I just got back from errands and was shocked by the way you spoke to me on the thread upstairs about Blackwater. I asked the question of the moderator because I wanted to make sure that I was being fair to you.

I have no idea how things work behind the scenes and I thought that I would put information up about Beth Israel Deaconess Hospital and Paul Levy which might give a more complete picture than you painted.

I am completely at a loss in understanding why you are annoyed with my work to give a fuller picture of the situation in a hospital with which I am familiar.

I thought that after finding out that there is already a union which Massachusetts nurses are part of, and that there is an extremely important bill they are sponsoring on October 24th, you might rethink your position.

I also thought that giving more exposure to what Paul Levy has done through blogging was a good thing. He is an extremely approachable CEO, open to ideas from his staff. He has brought Beth Israel, a non-profit hospital, through a bleak time.

I am completely puzzled by your irritation, especially when you feel so comfortable offering him your advice.

I am not privy to what Ms. Hamsher has, or has not, read today. I do know that she frequently returns to old threads to read the comments.

Before I say anything, I would like her to have the option of writing more about Beth Israel, Paul Levy, his decision to blog, and the quality of healthcare at Beth Israel Deaconess Hospital.

He asked: Do I get paid too much?

Sunday, January 28, 2007
Do I get paid too much?
Every year, the Boston Globe publishes a story listing the total compensation received by the CEOs of the major Boston hospitals. The story is derived from the Forms 990 that are filed by every non-profit, and the numbers are interesting enough that the story always gets good placement in the newspaper.

CEOs do not set their own salaries. Each hospital has a public board of trustees who determine the compensation for their chief executives and who also hold that CEO accountable for running the organization. The levels of compensation are subject to review by the Internal Revenue Service to ensure that they are within reason for that organization and compared to other organizations, and also to ensure that the board itself, rather than the CEO, has made the compensation decision.

Notwithstanding this level of legal guidance, the issue often arises as to whether hospital CEO salaries are out of line. Americans are often ambivalent about high salaries for corporate executives: They often complain about them, but, at the same, time, everybody hopes that he or she can someday earn them! Putting aside that personal sociological observation, let me ask you the question directly: Do you think I earn too much?

Here are the facts. As noted by the Globe, my total compensation was about $1 million in fiscal 2005. Of this, $650,000 was the base salary. Also, I was eligible for a 30% incentive compensation payment if the hospital achieved specified results for clinical quality, patient satisfaction, and financial performance. I received the full amount that year, $195,000. The rest of the million comprised payments made by BIDMC for life insurance and retirement. (Don’t worry, there are no other perks, like cars or country club memberships!)

Now, some background on BIDMC: The hospital is a billion-dollar-a-year enterprise, about $800 million in clinical revenues and $200 million in research programs. Our annual capital budget is roughly in the range of $80 million. Last year, we raised $30 million in philanthropic donations from people in the community. We have facilities that cover about 3 million square feet. We see 50,000 emergency room visitors per year, 40,000 inpatients, and 500,000 outpatients. We have about 8,000 employees and about 800 doctors on staff. We are affiliated with six community health centers (one of which we own); several community hospitals and physician practices; and we own and run two off-site clinics in Chelsea and Lexington and one small community hospital in Needham…

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A nurse in the hospital replied:

Anonymous said…

Why do we go to work everyday? What is our professional objective? What makes us tick…

Compensation

Whether financial, emotional, or social – there is a catalyst in all of us. It is clear that Paul’s financial compensation may be higher than average person’s, but I would guess that he is fairly compensated for his work in the other areas as well.

In Paul’s case he lives in the microcosm of Beth Israel where he cultivates his staff and reaches for greatness. His blog reflects his train of thought as he manages his team. Feedback is welcomed and discussions are always honest but not always easy. Paul’s message to his hospital is clear…dare to be different…dare to be a leader…dare to make a difference.

As a RN at his hospital I know I am part of an organization that is saving lives, healing the sick and making a difference. I don’t feel threatened by our CEO’s salary. I feel grateful that I am part of an organization that enables me to practice nursing gracefully.

I am not sure that other leaders, who I assume would be making the same, would offer the same gifts to Beth Israel.

I walked into work the other day and a harp was playing in our lobby. I read in the Globe that my hospital is sharing its central line infection rates with the public. I drive by the Fenway and see that my hospital is the official sponsor of the Red Sox. I jump online and see that our CEO is not only sharing how much he makes with us, but also asking what we think.

I believe that I am part of something special that is going on in healthcare. So does Paul make too much? Financially, some may say yes. However, I would have to argue that his leadership creates a climate at our hospital that is worth more than a million. When seen through this lense; he is responsible to each employee and patient. In reference to the tally of staff/hosptials/patients on his post, there are roughly 700,000 people under the umbrella of Paul’s leadership. That is less than 1.50$ per staff/patient a year!

When people feel that something “special” is happening at BID, part of it has to do with the leadership. Would I pay $1.50 a year towards my CEO’s salary? Of course! It is a lot less then the 100$ ticket I will pay to watch Big Papi his one over the green monster.

The Latest Developments in the Massachusetts Nursing Environment
MNA and SEIU Local 767 Sign Pact of Aid and Support
Prepare for Organizing Push in Southeastern Mass.

In a show of union solidarity and cooperation, the Massachusetts Nurses Association (MNA) and the Hospital Workers Union, Local 767 SEIU, AFL-CIO have entered into an “agreement of mutual aid and support in the collective bargaining process, organizing, the legislative/political arena, and other health care policy forums.”

Local 767 of SEIU represents 3,600 health care workers in seven hospitals, 10 nursing homes and a number of home health agencies throughout Southeastern Massachusetts the Cape and Islands, including workers at Good Samaritan Medical Center, Cape Cod Hospital, Falmouth Hospital, Jordan Hospital and Tobey Hospital. The local’s members include nurses’ aides, technicians, clerical workers, health care professionals and other support personnel.

The Massachusetts Nurses Association represents more than 19,000 registered nurses and health care professionals working in 85 health care facilities statewide, including a number of hospitals, VNAs and public health departments on the South Shore, including Good Samaritan Medical Center, Jordan Hospital, Tobey Hospital, Cape Cod and Falmouth Hospital.

“This agreement signals a real commitment by those of us who organize health workers to combine our efforts and share resources to step up organizing and enhance the power of unionized health care workers in this regions of the state,” said Karen Higgins, a nurse at Boston Medical Center and chair of the MNA Cabinet for Labor Relations, who helped forge this alliance.

“The key is to pick a topic that garners a headline and public concern, like provision of care to poor people,” Levy wrote. “It is also helpful to pick an arcane accounting issue that few understand, so that a cogent and concise rebuttal by the hospital is virtually impossible in the regular media.”

The union said the hospital lowered by 30 percent the figures it had reported for un-reimbursed charity care in 2005, without providing an explanation for the change.

“BIDMC’s financial reporting with respect to charity care may deny board members necessary information to evaluate the extent of the hospital’s charitable activity,” Fadel wrote in the July 26 letter sent to trustees with the union’s report.

Levy said his colleagues at the hospital are wondering whether SEIU is preparing for a union drive at Beth Israel.

“Or is it sending a message to other hospitals in the city that it will attack anybody who has the nerve to speak out against its tactics?” he said they are asking.
Posted by Elizabeth Cooney at 06:27 PM

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On August 25, 2006, Paul Levey wrote this in his blog entitled Running a hospital:

“On the union front, you may recall that I wrote last fall to inform you that the Service Employees International Union had announced plans to organize workers in the Boston hospitals. They appear to be interested in BIDMC. During the last months and weeks, the SEIU has submitted Freedom of Information Act requests about several of our researchers and research projects funded by the NIH; has submitted an FOIA request at Mass HEFA, the state agency that issues our bonds; and most recently has been conducting telephone surveys of our some of our employees. Some of you may have received these calls. These activities are entirely legal, although you might wonder, as we do, what relevance our peer-reviewed research has to a union organizing process.
In other situations, the SEIU has attempted to get hospitals to agree to bypass or modify the normal union organizing procedure envisioned under the National Labor Relations Act. A normal unionization process consists of getting authorization cards from 30% of the members of a future bargaining unit, followed by a secret ballot election of that group of workers, under federal rules and monitored by the National Labor Relations Board. Each employee, unencumbered by peer pressure or other outside forces, gets to vote “yes” or “no” in the sanctity of a private voting place.
Instead, in some cases the SEIU has pushed for a “card check” system, in which the election process is bypassed once 50% of the workers sign authorization cards, and the management of the hospital agrees to not talk about unionization – a process called “neutrality”. In some other instances, the union has agreed to an election, but with the same one-sided “neutrality” terms during collection of signatures and the voting.
My belief is that a topic as important as unionization deserves a free exchange of views. If the management of the hospital agrees to a “neutrality” agreement that limits our ability to discuss the pro’s and con’s of the issue, that would be at variance with the history and culture of this academic medical center, a tradition steeped in open dialogue and exchange of views.
Let me say again: We believe in free elections in which each employee, unencumbered by peer pressure or other outside forces, gets to vote “yes” or “no” in the sanctity of a private voting place. Thus, we cannot agree to a “neutrality” agreement nor to a system that bypasses the federal NLRB election processs.
In other parts of the country, hospitals that have taken similar positions to ours have found themselves subject to massive public relations attack by unions. The object of these attacks seems to be to denigrate the reputation of the hospitals and to put pressure on volunteer boards of trustees and management to agree to the unions’ organizing terms.
We hope and trust that the SEIU will not use these tactics in Boston. It is hard for us to imagine that a union that says that it is dedicated to improving the healthcare system would intentionally undermine public confidence in one of the world’s best hospitals. But this has happened elsewhere, so we must be prepared for that eventuality. We will hold fast to our principles and would participate in a union organizing process based on the rules and regulations set forth in federal law, a process designed to protect the rights of all parties. We have too much respect for our employees to bargain away your rights to a free and fair election. We trust the people who work here, and we would respect your judgment should an election be authorized. You earn that trust every day by the way you take care of patients, participate in research, train medical professionals and one another, and support a wide variety of community activities.
In closing, if any of you have concerns or questions about any of these matters, please contact me directly, or your Human Resources representative, or your supervisor.”

I would welcome your thoughts about what I have said in both of these notes.

See this Boston Globe article about the battle between the unions. The Globe article:

But labor experts said the SEIU made itself a target through its aggressive attempts to increase its presence in the Boston healthcare industry. Last year, the union said it wanted to organize all healthcare workers at Boston teaching hospitals, including nurses, most of whom have traditionally been represented by the Massachusetts Nurses Association.

“This gauntlet thrown down by the SEIU is having an effect on other unions in healthcare,” said Jeffrey Toner , a labor consultant at Dietz Associates , in Kennebunk, Maine.

At the July 13 election, authorized by the Boston office of the National Labor Relations Board, 1199 SEIU nurses can vote to keep their current representation, join the Massachusetts Nurses Association (which already represents 600 of the 1,500 registered nurses at Boston Medical Center), or withdraw from union representation altogether.

The association’s takeover attempt would disrupt a relatively peaceful coexistence between two unions at Boston Medical Center that began 10 years ago when the hospital was formed through the merger of Boston University Medical Center and Boston City Hospital. The hospital, led by chief executive Elaine Ullian , is not siding with either union.

They are working hard to pass legislation which comes up on October 24th. It is H.2059 which is working to limit the number of patients each nurse can have. MNA President, Beth Piknick writes:

In addition to our new look, we have a new and vitally important opportunity to finally pass legislation to regulate RN staffing levels in our state’s acute care hospitals. As this month’s cover story indicates, Oct. 24 is a key date in this process, as this is the date for the first public hearing for H.2059—our landmark bill to set a safe limit on the number of patients a nurse can be assigned at one time. The bill would also ban the practice of mandatory overtime and provide a variety of important recruitment initiatives to address the long term supply of nurses.

The need for this bill was given strong support last month when the DPH issued a report showing that as many as 2,000 patients a year die needlessly in our hospitals from hospital-acquired infections. The associated costs for these infections total more than $400 million annually.

In the months prior to the release of this report, two studies were published that made a direct link between RN staffing ratios and these types of infections. In fact, there have been no less than five studies published in the last seven months that validate nurses’ positions on this issue, which adds to the 25 other studies that have been published in the last five years.

The evidence is unequivocal and overwhelming: safe patient limits save lives, save millions of dollars in hospital costs and are the key to recruiting/retaining the nurses to meet the needs of hospital patients. Our case has been made. Last year we passed this bill in the House, and it would have passed in the Senate if it had been brought to a vote by the then Senate president.

Now we have more evidence, and a new opportunity, to push this bill on towards passage. To date, 107 organizations have signed onto the bill. Our support in the House of Representatives is stronger than it was last time around. We have a new Senate president and our support in the Senate is growing. We also have a sympathetic governor who is in support of this measure.

But our first step in this process is to get this bill out of the Public Health Committee, and that requires a strong showing of nurses at the State House on Oct. 24, as well as phone calls and e-mail messages to legislators from every nurse.

To contact your legislator quickly and easily, visit http://www.capwiz.com/massnurses. The campaign for this bill is gaining strength and with your help we will achieve victory.

You will notice that between pages 8 and 9 of this issue of the Massachusetts Nurse Advocate is a bumper sticker that promotes the campaign. We hope that each of you will take the time to put this bumper sticker on your vehicle, as it will become a powerful and visible symbol for the nurses’ campaign throughout the commonwealth.

Finally, I wanted to call your attention to Page 29 of this publication, which features a call for participation by nurses in a research study about the MNA and our recent experience in going through disaffiliation from the American Nurses Association. Barry Adams, a doctoral candidate at Brandeis University, is conducting an important study of this issue and its impact. We invite nurses who are interested to check out the ad and to participate in this study.

What you will get with the passage of H.2059
Among other things, the safe staffing bill will:Have the state’s DPH develop and implement limits on the number of hospital patients assigned to RNs.

* Reduce errors caused by fatigue and overwork by prohibiting mandatory overtime.
* Prevent RNs from floating without proper orientation.
* Stop hospitals from assigning unlicensed workers to perform care that demands licensed nursing expertise. Only nurses should provide nursing care.
* Protect against the reduction of other members of the health-care team including LPNs, aides and technicians.
* Instruct DPH to account for ancillary staff in the development of the staffing limits and the standardized acuity system.

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