Workplaces that used to be relatively stable are now going through major reorganization from top to bottom. New technologies are being introduced that automate functions, monitor the workforce, de-skill jobs (even as they require new skills), and generally change the nature of care. New ways of organizing work like cross-training, job combination, patient-focused care and teams are being implemented. And "change processes" like Six Sigma, problem solving groups and process improvement teams are being brought in (often with the help of outside consultants).

The restructuring in health care is impacting the lives of health care workers, both on and off the job. It is creating stress and insecurity, causing injuries and generally intensifying the work, even as it removes much of the satisfaction that comes from providing care.

Electronic patient monitoring and diagnostic equipment, robotic orderlies, tele-medicine (home visits over a phone line) and active badge systems which monitor the movements of workers throughout the facilities are only a few of the new technologies that are changing the lives of health care workers.

Work reorganization comes in many forms as well. Some of the basics are:

1. Job combination: Under nice-sounding names like multi-skilling, job enrichment, flexibility and cross-training, work is being reorganized by combining tasks that used to be part of separate jobs. Sometimes this is adding particular tasks to a job and sometimes it is combining all the tasks of two completely different jobs. It almost always ends up with fewer jobs.
2. De-skilling: New technologies or new processes are used to simplify work so that it can be handed off to lower skilled, lower paid workers.
3. Downsizing: A key part of the work reorganization picture is job elimination – simply making those who remain do more with less. Downsizing often leads to increased overtime and changes in schedules.

In order to help restructure work processes, management is using problem solving groups, process improvement teams and other mechanisms that involve members as individuals in making suggestions about how to change the work. These mechanisms are also used to soften up the workforce and gain acceptance of the changes that management wants to make.

One example of a restructuring process that is currently be introduced into Health Care is Six Sigma. Six Sigma was originally developed by Motorola and was made famous by General Electric. It is given credit for saving billions of dollars for GE, as GE’s North American production operations were being closed and jobs forced offshore.

Workers facing restructuring without a union have no real chance of inserting workforce concerns into the changes that are ultimately made. The Steelworkers Union has a great deal of experience in dealing with restructuring programs and technological change in many different industries.

Local unions are now implementing programs of ongoing bargaining over all the changes that management is trying to impose through restructuring efforts and technological change. Key aspects of a union program on dealing with change include fully investigating any potential changes, including changes in technology, work organization and management policies; evaluating the changes for impacts on the workforce and on the union; formulating bargaining demands in order to insert a union voice; communicating with the members about the changes; and bargaining with management.

Resources:

A Union Guide to Evaluating Workplace Change (PDF file)

Tricks and Traps (PDF file)

Draft Code of Conduct (PDF file)

Treat It As Continuous Bargaining (PDF file)