Aging Workforce in Healthcare

It is predicted that by 2050, nearly 20% of the national workforce will be 65 or older. This in an increase of 75%, and the healthcare workforce is even older than that (Lyman, 2016). These workers will be the main part of the healthcare workforce for a long time, and these older populations can require special needs in order to be as efficient and happy as possible. There are a number of different tools an organization can use to both keep its more elderly workers happy without sacrificing much of the upward mobility for younger and more ambitious employees.  It is the responsibility of a good healthcare workforce plan to both meet the needs of the current aging workforce, as well as provide opportunity for young talent to thrive. Otherwise, we risk high turnover rates and loss of talent in both age groups. Following are a number of facts relating to this issue:

  • By 2020, nearly half of all nurses will reach 65, the traditional retirement age (Harrington, 2013)
  • 25% of physicians are 60 years or older, and this is projected to increase (Harrington, 2013)
  • Replacing the workforce with younger employees is a high priority
  • With older workers holding positions at the top for extended periods of time, promising younger workers with less experience can become frustrated, which results in higher turnover and lower productivity
  • As employees age, some will require strategies to accommodate changing abilities resulting from disabilities, health conditions, and other age related issues
  • “If a hospital with 100 nurses experienced turnover at the national average of 21.3 percent in 2000, annual expenditures associated with the turnover of medical-surgical nurses alone amounted to as much as $1,969,015”(Hatcher, 2006).

It is obvious, given both the workforce shortages in healthcare, as well as substantial turnover costs, that any system should make it a priority to increase the well being of its older employees to ensure the ability to take advantage of their labor and experience. There are a number of potential ways to do this, such as taking advantage of part time labor, allowing employees to take out pensions early, limiting the need for physical activity on job sites, and a phased retirement plan.


Harrington, L., & Heidcamp, M. (2013, March). The Aging Workforce: Challenges for the Healthcare Industry Workforce (Rep.). Retrieved April 26, 2017, from The National Technical Assistance and Research Center website:

Hatcher, B., Bleich, M., Conolley, C., Davis, K., Hewitt, P., & Hill, K. (2006, June). Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace (Rep.). Retrieved April 24, 2017, from Robert Wood Johnson Foundation website:

Lyman, Stephan. The Aging Workforce in Health Care: Challenges Ahead. (2016, April 13). Retrieved April 26, 2017, from


Performance Management Blog

In healthcare, it is difficult to manage what you are unable to measure. Following this logic, many healthcare systems attempt to measure as much data as they can in order to measure and improve performance. When HR is looking at integrating performance measurement strategy, what kind of policies do they set to ensure that they gather data that is actually helpful, and implement it in a way that drives innovation, value, and safety? Many current information systems focus on a number of issues with both individual, departmental, and hospital-wide performance to give managers the tools to make decisions on operational improvement. Many of the most commonly gathered informational tools are patient satisfaction surveys, patient outcomes information, readmission rates, follow up % rates, ability to follow best policy, safety scores, and much more. This type of information can be scaled up to any level to see the efficiency of any system, and to derive from the high performance system best practices that can be used to improve desired outcomes system wide. There are also many ways to come at seeing this information. It can be through patients, 360 analysis, top down, bottom up, and many others dependent upon the time you have to collect the data. The following are important analysis about how this data is used:


  • It is popular to use a balanced scorecard to decide upon strategic priorities and quantitative goals
  • Many organizations, such as the Joint Commission and the National Committee for Quality Assurance require reporting on a number of indicators that cover quality of care, resource management, finance, and organizational management
  • Some rely on a clinical practices committee under the Board to report on topics related to Performance Management
  • How employees see the value in Performance measures is dramatically impacted by perception of management (Groscurth, 2015).
  • It is important to remember, especially in the case of non-profits, that they must measure performance in part through outcomes in their community
  • There are a number of subcontracted systems one can use to get proper analysis for a charged price (Grey, 2016)



Curtwright, J. W. (2000). Strategic Performance Management: Development of a Performance Measure System at the Mayo Clinic. Journal of Healthcare Management, 45(1), 58-68. Retrieved March 21, 2017, from

Groscurth, C. (2015, March 31). Hospitals’ Performance Management Must be Improved Fast. Retrieved March 21, 2017, from

Grey, C., & Steiko, S. (2016). CHOOSING THE RIGHT PERFORMANCE MANAGEMENT SYSTEM FOR YOUR ACO. Physician Leadership Journal, 87(2), 58-60. Retrieved March 21, 2017, from



Unions in Healthcare

State of Unions in Healthcare

Although healthcare is not a typical model one thinks of when studying union organization, there has been a slight increase in both participation in private hospital unions and larger national unions since 2004 (Daly, 2016). The number of healthcare and social assistance union members increased by 22,000 in 2015 to reach 1,242,000, which was enough to maintain the 7.3% share of workers in 2015. This proportion has seen small rises and drops since, but as the healthcare workforce gears up for potential repeal and replacement of the ACA, many could start to rely on unions in an attempt to keep their job and negotiate new pay if this results in a drop in demand.

The main organizations on the national stage are SIEU United Healthcare, National Nurses United, the American Federation of Labor, and The United Food and Commercial Workers International Union. The job of most of these organizations is to provide resources and support for local unions and encourage unionization. Even though two of these examples integrate outside of healthcare, they sometimes represent the many healthcare workers that are not providers of care. National Nurses United has become a much more significant advocate in recent years, campaigning aggressively to represent a number of workers in healthcare previously represented by the SIEU (Maher, 2013). In the state of Texas, we are most likely to deal with National Nurses United if our employees want to unionize.


Recent Union Operations

Given the gradual increase of unionization activity in healthcare, a number of unions have been very active for employees. A majority of larger union activities include the activation of union groups at certain hospitals as well as negotiation processes in the ratification of labor deals. Below are a number of hospitals where unions have organized to meet different goals for the employees (Gooch, 2017):

Providence based Rhode Island Hospital- Rally over changes in lifespan sick policy

Windham Community Memorial- Ratification of 3 year labor deals

Partners Healthcare Hospital- allowing union of about 500 service workers

Providence Tarzana Medical Center- contractors demonstrated over housekeeping jobs lost to internal services department

Pocono Medical Center- Organized Protests against layoffs and staffing changes

U.S. Appeals Court- Backing Massachusetts hospital system’s ability to incentivize hiring non-union employees

Impact of Law and Policy in Texas & Nationwide

At the state level, there are a number of legislative acts that limit and regulate unions. Texas is a right to work state, where one cannot be forced to join a union in order to be hired. Furthermore, and “open shop” policy prevents, “strike or picket to force an employer to recognize the union or to force other employees to accept the union as a bargaining agent if the union does not actually represent a majority of the employees working when the strike began” (TSHA, 2010).

There are a number of national laws that Unions and employers must meet. The two most important are the Taft-Hartley act and the Landrum-Griffen act. The Taft Hartley Act prevents jurisdictional strikes, political strikes, secondary boycotts, mass picketing, and donation to political campaign. The Landrum-Griffen Act created bodies in trusteeship, union officers as fiduciaries in asset control, and annual financial report submissions among others.

Both the ACA and other legislation have had an impact on many unions, including those in healthcare. Healthcare benefits are an important part of union advocacy, and depending on the state, the ACA has reduced access to the most plentiful benefits due to mandates and lack of tax subsidies now available to them (UPMC, 2014). Perhaps even more importantly, they were unable to prevent the passing of the “Cadillac tax”, which is a 40% excise tax on high cost employer health benefit plans (Lemieux, 2016). This plan will go into effect in 2018 unless the ACA is repealed before this happens. Given the uncertainty that will come with an ACA repeal, it will be interesting to see how unions and workforces react to the potential drop in demand that could come if insurance coverage drops significantly.

Individual Hospital Policy

It is important for any healthcare providers to have both preventative and reactionary policies in place for the unionization of their workers. While the existence of unions is not inherently detrimental, their existence at an organization does show a lack of trust or communication between management and employees. Because of this, it is important for human resources to be involved in strategic workforce planning. They and upper management must ensure that employees trust them, lines of communication are in place for issues, and that they recognize legitimate employee concerns. On the reactive side, management must be willing to recognize if mistakes are made, or if employees are not receiving proper pay or benefits. They must be willing to approach any negotiations seriously, and remain respectful of their employees.



          Daly, R. (2016, January 29). Unionization Surges in Healthcare. Retrieved February 10, 2017, from

          Gooch, K. (2017, February 6). Hospitals and Unions: 8 recent conflicts, agreements. Retrieved February 10, 2017, from

          Gooch, K. (2017, January 20). Hospitals and Unions: 13 recent conflicts, agreements. Retrieved February 10, 2017, from

          Lemieux, J., & Moutray, C. (2016, April 25). About the Cadillac Tax. Retrieved February 10, 2017, from

         Maher, K. (2013, January 3). Healthcare Unions Will Join Forces. Retrieved February 10, 2017, from

         Texas State Historical Association. (2010, June 15). Union Regulation. Retrieved February 10, 2017, from

       UMPC. (2014, September 17). Obamacare and Unions. Retrieved February 10, 2017, from