A Labor Management Partnership The Mount Sinai Medical Center Experience

1. A Labor Management Partnership The Mount Sinai Medical Center Experience May 12, 2010 Angela Doyle , Executive Vice President – 1199/SEIU Carol Porter DNP, RN - Chief Nursing Officer/ SVP – MSMC Janet Johnson, APN-BC – MSMC Heart Hospital

2. The Mount Sinai Hospital • 1,171-bed tertiary-care hospital within an academic medical center • Over 3,700 physicians • Over 2,200 Nurses including 200 Advanced Practice Nurses • Internationally acclaimed for excellence in clinical care, education, and scientific research and now ranks 18th in National Institute of Health funding • MSH Department of Nursing is a Magnet designated hospital: 2004 - 2013

3. Mount Sinai Labor Management Partnership • 2002-2003 Difficult financial times • 2003 - There was a change in Senior Leadership – CEO, COO • Strategic Plan focused on growthrather than downsizing • Opportunity to rely on The Mount Sinai family including the staff, unions, and community to work together to rebuild Mount Sinai Hospital 2004 - A formal Labor Management Partnership Committee was established: First with 1199/ SEIU and then with the local nursing bargaining unit (New York State Nursing Association) • 2005 - Inclusion of Local Union Leadership and Senior Operations Leadership, local union representatives partnership work rose to a new level of relevance and productivity

4. Mount Sinai Labor Management Partnership (continued) • 2006 - Both Labor and management focus on the best interest of our constituents & the constituents best interest is in the success of Mount Sinai Hospital. Labor Management Partnership Agreement signed - Sept 2006 • 2007 – Embarked on a cultural transformation initiative deep rooted in quality targets, accountability, excellence in patient care, and a positive work environment supported by management & staff engagement. • 2008 - Realization that we are working towards similar goals even though our approach may be from different perspectives at times. Successful negotiation of new BU contracts. • 2009-2010 - Continued progress and positive outcomes with LMP as our foundation. Ongoing communication, collaboration, and relationship building

5. Labor-Management PartnershipAgreement “We, representatives of the Mount Sinai Medical Center, Local 1199 SEIU United Healthcare Workers East, and the New York State Nurses Association Local Bargaining Unit at the Mount Sinai Hospital, declare our commitment to partnership in pursuit of mutually defined objectives. We are dedicated to achieving unprecedented excellence in the care of patients, their families, and our community. Towards these ends, we believe in creating and nurturing a positive environment of collaboration, work, and clinical practice. We recognize that we are just beginning our journey. Although we may not always agree, we will respect our differences, seek common ground, and strive for success. As leaders, we will inspire and engage our constituents in this journey to excellence. We commit to work together to provide leadership and direction in this effort to make The Mount Sinai Hospital the best it can be. In unity, we believe that we will succeed. Signed by the Labor Management Partnership Committee September 2006

6. Signing of the Labor Management Partnership Agreement The Mount Sinai Hospital, New York- September 2006

7. Levels of Involvement Between Labor and Management Strategic Partners* Full partners in reaching final decisions, formulating plans, monitoring, and taking corrective action. Opportunity to influence final decisions; participate in monitoring and taking corrective action. Participate in developing solutions, changes and proposals. Opportunity to influence through giving feedback on what is already designed FULL PARTNER IN DECISIONS INPUT IN DECISION MAKING DEVELOPERS Communication CONSULTED Informed *Adaptation from 1199 SEIU Labor Management Project (2007)

8. Nursing Labor Partnership • Joint Council Meeting • Nursing LBU & CNO meetings expanded to include all Nursing Directors – Improved communication, build relationships, share data, discuss nursing practice • Clear statement from the CNO that the LBU President lead the same nurses and need to have a collaborative approach to leadership of the nursing staff, stated at a Joint Council Meeting with Nursing Leadership both nursing management and LBU present • CNO approached 1199/SEIU to replicate the Council meeting with 1199/SEIU leadership

9. Labor Management Partnership Concept Map

10. The Magnet Award for Nursing • 6% of U.S. hospitals have Magnet designation. • 2% of US Hospitals have both Magnet Designation and a unionized nursing workforce( YTD August 2008 ) • Nurses in the LBU Clinical RNs + Case Mgrs + APNs Nursing Education specialists, Nurse Clinicians + Per- Diem Clinical Nurses, Per Diem APNs = 2106 • Over 100 RN Magnet Champions & now created Magnet Champion Partners 2004 - 2008

11. 2008 YTD Agency Usage 9.2 FTE

12. Outcomes • Improved Nurse / Physician collaboration • Nursing • Improved RN Turnover: 2005 = 9.9% 2008 = 6.8% 2009 = 5.1% • NDNQI RN satisfaction: 2005 = moderate and 2008 high RN satisfaction • Magnet Re-designation 2009-2013 • Hospital Acquired Pressure Ulcers decreased by 30% • Improved Compliance with Quality Measures – • Utilization of Constant Observation (1:1) decreased by 25% • Agency Nurse utilization decreased by 80%:2009 = 3FTEs and currently 1 FTE • Improved Nurse / Physician collaboration Establishment of the: Center for Nursing Research and Education –MSSM 2009

13. Operational Performance

14. Our labor management partnership is like any relationship requiring time, caring and the courage to take a Leap of Faith The Mount Sinai Medical Center 1199 SEIU Health Care Workers East New York State Nurses Association Local Bargaining Unit

15. The effects of a nursing labor management partnership (NLMP) on nurse turnover and nurse satisfaction were examined. Background: Job satisfaction and retention are among the factors related to the nursing shortage. The NLMP was a specific intervention where nursing leaders, both nonbargaining and bargaining, worked collaboratively to improve patient care and outcomes. Methods: The study was conducted in a large, Magnet-designated urban academic medical center in the Northeastern United States. The hospital has more than 1,000 inpatient beds and more than 2,200 registered nurses, 2,107 of whom are members of a nursing union. Nurse turnover and satisfaction were studied before (2005) and after (2008) the implementation of the NLMP model. Results: There was a significant decrease in nurse turnover and a significant increase in nurse satisfaction (from moderate to high) post-NLMP. Conclusions: This study establishes a basis for further nursing research on the implementation of an NLMP in union environments. (C) 2010 Lippincott Williams & Wilkins, Inc.