Analysis Of Results
This section presents the analysis of variables collected in this study in the form of four analytical models:
Model 1: Effect of Nurse Unionization on Fiscal Viability Index Model 2: Effect of Nurse Unionization, Asset Age & Quality of Hospital Care on Fiscal Viability Index Model 3: Effect of Nurse Unionization on Quality of Hospital Care Model 4: Effect of Nurse Unionization, Hospital Staffing & Labor Costs on Quality of Hospital Care
*Implication – Although this model is not statistically significant, the result indicates that nurse unionization impacts negatively on the fiscal viability of hospitals. In other words, unionized facilities are less financially viable than non-unionized facilities.
*Implication – Compared to Model 1, with the introduction of age of asset and quality of hospital care, the negative impact of nurse unionization on a hospital’s fiscal viability decreases from -0.36 to -0.18. This means that if a hospital has higher quality and newer assets, the hospital can absorb most of the negative financial effect of nurse unionization. As expected, the negative effect of asset age and positive impact of quality care on fiscal viability are statistically significant.
***Implication – This result indicates that hospitals with unionized nurses tend to provide less quality patient care, statistically significant at less than the 10% level. Staffing shortages in unionized hospitals may contribute to lower quality of patient care.
***Implication – Compared to Model 3, the significant negative impact of unionization on hospital quality is reduced at least by half (-0.091 to -0.042), and becomes statistically insignificant with the introduction of man hours per discharge, FTE per occupied bed, and labor cost variables into the analysis. Nurse unionization itself does not have as much of an effect on hospital quality when the four additional variables are considered. Overall goodness of fit (adjusted R square) indicates that variables in this model explain more than 16% of hospital quality, a significant increase from Model 3 (3.14%). The level of FTE staffing per occupied bed becomes the most dominant factor for hospital quality. This means that the greater the staffing in a hospital, the less impact nurse unionization has on hospital quality. A higher level of FTE, regardless of union status, improves hospital quality.
The negative effect of man hours per hospital discharge on quality is statistically insignificant, and this is most likely due to the high correlation between man hours and FTE variables.
The effect of labor cost on quality is statistically significant, but its relative magnitude is negligible.
According to our analysis in Model 4, fringe benefits as a percentage of cost, has a negative and statistically significant effect on hospital quality. With the relatively high costs associated with providing fringe benefits to employees, hospitals may rely more on part-time employees than full-time. The frequency of staff turnovers with part-time employees may also impact quality negatively.
CONCLUSIONS AND FINDINGS
Numerous factors influence the financial viability and quality of care in a hospital, and it is difficult to specifically correlate union status with fiscal viability and quality. However, the evidence is compelling that the fiscal health of an organization will directly affect the outcomes of hospital care. That being said, union status has significant implications as it pertains to hospital operations. Ultimately the question that needs to be addressed is can hospitals “afford” the effect of unionization and do they have a choice. The key findings of this research are:
• Unionization by nurses has a negative impact on fiscal viability when analyzed on a cause and effect basis. • When age of assets and quality are added to the analysis the impact of unionization on quality diminishes. • When hospitals with unions are analyzed for quality, there is statistically significant lower quality. • The impact of unionized nursing on quality is reduced by half when man hours and FTEs per occupied bed are included in the analysis; and the effect of FTE per occupied bed becomes the most dominant factor. Quality increases with increases in FTE per occupied bed. • Staffing, regardless of union status is the most significant factor in quality. • Labor cost per employee is not a significant factor on quality.
In conclusion, unions per se have no direct affect on financial viability or quality; but have significant indirect affects. These findings have important implications for policy makers and hospital administrators when planning to engage unions in salary negotiations and staffing levels.