Solving Systemic Problems in Hospitals and Beyond

  • December 2, 2020

America has worse medical outcomes than those of 11 nations comparable in wealth and level of industrialization. It has higher infant and maternal mortality rates, poorer control of diabetes and hypertension, higher numbers of hospitalizations for preventable causes, a higher number of avoidable deaths, a lower overall life expectancy, and higher suicide rates than occurs in these nations. Overall, the United States ranks lowest among these countries for having the lowest overall health outcomes, despite the highest per capita healthcare costs.

Why Are America's Care Outcomes Worse?

This poor performance is due to our for-profit health care system: our multiple private insurance companies, corporate hospital chains, and mega-pharmaceutical companies for whom the bottom line is more important than patient care. Even nonprofit hospitals spend considerable amounts on new buildings, plush administrative offices, and lobbies that do little to benefit patients.

Our care systems are also top-heavy with administrators hired to handle the demands of insurance companies and of government regulations: there has been a 3200% increase in hospital administrators over a twenty-five year period, adding hugely to the cost of medical care and to the complexity of hospital systems. A widening gulf has grown between clinicians and the administrators who manage their time and working conditions since the latter group knows a good deal about insurance requirements but much less about actual clinical care.

During the initial months of the COVID crisis, this gulf was illuminated when administrators simply did not understand the need for adequate personal protective equipment to protect frontline workers from a highly infectious and dangerous disease. The gap between frontline staff and administration is also seen in the distress of clinicians who no longer have the time to provide adequate care to their patients. They are told how long they may spend with them, according to what insurance companies decide to pay. Many clinicians interviewed by us feel strongly they thus face a huge ethical dilemma: they currently cannot provide adequate care for their patients within the limits of these time frames.

How Can Systemic Change Happen?

from-the-ground-upIn our book, From the Ground Up, we describe the successful use of Labor-Management Partnerships (LMPs) within healthcare as well as in other sectors of our economy. A structured form of negotiated, cooperative decision-making which was used first in industry (for example, at Saturn Cars and the Xerox Corporation) these Labor-Management Partnerships have been widely used in Europe, and in recent years in the technology sector in the United States. From the Ground Up provides a roadmap for how they work, describing essential core practices for their success.

Involving all constituents in a well-structured analysis of organizational problems, unit by unit, LMP’s allow groups of managers, administrators, and staff to develop and implement solutions to their pressing quality of care or production issues. In healthcare, Labor-Management Partnerships have improved patient care, controlled costs, and helped to create more meaningful work for frontline clinicians in a variety of settings. Examples of some results are as follows:


  • Patient Safety. The Partnership at Brooklyn’s Maimonides Hospital dramatically cut response time to cardiac monitor alarms, reduced lab result turnaround time to the ER, and reduced patient falls and rates of hospital-acquired infections by 50%. Further, costs were cut dramatically for equipment purchases and hospital cleaning, while at the same time, hospital cleanliness improved dramatically.
  • Patient Satisfaction. The Partnership at Los Angeles County Department of Health Services, the nation’s second-largest public hospital system, boosted patient satisfaction by 91 %, cut uncontrolled diabetes rates by 29%, and established a comprehensive care system in which each patient is now assigned to his or her own team of caregivers rather than to random clinicians who don’t know them or their histories.
  • Improved Operations. Kaiser Permanente, one of the nation’s largest nonprofit healthcare plans, has used Labor-Management Partnerships throughout its 39 hospitals and over 700 medical offices to address their clinical or operational problems.

Labor-Management Partnerships also offer an opportunity to revive health care unions, which represent 21% of healthcare workers. Several healthcare unions have become expert in this method, contributing large sums of money to support Partnerships, re-assigning staff to work with problem-solving teams, and encouraging staff to participate in Partnership activities. Our research has also shown that staff who participate in these Partnerships, empowered by their new skills and by the respect paid to them for their analyses, are much more likely to become involved in wider avenues for civic participation.

Core Practices for Successful Labor-Management Partnerships

  1. From the start, hiring a consultant knowledgeable about practices for securing cooperation between front line staff and administrators.
  2. Providing educational workshops for senior managers and staff to help them understand the present need for change and the routes toward achieving it.
  3. Creating a social contract between labor and management that spells out clear ground rules for decision-making processes and specific, mutually advantageous goals.
  4. Training frontline staff and managers to become internal consultants who will support problem-solving workgroups.
  5. Improving overall labor relations in the organization
  6. Using sector strategies to identify successful, known methods for achieving change.
  7. Documenting results to learn from each process.

We highly recommend that each of these practices be employed to avoid known pitfalls that can sabotage Labor-Management Partnerships. When successful, these partnerships help complex organizations use information about their operations directly from all levels, create breakthroughs, and greatly improve the quality of employees’ work lives.

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