospital in Parkersburg, WV; Pampa Regional Medical Center in Pampa, TX; and Gulf Coast Medical Center in Wharton, TX.
"Based on current economic conditions and the impending healthcare reform, we believe Signature does not have the scale to continue to ensure long-term financial stability for Pampa Regional Medical Center and Gulf Coast Medical Center," Peterson said. "We hope to have the sale of St. Joseph's completed in the 1st Quarter of this year and the sale of the two Texas hospitals finalized before the end of 2011."
FTI Consulting was hired to find a buyer for Signature's Texas hospitals, and to manage them in the interim. In September Signature announced that it would sell St. Joseph's to West Virginia United Health System.
"It's in the best interest of the hospitals and the communities that they serve that we not only find the right buyer, but that we also find the right firm to assist in the day-to-day operations of the hospitals while we are working on the sales process," Peterson said.
PRMC is a 115 bed acute-care hospital located 60 miles northeast of Amarillo and 180 miles north of Lubbock. GCMC is a 161 bed acute-care hospital located 55 miles southwest of downtown Houston and 30 miles from Sugar Land, Texas.Both hospitals will continue normal operations during the transition.
A consumer watchdog group is criticizing the Blue Cross Blue Shield Association's hiring this week of a high-profile former state insurance commissioner as a lobbyist, saying the appointment of Kim Holland raises "tremendous concerns" about the revolving door between politics and lobbying.
Holland was until November insurance commissioner for the state of Oklahoma, and treasurer-secretary of the National Association of Insurance Commissioners.
Craig Holman with Public Citizen said Holland's appointment raises "tremendous concerns" about conflict of interest. "This is the classic abuse of the revolving door. What Kim is selling is not so much expertise but her Rolodex. She is well connected with those who are in government making decisions that directly affect the insurance industry, and the industry realizes that," Holman says.
Holland was the first woman elected insurance commissioner in Oklahoma in 2006 after having been appointed by Democratic Gov. Brad Henry in January 2005 to fill an unexpired term. In November she was defeated by Republican challenger John Doak, 47, who strongly opposed federal healthcare reforms.
Holland said Holman's concerns are baseless. "I have heard that statement about revolving doors throughout my tenure as insurance commissioner," she said. "I've spent my entire career in the insurance industry. Before I was appointed insurance commissioner I was a health insurance broker and consultant. That is one of the reasons why I was tapped for insurance commissioner. Our governor, and then later the voters, wanted someone who could come into the insurance department with not only knowledge of the industry but knowledge of consumer needs."
Holland said her "values are very much aligned" with BCBSA, particularly with respect to support for federal healthcare reform. "My role is to help provide resources at the state level to help them work with their policy makers to implement the important reform measures, to make sure we get people insured, that we improve the delivery system, and that we lower costs," she says. "That is what I worked on as commissioner and this is a wonderful opportunity for me to continue to work on the things that I think are important to the citizens of America."
Healthcare workers can expect an average base salary increase of 2.6% in 2011. That's up from the 2.3% base increase reported in 2010, but slightly below increases of 2.8% projected across all industries for 2011, according to a survey from Hay Group consultants.
"The healthcare industry did not see salary budgets fall until 2009, while other industries felt the effects of the recession much sooner, lowering salary budgets as early as 2007," said Ron Seifert, executive compensation practice leader for Hay Group's healthcare practice. "So, while healthcare is still 0.2% behind other industries, it seems to be rebounding at a faster pace after taking a deeper dip in a much shorter timeframe."
The survey found that 18% of respondents in all industries said they will maintain a salary freeze across all levels in 2011 to reduce compensation costs, while 4% of respondents in healthcare reported an across-the-board freeze on salaries.
"Healthcare providers have felt the pinch, but salary budgets are beginning to move upward, mirroring the slow ascent we are seeing in the broader economy," Seifert said. "Interestingly, healthcare salary trends are also starting to track those of other industries, which we haven't seen for at least a decade."
Fewer healthcare executives will see their salaries frozen in 2011, with 8% of organizations reporting a freeze of executive pay. That's compared to more than 20% of organizations that reported freezing executive pay in 2010.
Hay Group's survey also shows a parity of planned salary increases for healthcare employees in 2011 with both executives and all employees seeing a 2.6% increase.
"With executive salary budgets rising at the same level as staff this year, it's clear that boards are concerned about public perception of executive pay," Seifert said. "However, it's critical that compensation committees balance their concern of scrutiny with their need to attract and retain the best possible talent to lead their organizations."
Salary increases for physicians are still lagging at 2.3%, while nursing will see a 2.7% salary increase in 2011. High performers will see less than 1% more than all employees with 2.8% planned base salary increases for 2011. "With limited budgets, healthcare organizations are still resistant to differentiate pay for top and average performers," Seifert said. "However, if healthcare organizations want to retain high performers and high potentials, they need to treat them fairly – which does not always mean that everyone gets the same amount."
The survey uses data from more than 486 organizations in November 2010 in the general industry survey, and 90 hospitals and health systems of varying size, structure, and location in the healthcare survey. Respondents include compensation professionals in human resources departments. Hay Group's core compensation database represents compensation practices for almost 3,000 companies and more than 6 million employees.
Amid the volumes of stories written lately about the GOP takeover of the U.S. House, one item captured the pettiness of the political classes and special interests that claim to be working in our best interests.
The Hill reports that one of the first acts of the newly empowered House Republicans was to remove the word "Labor" from the committee formerly known as the House Education and Labor Committee. For the next two years that committee will be known as the House Education and Workforce Committee.
Labor relations remain one of the most contentious issues in healthcare, affecting the lives of millions of people who work in this nation's hospitals and other provider settings. The search for common ground is a daily battle that is critical to successful healthcare delivery. In the larger economy, there are about 15 million unemployed people in the United States – many of them jobless for several months, according to the Bureau of Labor Statistics. These people are hurting. And the first action by a key House committee that is supposed to address relations between management and labor, and the plight of the unemployed is to remove the word "labor" from the committee name. Wow! That'll fix 'em!
In what could be interpreted as just a wee bit of hyperbole, Chuck Loveless, director of legislation at the American Federation of County, State and Municipal Employees, told The Hill "this name change is symbolic of the new majority's hostility toward the rights of everyday working Americans."
No, Mr. Loveless. It's just politics — returning favors to the people who donated money to get you elected. Both sides do it.
Alexa Marrero, a spokeswoman for the House Education and the Workforce Committee, coyly feigned bewilderment at labor's objections to the name change when she told The Hill that the unions' claim that the name change reflected hostility toward workers was "bizarre" because union members are part of the workforce. She said Republicans changed the panel's name to reflect its "broad jurisdiction over polices that affect American students, workers, and retirees."
Not exactly Kumbaya. And this is just the first week.
We could go back and forth about which side started this hostility. It wouldn't settle anything. For every point or past grievance one side brings up, no doubt, the other side will have a counterpoint. This has been going on for decades and it's not going to change. President Obama used recess appointments to stack the National Labor Relations Board with union cronies, for example, but only after the board was run for years by management-friendly appointees under President Bush.
Here's the problem: The rest of us have to muddle through with the actions of these highly charged partisans whose first order of business is to destroy the middle ground. These actions fuel rancor, distrust, divisiveness — and paranoia — and set a terrible example for union-management cooperation that people in the real world have to strive for.
Many management consultants on labor issues — while obviously not enamored of unions— also understand that hard-headed, heel-digging opposition and denial on the part of management are not good strategies for keeping unions at bay. Employee engagement is far more effective. Jay Krupin, a veteran labor relations attorney, told me recently, "Employees only go to unions when they feel the employer is not listening. Unions don't organize employees, managers do."
Unions are a reality, they have a proud tradition of standing up for working people, they've indisputably improved the lives of tens of millions of people, and they are here to stay, particularly in healthcare. Deal with it.
However, unions lose public support when their top priority is perceived to be self-preservation of their members — particularly senior leaders — at the expense of raising standards and the common good. Teachers' unions have been particularly and effectively maligned for this. But healthcare unions will run the risk as well if they're not careful. Is the push for mandatory staffing ratios for nurses fueled by a genuine desire for better care, for example, or a savvy strategy to sign up more dues-paying union members? Are unions truly interested in employee engagement with management, or do they resist engagement because it weakens "them-against-us" organizing efforts?
There's nothing wrong with debating the management-labor relationship, and taking a firm stance on one side or the other. At some point, however, even capitalist stalwarts such as Henry Ford realized that compromise has to be brokered or nothing gets done. Most people outside of Congress understand this.
In Congress, however, politicians and special interest lobbyists are so intent on gridlock, turf wars, maintaining the status quo, and appealing to their hyper-partisan bases that they have no interest in compromise. In fact, they're encouraged not to compromise; praised for their resolve when they're inflexible, and scorned by true believers when they cede ground. These are the people who are supposed to lead us.
In the real world responsible people — managers and staff — work in common purpose to meet timelines, budgets and other important responsibilities. They are held accountable if they don't. They shouldn't look to Congress for leadership. They should look to themselves.
