Category Archives: Working at OHSU

Conflict Coaching Certificate Program Now Accepting Applications

 

Applications for the next cohort of the Conflict Coaching Certificate Program, offered by the OHSU/AFSCME Career and Workplace Enhancement Center are due on Friday, November 15. This is a unique training opportunity that only occurs every two to three years, and half the seats in this cohort are reserved for AFSCME members.

Are you a good listener? Are you comfortable handling conflict? Are you motivated to serve the OHSU community? The CWE Center Conflict Coaching Certificate Program identifies strong interpersonal communicators at OHSU and trains them to provide conflict coaching in order to help colleagues manage early stages of workplace conflict.

Qualifications:
• Be an OHSU employee in good standing
• Attend all required training sessions
• Commit to four hours of coaching per month after certification
• Demonstrate an aptitude for coaching during the application process
• Provide a letter of support from  your manager

Applicants must be available for trainings from 9:00 a.m. – 1:30 p.m. on Thursdays from January 16 through February 27. The program may also require additional time commitments.

For additional information, visit  the program page on O2.  To apply for the program, submit the online application by Friday, November 15.

EBC Decision Revisited—Wellness Surcharge Indefinitely Delayed

 

We are pleased to inform our bargaining unit that on Tuesday, August 27, the Employee Benefits Council voted to rescind the wellness decision made earlier this year. This means that the wellness requirement/surcharge is indefinitely delayed until the EBC gathers further employee feedback and conducts further evaluation.

As stated in our previous blog article about this matter, our union’s representatives on the EBC had been led to believe that the OHSU president would break any tie and the surcharge would proceed regardless of how our union voted, and that it was better to vote yes and be an active participant in planning the program than vote no and refuse to participate.

Upon further discussion in recent days, we learned that OHSU did not have the intention to have the president break the tie; our understanding of other aspects of the wellness requirement/surcharge also changed. Because of this, our EBC representatives’ rationale to vote yes also changed. Our union appreciates OHSU’s willingness to revisit this decision, and we are grateful that the entire EBC supported suspending the wellness surcharge indefinitely.

Our union does support employee wellness initiatives and we do want to find ways to save our members’ money on their health-insurance premiums through improved health outcomes. However, it’s clear that we need to gather more feedback from our members before our EBC representatives make decisions about wellness initiatives. 

In the days ahead, our union’s representatives on the EBC will also be changing. Please stay tuned for additional information.

EBC and the Wellness Requirement

 

Note: This EBC decision has been rescinded, so comments are now closed on this post. Please see the update for additional information and commentary.


Several days ago, OHSU announced that it is resuming a wellness requirement, with a surcharge for non-compliance. This has understandably has upset a lot of our members and other OHSU employees. While the information we’re sharing here won’t change any minds about the wellness requirement itself, we hope that it does illuminate the process behind the decision and ease folks’ minds about our union’s role in the EBC. (We apologize that it has taken us a few days to get this information out to you.)

What is the Employee Benefits Council?

The EBC is a body that provides employee input on OHSU’s benefits decisions. It is made up of representatives from AFSCME and ONA, as well as unclassified employees (management and faculty). OHSU has three votes, AFSCME has two and ONA has one. The EBC is responsible for making decisions about OHSU’s medical-plan design and benefits, including health-promotion and disease-management programs. In the event of a tie vote within the EBC, OHSU’s president (or designee) serves as tie-breaker. 

Why aren’t these decisions made during bargaining?

While our union successfully negotiated a contract that preserved existing benefits contributions, expanded our bereavement-leave options and prevented a spousal surcharge, certain decisions fall within the scope of the EBC and aren’t part of contract negotiations. The EBC determines things like what types of medical plans OHSU offers, what vendor is used to administer claims (e.g., Moda) and what wellness programs are offered (and what sort of incentives or penalties might be applied). Previous iterations of the EBC have approved wellness requirements such as getting a flu shot or taking an online health assessment. 

What are the disadvantages to the current structure of the EBC?

When the EBC was discussing the wellness requirement and surcharge, many of its members expressed a desire to see more of a “carrot” and less of a “stick” approach to employee wellness. Although the EBC was designed to work by consensus, one of the disadvantages its current structure is that OHSU can ultimately force through a change or new requirement if consensus can’t be reached. Since OHSU has three votes by itself and the two unions have three votes total, a tie can result. If the unions vote against something OHSU wants, OHSU can take the issue to its president to break the tie and side with the employer. We wrote about the problems with this model about a year ago (see here).

Why couldn’t AFSCME have prevented the surcharge?

Some of you may recall that in 2018, AFSCME won an arbitration against OHSU about the EBC trying to force a spousal surcharge. (OHSU tried this again during bargaining this year and was again defeated). The arbitrator determined that a surcharge like the spousal surcharge cannot be implemented by the EBC. However, the arbitrator specifically called out OHSU’s previous wellness surcharges and its existing tobacco surcharge as examples of surcharges that are justifiable under our agreement. This means that OHSU has the authority, through the EBC, to impose a surcharge associated with non-compliance with a wellness program.

Why did AFSCME’s EBC representatives vote for the wellness requirement?

To summarize the situation: OHSU decided that resuming a wellness requirement with a non-compliance penalty was a priority and proposed it to the EBC. (The amount of the surcharge is the same as in previous years.) A recent arbitration decision highlighted that a wellness surcharge was within the purview of the EBC. OHSU has half the votes in the EBC, and the ability to break a tie should the need arise. Simply stated, there unfortunately wasn’t a scenario in which the wellness requirement and surcharge weren’t going to happen.

We realize that many of our members don’t understand why our union’s EBC representatives didn’t vote no on this on principle. By voting no, we would have given up any role in the process and any chance to make the requirements less onerous for our bargaining unit. After weighing it over, we felt that AFSCME could better serve our members by being an active participant and working to mitigate things to the best of our ability.

What does this mean, practically speaking? We were instrumental in getting OHSU to offer the screenings more frequently and in more locations, to make the process less inconvenient. The health evaluation is now narrower in scope from OHSU’s initial plan. Employees who are penalized will be able to appeal that decision before an appeals committee and our union will have representation on that committee. Other ways the requirement has been made less burdensome include offering resources to employees who speak English as a second language, offering the screenings during a variety of shifts and including the option to be screened by one’s own medical provider. We are also firmly committed to get an extension of the deadline for compliance with the requirements. 

What can we do to change things?

In the short term? The EBC can always amend its decisions. Keep the feedback coming! The EBC works on plan design every year, so things could change in 2020.

In the long-term? While we can’t do anything in bargaining to eliminate wellness requirements, we absolutely can fight to change the structure of the EBC to hopefully prevent this kind of thing from being implemented in the future.

Some of you may recall that during the negotiations that just ended, our union introduced a proposal that would have prevented OHSU from using Dr. Jacobs to break a tie to get its way — instead, the EBC would have been required to work through any ties until consensus is reached. (You can read more about our proposal here.) Not only did OHSU refuse to consider our proposal, it made a counterproposal to turn the EBC into an advisory body only, meaning our members would have effectively had no voice in the process at all — instead, OHSU proposed that the vice president of HR (yes — Dan Forbes!) be the ultimate decision-maker about your benefits. While OHSU dropped that proposal, management made it abundantly clear that we wouldn’t reach an agreement that included our proposed change to the EBC. Our bargaining team didn’t feel that this was strike-worthy as a stand-alone issue, so we withdrew our proposal. Our union will absolutely reintroduce this proposal during negotiations in 2022.

“If Our Union Can’t Fight for Us, Who Will?”

—guest post by member Anna G.*—

I began my career at OHSU in 2012. When I was choosing which clinical site to spend my externship at, OHSU was the very first choice on my list. I still remember the butterflies in my stomach when I received confirmation that I would be learning at this institution. My face lit up with pride and glee every time I told someone where I worked. My family was absolutely ecstatic when they learned that I would be starting my career at OHSU. I was the first woman in my family on both sides to graduate from high school, much less go to college. There were times when my grandmother would tell strangers in the supermarket while I took her shopping, and the glow in her face as she did this would bring me tears of joy. I couldn’t have been more proud and delighted to be affiliated with OHSU.

Not long after I started at OHSU, the first round of AFSCME contract negotiations came about. It was disheartening to learn that so many take-backs had occurred. I especially remember the longer duration for step increases and how it would take more years of employment to reach the top of my pay scale. Even so, I still held onto the joy and pride I felt to be part of such an amazing hospital.

A couple more years went by and I started to feel a bit more ragged. The workload and patient population had increased substantially, yet the staffing levels had not. I was being forced to work a lot of mandatory overtime to make up for it. I had to stay late and come in on my days off on a weekly basis. As a single mother, this was very taxing. I was starting to miss out on my children’s lives, due to having mandatory overtime constantly hanging over my head. I couldn’t afford OHSU’s high parking rates, and instead rode public transit to work from across the city — my three-hour round-trip commute added to my frustration. Even with all the hours commuting and working at a fast pace, I was still a proud employee of OHSU.

Then everything took a turn for the worse — a coworker started harassing me. After a year of asking him to leave me alone and stop paying me so much unwanted attention, I faced my fear, risked humiliation and spoke up, asking for help from my supervisor. I thought that my courage in seeking help with the situation would be dealt with appropriately — after all, it’s OHSU, the hospital that talks about diversity and “respect for all” as easily and as often as the rain falls in the Pacific Northwest.

My concerns were alternately ignored and dismissed by my supervisor, and the harasser’s behavior was allowed to continue. My coworkers started to become concerned. I became an empty shell of a woman. I feared coming to work. My self-worth and self-esteem had all but disappeared. I was told that I was creating discontent in the workplace and was made to feel as though all this was somehow my fault. His actions were being validated by inaction and the whole thing was being swept under the carpet. With nowhere else to turn, I reached out to my Local 328 representative.

Within 10 minutes of the conversation, my union rep had me on the phone with two different departments for help. My rep went to bat for me in all of the management offices in my department, demanding that something be done. My rep gave me the advice I needed and made me feel heard and that someone was on my side. Even with my union representative fighting for me, I still had to utilize the justice system in order to ensure my safety at work. After all the time, anxiety, sleepless nights and heartache, I was finally able to come to work without fear of sexual harassment. I was able to start to breathe again — or so I thought.

The retaliation from OHSU that ensued after this hit me like a ton of bricks. All I ever did was cry for help, but I was punished for bringing light to my situation. How dare I tarnish the golden name of OHSU?

All this went on while my department was consistently understaffed, while my overworked coworkers and I attended meetings where staff were told about record-breaking exam numbers for our department and record-breaking profits. Now OHSU wants to take more away from me and my family. My family and I used to feel pride and joy about my employment at OHSU. Now that has been replaced by fear, sadness and distrust.

We need our union to fight for us. I can’t imagine how my situation would have turned out without our union supporting me. I can’t imagine how much worse OHSU would become without our union keeping it in check. Our solidarity means more now than it ever has.

*Name has been changed.

Patients Deserve Rehab Services

Sign Our Petition For Excellent Patient Care

For the last two months we have been describing how the staffing model regarding use of part-time FTE and the productivity system in use by OHSU’s Rehabilitation Services Department affect the rehabilitation therapists.

We believe this model and system has resulted in the loss of wages and benefits to rehab employees as well as producing possible wage and hour law violations by creating conditions which lead to employees working off the clock. Other impacts include the inability of employees to avail themselves of continuing professional education and increased staff turnover rates due to low morale and provider burnout.

Now let’s talk about patient care

Rehab members tell us that OHSU chronically and systematically understaffs the department. Simply, there are not enough therapists to provide services to the patients.  When members raise concerns and ask for more staff, they are told the budget does not support it because the department does not meet the productivity numbers. Previous articles (Timekeeping and Patient Care) have shared the errors in OHSU’s productivity system. Here are some examples from members about the lack of patient services:

  • The NICU (babies in intensive care) is staffed with one therapist per, on average, about 40 patients.
  • Acute Pediatrics has no Occupational Therapy coverage in the hospital on Sundays or holidays. There is often no Physical Therapy coverage in the hospital for Sundays.
  • Adult Acute Occupational Therapy is not available on Sundays, holidays or in the medical, trauma/surgical or cardiovascular ICUs.
  • Adult Acute Physical and Occupational Therapists are so understaffed that most therapists are routinely assigned 2-3 times the number of patients they can see in a day.
  • Adult Acute Speech Language Pathology had chronic and severe staffing shortages the past year and only recently achieved staffing at a level appropriate for patient care needs.
  • Often patients in Inpatient and Outpatient care are able to receive an evaluation, but have delay in follow-up treatment services. In some cases in acute care, a patient may go several days without services because there is not enough staff.
  • Adult Acute Rehab has only one rehab aide to provide assistance to the entire department, a position essential to providing assistance to therapists for patient care.

The ultimate result of OHSU management’s staffing plan is the daily certainty that many patients who need to be seen by rehab therapists will not receive rehab services. No amount of efficiency, productivity or working off the clock will change that. Patients not getting seen is directly related to OHSU management’s staffing and budget plan. Members would like to share more specific data in support of these claims, but are fearful of retaliation by the organization.

What happens when patients who need rehab therapy services don’t receive them, or receive them late or at sub optimal frequency?

Our members raise concerns that several undesirable outcomes are possible:

  • Patients may suffer loss of function or sub-optimal functional recovery
  • Patients may suffer longer length of stay
  • Sub-optimal discharge planning
  • Lower patient satisfaction
  • Moral distress/burnout for rehab providers

All of this can combine to result in increased costs to OHSU related to longer patient length of stay, less available beds for new admissions due to delayed and sub-optimal discharge, return of patients to the hospital due inability to succeed at discharge, and poor recruitment and retention of rehab staff.

Members have and continue to raise staffing concerns directly with their manager(s) and director. Members have and continue to raise staffing concerns through the employee engagement survey process. Our union has repeatedly raised these concerns to OHSU leadership.  The staffing issues continue. The patient care concerns continue. The stress on therapists trying to accomplish what is literally impossible, continues. Fear of retaliation for speaking up about these issues continues.

OHSU leadership needs to address these concerns, with our members and our union, in an atmosphere that can be guaranteed to be free of retaliation.

“I stand with all my colleagues” – Our Readers Respond

“I stand with all my colleagues.”

Over the last six weeks we heard this many times, from coworkers, former staff, and public employees outside OHSU. It’s uplifting to read and hear expressions of support.  Comments on our articles about the ongoing issues in the Rehab department have been, at once, eye opening, compassionate, devastating, expressing the full range of emotions from outraged anger, compassionate concern, and most commonly, disappointment with OHSU.

In this article we turn the page over to those who cared enough to share their stories and thoughts with us.

“It takes courageous authentic leadership and advocacy to stand against exploitive health care delivery models. OHSU is perched to see and lead the way. Isn’t it? It requires a servant heart and leadership style to care, to push for change and align the walk with the words, for the sake of all stakeholders.”

“As a former employee of the OHSU rehab department I understand what all of the therapists are going through. I LOVED my job. But the culture of negativity created by management made the daily stress no longer sustainable, so I left a job and coworkers that I loved. I am proud of what the rehab department is doing now in collaboration with AFSCME, and I truly hope real change is created.“

The benefit of our OHSU rehab specialists is unmeasurable. They are INCREDIBLE and an invaluable member of the critical care team! As an ICU RN, I am totally grateful for all the hard work and expertise they provide and am disappointed to hear they are being treated this way. Not only is OHSU harming their relationship with their employees, they are threatening the successful outcomes of their patients.”

Coming to work for the OHSU rehab department was something I was very proud of until realizing the complete lack of support there is from the management level.”

“I’ve worked in the ICU and acute care alongside many hardworking, professional, and dedicated practitioners in rehab services. Their work is crucial to getting our patients out of the ICU and discharged from the hospital. They are integral members of our team and we can’t give our patients the best care without them. I can’t imagine the stress and demoralization they are feeling in this work environment. “

I’m proud of the rehab team coming together to fight for fair treatment and quality patient care. Thank you all for sharing your stories! We stand united!”

“Thank you all for sharing. I can’t express how validating it feels to read this posting and some of these comments. As an acute care clinician on the OHSU rehabilitation team I echo all the aforementioned remarks. I too fear that OHSU is not a place I can set the roots of my career due to mismanagement and lack of support.”

“ We are supposed to be the premier hospital in the region, providing the most up to the minute evidence based care. Our upper Management can’t support the one measure that has been proven throughout the years of research to provide favorable outcomes from patients across the spectrum of illness and injury. Our patients and staff deserve so much “

“ I work as a nurse in an adult ICU at OHSU and our P.T.s are a crucial part of our treatment team. The patients in my particular unit are extremely ill, both chronically and acutely, and generally require a great deal of time and staff in order to mobilize. The therapists I work with ROUTINELY go above and beyond to make sure their patients get the services they need in order to ultimately discharge from the hospital and be safe in doing so. “

“As someone who has been through physical therapy, I cannot fathom how this could or should ever be measured by quantity of throughput. Quality of treatment, both physically and emotionally, are critical to success. Having the patience and skill to push someone through a sometimes horribly painful process and to keep their patient’s spirits up is vital to recovery.”

Time and time again, during staff meeting after staff meeting and employee engagement survey after survey, therapists consistently report patient care as the single most rewarding aspect of their profession and the primary contributor to job satisfaction. This has worked out supremely well for the organization so far, as many of us continue to work under these demoralizing conditions because we simply love what we do and want to provide the best patient care possible, and therefore put up with this state of affairs .”

“So many aspects of being a good therapist-of going above and beyond-involve tasks/time which may not be “billable.” Management does not care. OHSU does not care. These productivity expectations are only creating a toxic work environment, not contributing to quality patient care, and are discouraging professional development.”

Throughout the course of these reports it has been clear that the first concern of therapists has been the well being of their patients. Outside of the most basic concerns – not wanting to be disciplined for taking the time to give the best patient care and wanting to be compensated for the time they are actually working, almost none of this is about them. It’s about their patients first, their love of and concern for their professional responsibilities second, and themselves third.

We are grateful for your continued support.

Rehab Concerns: Working Off the Clock, Split Shifts and Curtailment

Over the last month several members of the Rehabilitation Services Department raised concerns about having to work off the clock, being asked to clock out during their shift if not seeing a patient and feeling pressured to clock out during their shifts in order to keep their productivity ratios high. Additionally, legal and ethical concerns were raised over management suggested billing practices in order to improve productivity metrics.

We interviewed members over a period of about two weeks.

  “We are asked to clock out if patients cancel, but patients don’t get charged if they don’t cancel in a timely manner. The assumption is that if a patient cancels we should clock out. But we have work to do other than give treatments to patients. We are left with the choice of working off the clock or clocking out; otherwise our productivity stats suffer.”

“They don’t do shift curtailment per contract, they just curtail based on whether or not individual patients cancel.”

“Employees do charting on lunch, about 90% chart on lunch breaks to get our charts done. If a patient calls in the night before we get told to come in late. I get here early to do chart reviews before my shift starts [without pay]. It’s the only way to keep productivity up.”

“If you don’t keep your productivity numbers up you get denied the opportunity for continuing education, you get emails and phones calls.”

“It’s easier to work off the clock than deal with all that.”

One former member spoke with us shortly after she left OHSU to work at a competing health care facility. They state that:

“75% of therapists chart through their break and lunch.”

“You can go into the break room and see people eating and charting at the same time. Managers see it and they know it’s going on but they don’t say anything to discourage it.”

“If you mention working off the clock in an email they will tell you not to because they know it’s wrong, but they set up conditions so that the only way you can meet productivity is to work off the clock for many people.”

“Productivity is impacted by things therapists have absolutely no control over. They feel that they have to make their units this week so they have to work through lunch to make units.”

Members told us if therapists take paid time to chart, they will not have enough units billed in relation to hours worked to make their productivity standards. Several members also said that consideration is not given that some patient cases require more charting than others, especially evaluations. There is pressure to make productivity even if it means working off the clock.

“Employees are denied the right to get time to do continuing education if they don’t maintain productivity for three months in a row, which creates more pressure to work off the clock.”

“My patient had arrived late but had been told they would get a full treatment. The patient eventually arrived but I didn’t know it so some time had passed. I had told the patient that I would see him for the full treatment and therefore I ran late. [My manager] said I should have been going out to check every five minutes to see if the patient was already there. This discounts the fact that I have lots of other work to do – not just charting, but for complex patients there are other resources and staff that must be engaged in a treatment plan, all that takes time, but it’s time that many therapists put in before their shift starts or after it ends, off the clock.”

This member once asked coworkers how they get their charting done and many of them said that they get here an hour early and open all their charts.

“I definitely stayed late working off the clock frequently.” “They would send emails saying you aren’t supposed to work off the clock, but managers would see people on computers charting well before shift, but would never question whether they were on the clock when they obviously weren’t but, if I mentioned in an email that I was working off the clock, they would tell me I should be on the clock for that. They only seemed to care if there was documentation.”

“Some people were billing three units when they should have been billing one, maybe two. I would only bill them one unit. If I only saw them for fifteen minutes I’m not going to bill for three units.”

Other examples:

“I can’t chart while I am in the room because the patient can’t move, I can’t chart and move them at the same time – [Supervisor] said “maybe you should be billing more units if you are taking more time to document.”

“[Supervisor] is the one who encouraged me to bill more units than I felt comfortable with in the ALS clinic. When she took on this job she knew she was going to do ALS clinic, she shadowed a couple of days, and there were times when I wasn’t making productivity because I stayed clocked in to chart.”

[Supervisor] told the member they could bill units for doing charting but the member contacted the licensing board. The board told the member to contact coding compliance and the member found out that type of billing would have been illegal. The member advised the supervisor but the supervisor never advised the rest of the staff that the practice of billing for charting was inappropriate.

One member was told their time was valuable and that they should bill for it. The member’s response was “if my time is valuable you should pay me for it.” The member would work off the clock at the beginning or end or end of shift but refused to clock out for no shows during the day. “I told [Supervisor] I was not going to clock out in the middle of the shift. The supervisor would make a lot of suggestions about things I could do when I was clocked out like go for a run or do errands.”

“I once billed 45 minutes of OT [the manager] told me to “correct this” or give him an explanation.”

A few days after our initial interview we had an opportunity for a follow up interview with our former member.

“Multiple times when I got messages from supervisors, I’ve been told you should clock out because you have two no shows. You should come in late in the morning if patient cancels”

“It’s not fair to make us clock out to keep our per hour productivity up.”

“The only way therapists have control over productivity is if they clock out when they are not seeing a patient. The effect is that they can’t meet standards unless they are willing to clock out every minute they are not seeing a patient and charting. They have no control over scheduling yet they lose money and opportunity due to scheduling.”

When one member finally got her full time FTE her supervisor told her to develop hand therapy skills. The member said “Sure, when are you going to block time for me to learn?” The manager said “you can come in and shadow on your time off, that’s what previous staff did, they came in early and on their day off to shadow and learn” This member was able to give us the name of at least one other therapist who trained during her time off.

Several other members also had information to share:

“I’ve been told by my supervisors that you need to tell therapists to clock out if they are waiting for a patient.”

“They gave me 45 minutes to prepare for a one hour academic presentation.” When this member said you can’t prepare a one hour presentation in 45 minutes, she was told that she “could do it on her own time.”

They told me that they “need to be billing for all the time you spend in clinic whether you are seeing someone or not.”

“If I work overtime they cancel patients the next day so as not to go over 40 hours per week. Which means some patients aren’t getting seen.”

Fear of Retaliation

We asked one member about working off the clock, clocking out for missed appointments, why people do that, and why more don’t express their concerns over these issues.

She felt that many employees were afraid of retaliation. We asked her what forms perceived retaliation would look like. Her answer:

“Some other examples of why individuals worry about speaking up:

  • Concerned they will not be allowed to change their schedule to desired shift
  • Concerned they will be paged or asked into a meeting where they are confronted
  • Opportunities for continuing education, program development, leadership roles will not be offered to them
  • Removal from leadership and differential paying roles such as Team Lead
  • Concerned they will be assigned to work that is not their preferred work area
  • Concerned they will not be granted exceptions for vacation or schedule conflicts or needs.”
  • Concerned they will be more closely scrutinized for missteps, errors, productivity and then put on a work plan”

OHSU management should:

  • Endorse legal and ethical billing practices
  • Follow labor law and contract provisions for scheduling of work and curtailment
  • Stop perpetuating a culture of fear and retaliation
  • Value all of an employee’s contribution and work by creating systems and environments that pay employees for all of the time to complete the job, not just the billable time.
  • Institute productivity measures that encourage the production of completed staff work and which do not pressure employees to work off the clock to meet standards.

What You Need To Know Today About The Employee Benefits Council

 

A Short History of the EBC

First off, what the heck is an EBC anyway? EBC stands for Employee Benefits Council. It’s a group that reviews health-related benefit plans, recommend plan-design changes and review and recommend contracts with various benefit-plan providers. The EBC is made up of 12 representatives: six from management and non-represented employees (managers, supervisors, faculty, research staff and the HR Benefits office) and six union representatives (two from ONA and four from AFSCME).

The EBC was designed to work by consensus; that is, it tries to get unanimous agreement on changes to benefit plans. Plan changes can happen for a variety of reasons. For example, in the years leading up to the implementation of the Affordable Care Act, the EBC tried to contain costs while maximizing coverage in order to avoid paying the so-called “Cadillac tax” that the ACA called for if health-insurance premiums rose above a certain level. Another example is that the EBC chose to limit the massage benefit, because we saw heavy use by very few people, using out of network providers, which drove up premium costs for everyone else.

Choices about changes like this are hard to make, because no matter what we do in the drive to contain costs and provide excellent benefits, some people will feel like they’ve been helped and others will feel like they’ve been hurt. The consensus process is meant to be a check against rash decisions or financial decisions that will disproportionately hurt others. Among the groups represented on the EBC, AFSCME is unique in that we represent employees, in about 300 job classifications, whose wages vary tremendously. We try to ensure that whatever we do, it does not leave our lower-paid workers in a position where they cannot afford their health care. An extra $25 or $50 has a very different impact on someone making $15/hour than it does for someone making $90,000 or more a year.

Through all of the EBC’s decisions, the consensus process has been the glue that has allowed all of the representatives to make decisions that, over the years, have kept our health-care benefits at OHSU affordable and accessible. So what happens when the EBC can’t reach consensus? Well, our contract addresses that. If consensus cannot be reached, then the EBC votes on the decision. Management/OHSU has three votes, ONA has one vote and AFSCME has two votes. If the vote ends in a tie, OHSU’s president casts the tie-breaking vote.

In all our union’s years of sitting on the EBC, we do not recall ever having to vote or ever having OHSU’s president break a tie.

Until now.

Consensus Breaks Down

This year has seen the first cracks in the foundation of consensus decision-making with the EBC. Within the last two months:

  • The EBC was in the final stages of reaching consensus on recommending changing the third-party administrator of our health plan to Aetna from Moda. President Robertson overruled the EBC and decided that OHSU would remain with Moda.
  • The EBC could not reach consensus on whether to offer a high-deductible health plan in addition to our current plan. The chair of the committee moved quickly to a vote and the vote was tied 3-3, with all union votes being against offering such a plan. President Robertson cast the tie-breaking vote in favor of offering a high-deductible health plan.
  • Several years ago the EBC was approached by our consultants with a proposal to raise deductibles rather dramatically, in an attempt to keep premiums down. In a compromise designed to keep health care affordable, the EBC reached consensus to raise deductibles by $25/year over several years. HR Benefits is now proposing throwing this agreement aside and imposing new, dramatically higher deductibles.
  • HR Benefits has also proposed adding a spousal surcharge of $50/month for every employee whose spouse opts for OHSU’s health insurance when they are eligible for health-care coverage through their own employer. Our union contends that a spousal surcharge is a premium increase, not a plan-design change and therefore needs to be raised at the bargaining table not at the EBC. Local 328 has filed a grievance on this matter; our grievance has already been heard by an arbitrator and we are awaiting a decision.

The EBC has functioned by consensus decision-making for about two decades. The breakdown of that model will have consequences far beyond the meeting room of the EBC. It will be felt in paychecks, at doctors’ offices and at the bargaining table.

 Where Does This Leave Us?

Why is HR Benefits proposing these changes that take money from OHSU’s employees’ pockets? Well, they have been given marching orders to save more than a million dollars on the OHSU’s health-care benefits budget.

Why? We have asked and have not been answered — unless you consider “to maintain the viability of OHSU” to be an answer of sufficient specificity to justify taking money back from our members and other OHSU employees.

Who made this decision? Asked and not answered.

Are these marching orders coming from Huron Consulting Group, which just decided that it would be a swell idea to grab a million or so benefits dollars back from employees? Asked and not answered.

How are management votes tallied at the EBC? Who decided how their three votes are cast? Asked and actually answered: they don’t know. In the one case where we voted, all management representatives were in favor of the high-deductible plan. They haven’t decided what they would do if the management representatives’ votes were ever split.

HR Benefits has indicated that the spousal surcharge will not be dealt with until we get an arbitration decision. Make no mistake — we will deal with the spousal surcharge at the EBC if our union loses the arbitration or at bargaining if we win the arbitration. This is not going away.

The proposed deductible changes will be dealt with at the EBC. The EBC has dealt with deductibles in the past. We suspect we will not reach consensus on ending the compromise deal we made and instead imposing new, higher deductibles. That will force a vote. You can see where this is going.

The move away from consensus decisions in the service of taking dollars away from our members and others — for secretive and unspecified reasons — is profoundly dangerous. The EBC has worked and worked well for more than 20 years — because of the internal checks and balances required by successful use of consensus decision-making.

Forcing votes on contentious issues and letting them be decided by tie-breaker votes by a brand new OHSU president just prior to our union embarking on contract bargaining is a risky proposition for all concerned. It unnecessarily raises the stakes at the bargaining table and, more importantly, undermines a model of labor management cooperation that — in the case of the EBC — has been remarkably effective for more than two decades.

Let us know what you think.

 

 

Local 328 Builds Workplace Equity Through Educational Opportunities

by Kate Baker, Local 328 Staff Representative

In developing priorities for the 2015 contract negotiations, AFSCME Local 328 identified that there were significant barriers for lower-wage workers wanting to access educational programs needed to advance within OHSU, which disproportionally affected underrepresented employees. Our union brought the issue of workforce development for low-wage earners to the bargaining table. During negotiations, Local 328 and OHSU formally agreed that recruitment and retention of a more diverse workforce is a priority for both organizations.

As a result, the parties formed the Community Employment Committee, consisting of equal representation from union leadership and OHSU management. The committee is focused on serving AFSCME-represented OHSU employees who are historically underserved and diverse in a variety of ways, including race, ethnicity, veteran status, disability, LGBTQ status and economic hardship. Together, Local 328 and OHSU are coming together to build equity within the workforce through education and new opportunities.

Since its formation, the committee has developed a strategic plan to achieve shared goals of increasing career-development opportunities for employees. One element of that strategic plan has come together in the form of grant funding through the U.S. Department of Labor’s NW Promise diversity grant. This grant will provide forty AFSCME represented employees with free job training for certain positions that require certification, support for testing and a program coach. Eligible employees can receive training in the following jobs:

  • Certified Nursing Assistant 1 and 2
  • Medical Assistant
  • Medical Coding Specialist
  • Patient Access Services Specialist
  • Pharmacy Technician
  • Sterile Processing Technician 2

Chinetta Montgomery, former Local 328 Vice President and one of the leaders on the Community Employment Committee, said: “Collectively our local leadership decided that equity and inclusion should be a bargaining priority in all future contacts starting in 2015. During that bargaining cycle, we addressed many different issues that impacted our bargaining unit including workforce development. It took many conversations internally at our local and with our employer but collectively we reached an agreement that is centered on providing opportunities to our underserved members in AFSCME. ”

The committee has been reviewing applications from more than 200 employees and is starting to announce the recipients.

Contract bargaining is about more than just cost-of-living increases and controlling health-insurance premiums — it’s also about establishing innovative programs to better serve our members and local community. Local 328 looks forward to our 2019 contract negotiations and assuring that our members’ needs are responded to.