An older New York City hospital that has been struggling to thrive in today’s healthcare environment recently faced a critical choice. It could close, like roughly 19 other NYC hospitals, or reinvest and be transformed into a modern healthcare network that can better serve the needs of both patients and the community. Thanks in part to an innovative collaboration between the organization and 1199SEIU, Mount Sinai Beth Israel (MSBI) is on the cusp of not only transforming how patients are treated but also how union and the hospital staff can work together to create a new successful path forward for everyone.
MSBI is a large, acute care facility located in lower Manhattan. While certified for 800 beds, it operates with a daily census of only about 450 and has seen a 10% decrease annually, resulting in significant operating losses for each of the past three years. To help address the issue, MSBI President Susan Somerville laid out these and other challenges facing the hospital and a vision for moving forward in candid meetings with the leaderships of 1199SEIU RN and Hospital and Guild divisions. In these meetings, she also asked the union to help plan and prepare the organization for the transformation required.
In addition to low census numbers and unsustainable operating losses, she explained, MSBI is experiencing substantial competitive pressures from a newly renovated New York University hospital located just blocks away. Readmissions have also fallen due to changes driven by New York State’s DSRIP program, value-based purchasing and the developing emphasis on community-based chronic care management and preventative care. Simply put, without changes the hospital was no longer sustainable.
Knowing the importance of the labor-management partnership and the pressures facing both the hospital and employees, the group understood that a creative and innovative solution was required. Working together, union and management leaders developed a remarkable agreement resulting in MSBI’s commitment to preserve and maintain a significant presence in the community below 34th Street in Manhattan. In addition, for any transitioning staff the management demonstrated a commitment to fairness and treating the staff with dignity, making a public commitment that all Union employees will be offered other Union opportunities at equal pay.
With four thousand members employed at MSBI, the Union’s goal was to maximize job and salary security for members to the greatest extent possible, either at the current location or within the larger Mount Sinai System. That goal was realized in the transition agreement crafted by Mount Sinai and 1199SEIU. 1199SEIU and MSBI leadership enlisted the help of the Labor Management Project and RN Labor Management Initiative to develop and sustain collaborative activities to improve performance, foster a high-engagement culture, and transition MSBI from a hospital-centric institution to a coordinated, community-centric health care network. Thus far, it has been a success.
Plans for MSBI’s future presence in the community, which includes 220 beds and a new ED, an enhanced behavioral health unit, significant renovations and expansion of the Mount Sinai Downtown Union Square (formerly know as Phillips Ambulatory Care Center) and the location of several additional practices below 34th Street, are cause for excitement. However, as with any change, there are also questions and concern among MSBI staff, many of whom have worked at MSBI for decades. Some are concerned about the transitions that may be required for new job titles and responsibilities and/or a shift to other locations. Once again, a collaborative and creative solution was needed.
To address those concerns, Union and management leaders formed a strategic collaboration whose goals are:
- To develop a high-engagement strategy to improve MSBI’s 2016 financial performance and to plan, implement, evaluate and adjust the transformation strategies;
- To share information, replacing myth and rumor with fact;
- To tell the story of new growth opportunities and replace fear with excitement for the future;
- To provide emotional and other support both to staff who transition and to staff remaining in place;
- To help Union and management leaders successfully implement the recently negotiated job and income security agreement; and
- To improve staff and patient satisfaction during a five-year transformation period.
To meet these six strategic goals, a Crisis Joint Leadership Team was formed. This team coordinates job placement fairs, where staff affected by the transition review available jobs, obtain job counseling and leave with a job offer in writing. It also plans, coordinates and communicates about staff issues and concerns regarding the transformation of MSBI. The team includes RN and Hospital and Guild delegates, MSBI’s president, chief nursing officer and vice president of Human Resources. Representing 1199SEIU are the Union’s senior executive vice president, vice president, and executive vice presidents for both the Mount Sinai System and the RN Division along with organizers and contract administrators.
In addition, the Union and management are collaborating on the following activities:
- Job placement fairs;
- A weekly meeting of the Crisis Joint Leadership Team;
- Joint rounding in all departments;
- Joint written communications;
- Overseeing the process of transition related to the agreement;
- Jointly developed training programs in collaboration with the 1199SEIU Training and Employment Funds;
- Emotional support programs in collaboration with the 1199SEIU National Benefit Fund; and
- Training local union leaders and delegates to effectively participate on the Crisis Joint Leadership Team.
The transformation of MSBI from a hospital-based health care system to a community-based coordinated care and prevention network, using high engagement through a strategic union-management collaboration, is a highly innovative model of organizational change. Its success may serve as a model for other unionized health systems in New York City. “Mount Sinai Downtown is an opportunity to not only transform how we deliver healthcare but also how management and our union partners can work together to productively solve challenging issues,” said Kenneth L. Davis, MD, President and CEO of Mount Sinai Health System. “I commend 1199SEIU President George Gresham, Union leadership and members at Mount Sinai Beth Israel for working closely with us to create a fully integrated healthcare network, offer all Union employees other Union opportunities at equal pay and, ultimately, deliver a 21st century model of care that can be replicated by other hospitals facing the same realities and challenges. This partnership can, and should, be the path forward for everyone.”