Office of Social Development & World Peace

A Fair and Just Workplace:
Principles and Practices
for Catholic Health Care


Preface

The working paper A Fair and Just Workplace: Principles and Practices for Catholic Health Care, is the result of a candid and constructive dialogue among leaders of Catholic Health Care, the AFL-CIO, and the Catholic Bishops' Conference. The following groups were represented on the working group: Catholic Health Association, Leadership Conference of Women Religious, the USCC Committee for Domestic Policy, the AFL-CIO, and the Service Employees International Union.


Background

In January of 1998, Sr. Mary Roch Rocklage, RSM, President and CEO of Sisters of Mercy Health System, St. Louis, and a member of the Domestic Policy Committee requested that the Committee bring together representatives of major superiors of women religious, Catholic health care leaders, bishops, and organized labor to explore areas of common interest regarding Catholic social teaching and work. The Committee agreed to appoint a Subcommittee and sponsor a dialogue in the hopes of developing a set of guidelines for labor/management relationships. Members of the Subcommittee included:

(* former Chairman of the U.S.C.C. Domestic Policy Committee)

The group attempted to address the three purposes which were outlined in the proposal for the project:

  1. identify the critical issues driving/shaping the work environment today;
  2. identify the core convictions within the Catholic tradition in regard to relationships within the work environment;
  3. identify new models of relationships between management and labor and between religiously sponsored health ministry and organized labor

Process

The Subcommittee met between January of 1998 and May of 1999. The meetings focused on the opportunities and challenges of the relationship between Catholic health care and organized labor, and the requirements of Catholic social teaching regarding work and workers' rights. The discussions were characterized by candor, openness, and respect for differing views. The Subcommittee was able to identify a number of areas of common interest and shared values including: respect for the dignity and rights of workers, support for universal health care, and concern for the weak and vulnerable.

The leaders who produced this working paper recognize:
  1. the gap between general principles and practices at the local level;
  2. the pressures on leaders of Catholic Health Care and workers in the local situation;
  3. the wounds, anger, and misunderstandings arising from particular local conflicts and controversies.
Nonetheless, we believe this working paper can be a helpful resource for bishops, Catholic Health Care leaders, union officials, and others.

We have not resolved all our differences. In fact, some differences have been more clearly defined as a result of our discussions. We have not agreed on every response to every situation, nor have we anticipated every problem. But we have found common ground on:

  1. the right of workers to choose if and how they will be represented in the workplace
  2. how Catholic teaching can guide both management and labor in their response to the choice of the workers
  3. what behaviors should be avoided by all sides
  4. the need for a new way for labor and management to relate to one another
The working paper is a statement of principles from Catholic social teaching about the dignity of work and the rights of workers, not a response to a particular situation. It is an attempt to find common ground, not an opportunity to advance the agenda of either side.

We also recognized that this process, taking place at the national level, was not subject to the daily tensions of the workplace. Though most involved in the discussion had past experience in a local health care setting, there was a deliberate attempt to keep the process insulated from any past or present labor-management conflict in Catholic health care. Nevertheless, the participants agreed that their process could be duplicated at the local level. In fact, the Subcommittee strongly recommends that such dialogues take place, even though past histories—and present conflicts—may be difficult to over come.


Recommendations

The Subcommittee proposed and the USCC Domestic Policy Committee agreed to the following recommendations regarding the working paper:


Conclusion

The bishops' Domestic Policy Committee and the subcommittee see this process as an important step for the future of Catholic health care and its workers. The product of their discussions, A Fair and Just Workplace: Principles and Practices for Catholic Health Care, is offered as a resource for reflection and discussion, information and input, and action.


I. Introduction

In Catholic social teaching, health care is a human right—not just another commodity; providing health care is both a service and a ministry. The mission of Catholic health care is to continue the healing ministry of Jesus by providing quality, faith-based care in the communities served. This mission of Catholic health care is carried out within a moral framework set by Church teaching and within an economic framework shaped by the market, public policy, and available resources. This tension between the mission and the market frames many important issues in Catholic health care today.

Significant changes in how health care is delivered, financed, and structured pose major new challenges for Catholic health care ministry. Among the factors shaping health care include: innovations in clinical practice, technological advances, mergers and consolidations of insurers and institutions, the growing number of uninsured, and a more competitive market environment.

In many places health care institutions, including Catholic health care institutions, are major economic actors providing jobs and financial strength as well as contributing to the social fabric of the community. They may be among the largest employers and purchasers of goods in the region. Their survival and the extent to which they flourish are often critical to the economic health of the surrounding communities and the families that live there.

These external transitions or pressures can increase stress within the ministry and between management and workers as they seek to deliver quality health care in today's competitive environment. In some places, the changing environment both within and outside of Catholic health care has led workers to seek union representation within its institutions. Because Catholic health care is part of the Church and its ministry, it is essential that Catholic social teaching on work and workers' rights guide worker-management relationships.

For the larger Catholic community, conflicts that may arise in these relationships are serious since they can divide the community, harm the ministry, and raise basic questions about how Catholic health care practices what the Church teaches about work, workers, and the rights of workers. This is especially important given the leadership role of Catholic health care as a major employer in many communities. Similarly, since the provision of health care is a fundamental social good that is essential to the well being of local communities and society, these conflicts can adversely impact the common good.

The mission of Catholic health care is shared and carried out by those who provide the care, steward the resources, maintain facilities, and provide the organizational infrastructure. Providing a fair and just workplace is part of this mission. According to The Ethical and Religious Directives for Catholic Health Care Services:

A Catholic health care institution must treat its employees respectfully and justly. This responsibility includes: equal employment opportunities for anyone qualified for the task, irrespective of a person's race, sex, age, national origin or disability; a workplace that promotes employee participation; a work environment that ensures employee safety and well-being; just compensation and benefits; and recognition of the rights of employees to organize and bargain collectively without prejudice to the common good. (NCCB, Ethical and Religious Directives for Catholic Health Care Services, 1994, p 8.)

II. The Catholic Tradition

Catholic social teaching affirms human life and dignity, outlines responsibilities and rights, supports the family, seeks the common good, and challenges all to put the needs of the poor and vulnerable first as we shape a just society. Since its earliest articulation Catholic social teaching has focused on rights and responsibilities relating to work.

In Catholic teaching, work is more than just a way to make a living. It is one of the ways that people express themselves and contribute to the common good. Work is also the ordinary way most people meet their material needs, so wages and benefits need to be adequate to sustain workers and their families. (Economic Justice for All, #97)

Catholic doctrine on work and workers' rights cannot be reduced to the simple question: Are workers free to join a union? The Catholic tradition should not be expressed in sound bytes or footnotes to defend union or management tactics or positions in a particular setting. Our tradition is much richer than that. It offers principles for reflection, provides criteria for judgement, and suggests guidelines for action for management, unions, and workers as they seek to pursue their own legitimate objectives and to build the common good. Catholic teaching does not and cannot provide specific answers to many difficult and complex questions. However, it can offer direction and help shape the dialogue about what is a just and fair workplace and how workers participate in the decisions which affect them.

The reflections and questions which follow are intended to help bishops, sponsors, supervisors, managers, union leaders, and workers consider how Catholic social teaching can be applied in the workplace.

A. Just and Fair Workplace

Providing a just and fair workplace for workers is one way that Catholic health care can affirm the dignity of each worker and make a contribution to the common good. Among the elements of a just and fair workplace are: fair wages, adequate benefits, safe and decent working conditions, and the right to participate in decisions which affect one's work, as well as opportunities for advancement, learning, and growth.

In assessing whether or not an institution provides the elements of a just and fair workplace, a number of questions arise, such as:


B. Participation

According to Catholic social thought, all human beings have the right to participate in society and in the institutions that make up their communities. Workers must be able to participate in the decisions made in the workplace that affect their lives and their livelihood. While the principle of participation is central to Catholic social teaching, achieving it is complex. There are a wide variety of ways workers can participate in the mission of Catholic health care—by their service itself; their skills, training, and experience; their work with others; their input into policies and planning, evaluation and compensation processes; as well as their support of and participation in the charitable and community service activities of the institution.

Even when these conditions are being met, as a means of further participation, workers may choose to join with others to advance their own legitimate interests and pursue the common good. Historically the Church has stood with workers as they struggled to form and join unions to overcome adverse working conditions in the face of many obstacles. Church teaching affirms the right of workers to form and join unions or other associations. "All church institutions must also fully recognize the rights of employees to organize and bargain collectively with the institution through whatever association or organization they freely choose.@ (Economic Justice for All, #353)

The core of Catholic teaching in this area is that it is up to workers—not bishops, managers, union business agents, or management consultants—to exercise the right to decide through a fair and free process how they wish to be represented in the workplace. Workers may decide to be represented by a union or not to be represented. Catholic teaching respects their decision.

Representatives of management and unions need to pursue their legitimate objectives without undermining or interfering with the workers' right to decide freely about their right to participate. This often requires restraint and a clear understanding of what is permitted and not permitted by U.S. labor law and Catholic teaching. All parties must act and relate to one another according to the principles of Catholic teaching and abide by the same standard of conduct. Their goal should be to promote a collaborative workplace of participation, harmony, and mutual respect for the roles of workers and management as well as to advance the provision of health care as a fundamental human good.


III. Roles, Rights and Responsibilities

A. Workers

Workers share with management the responsibility to advance the mission of Catholic health care. The staff who deliver the care, perform the technical procedures, maintain the facilities, and provide overall support services are an integral part of Catholic health care. Clerks, physicians, nurses, housekeepers, accountants, janitors, and supervisors all contribute to an effective caring, human workplace. Their responsibilities include: supporting and actively participating in the mission, stewarding the resources, and contributing to the delivery of quality health services. Workers have the right to a living wage, to health care coverage, to safe and healthful working conditions, and to dignity and respect on the job. To secure these benefits for themselves and their families, workers have the right to organize themselves for collective bargaining and to be recognized by management for such purposes. Management should respect their decision-making process; and, if workers decide to be represented by a union, management should negotiate in good faith towards a contract with their chosen representatives. Workers also have the responsibility as decision-makers to use care in deciding how to participate, including selecting a union that they believe can meet their needs, if that is their choice.

In whatever choices the workers make, they should seek to insure that the mission of Catholic health care remains central to the workplace and is not compromised. Working with management, their goal should be to build an economically successful organization devoted to quality service and the advancement of the well being of individuals and society. All workers should cooperate to foster a high-performance workplace: one focused on maximizing quality through efficient, effective, work practices; continuous skill development among staff; and a high degree of work integration and teamwork.

B. Management

Safeguarding and maintaining the institution's mission is both essential and non- negotiable for management. Management in the Catholic environment is called to be an advocate for the community, patients, and employees. Within the religious and social mission of Catholic health care, the role of management in part is to structure the workplace and steward limited resources to ensure that workers have what is appropriate to carry out their tasks. Also, management has the responsibility to engage in the public debate about the provision of health care, and to promote public policies that sustain and advance Catholic health care and its workers as well as the common good. Ultimately, management is accountable to the sponsors, the board, the Church, health care workers, and the larger community.

Providing a just and fair workplace is part of management's responsibility to ensure that a health care institution's policies and procedures are consistent with Catholic social teaching. Management should respond to workers' right to participate within a context that both reflects the mission and seeks the common good. Management should share fairly with workers the economic benefits of their work, and should provide the opportunity for and encourage workers to participate in decisions about the workplace, the delivery of services, and their own economic well being. At the same time, management needs enough flexibility in the workplace to accomplish the mission of Catholic health care, and ensure its economic viability in a competitive environment.

C. Unions

The primary role of the union is that of advocate and promoter of workers' interests in the institution. If chosen by workers to represent them, unions are legitimate vehicles for workers to carry out their right to participate. Beyond the workplace, the union is also the advocate for workers' interests in broader society, e.g., public debates over issues of working families such as: employment, family, health care, minimum or living wage standards, and social security. Unions give workers an independent voice in the workplace. Workers can choose unions to improve their ability to advance their own economic and social conditions, to help make the workplace safe and healthful, to promote skill development and individual growth/advancement of workers, and to promote and enable worker involvement in the institution's decision-making on work organization and service delivery through collective bargaining and community action. Unions share these responsibilities with the workers. Unions, like the workers they represent, have a shared responsibility with management to promote the mission of the institution and of health care as a fundamental social good. It is the responsibility of a union to inform workers of their rights and obligations.


IV. Respecting Workers' Choice on Unionization

While both management and labor profess support for the rights of workers, one of the areas where perspectives clearly differ and where consensus may be unreachable is defining the appropriate roles for management and union representatives as workers exercise their right to decide whether to join a union. Often in these situations, management feels under attack from those who seek to organize the workers. Management may view unions as using misleading or false promises to "sell" the idea of organizing. Union organizers see an inherently imbalanced situation, where management has unparalleled influence, access, and power with workers.

In our dialogue, representatives of management and labor expressed differences about the role and utility of the National Labor Relations Act and Board. Organized labor has long advocated a fundamental change in labor laws to address their concerns. Unions increasingly are seeking agreements from employers to stay out of workers' organizing decisions altogether, arguing that any involvement by management too easily leads to coercion. But management often sees this as tantamount to giving up their right to speak and inform and the ability to counter any misleading or false statements made by the union.

Without a concerted effort to overcome traditional labor-management antagonisms and prejudices an organizing effort could lead to serious divisions between workers and management, regardless of the result. Such an environment is not conducive to a productive workplace, to building a community of trust in the workplace, nor to the mission of Catholic health care ministry.

When an organizing campaign is initiated, all parties should address the concerns of workers and their right to participate in the decisions that effect them without impugning the motives of others. Consistent with the requirements of labor law and according to the principles of Catholic teaching, all parties should agree on ground rules for how the union and management will meet with workers, distribute materials, make public statements, and ultimately what process will be used for workers to make their final decision. Care should be taken to be fair and accurate in all communications and to avoid attacks on the institution and its leadership, the organizing process, the union involved or the organizers.

Although it is difficult to agree on what is ideal, it may be worthwhile to specify what behaviors and tactics should be avoided during an organizing campaign:

As members of the Church, Catholic health care leaders have a special responsibility to see that Catholic social teaching is upheld. Advisors and firms having a familiarity with and a demonstrated commitment to Catholic social teaching, labor law and related fields can be most helpful for a Catholic institution. Firms that have a record of tactics or guidance that violates Catholic social teaching and the principles outlined in these reflections are not appropriate for Catholic health care. This is true of firms and individuals who advise either management or unions.


V. Key Questions in an Organizing Effort

A. Unions and Management

B. Management

C. Union Representatives

D. Workers

When workers are serious about organizing, it seems the best approach requires a civil, focused, businesslike dialogue between management and the union on just how the workers' right to decide will be respected by both parties. This could include a mutual agreement on materials, communications, access, public statements and related matters. (See Section IV, para. 4)

It may be desirable and necessary at times to involve an independent, impartial mediator agreed to by all parties, when there is a serious effort to organize workers. This person should be familiar with Catholic social teaching, labor law, and health care. They would help to safeguard the process and ensure that all of the rights and responsibilities spelled out in this document are respected.

As pastors and teachers, bishops have special responsibilities to support the mission of Catholic health care and to defend the rights of workers: to promote the principles and practices outlined in this working paper and urge others in the Catholic community to act in accord with them; and, to fully respect the right of workers to participate and their right to decide whether or not to join a union. Bishops are called to advance the mission of Catholic health care, encourage the observance of the principles of Catholic Social Teaching and to defend the weak and vulnerable.


VI. Key Questions After a Campaign

Whether or not workers decide to organize, management and the union must accommodate the decisions of the workers. Workers also have the responsibility, whatever the decision, to continue the mission of the institution in partnership with management.

Workers, unions, and management should be prepared to pursue innovative and creative solutions to address the needs of the workers and Catholic health care. If such efforts are to be meaningful, all parties must recognize the legitimate rights of the other and work toward new kinds of relationships which move beyond traditional labor/management antagonism to work together to meet worker needs and advance the common good.

Despite controversies and conflicts involving labor management issues, Catholic social teaching sets forth some basic values that are shared by Catholic health care and the organized labor movement in this country. Both share a commitment to serving the poor and providing access to services that are essential to caring for human needs. Both are called to respect the needs of workers and their right to safe working conditions, a fair wage, and a voice in the workplace decisions that affect them.

Building on these common values, it ought to be possible to create a new paradigm for how labor and management can work together in Catholic health care when workers chose to unionize. A hostile relationship between union and management does not serve the interests of either workers or Catholic health care. But where unions and management foster creative dialogue in the workplace, the resulting exchanges can help shape the healing ministry of Catholic health care for the future, as well as reshape labor-management relations. A more positive exchange could help labor see its role in more creative and constructive terms and management see workers who have decided to organize not as a sign of failure but as an opportunity to collaborate. By creating new ways of relating to each other, Catholic health care and organized labor should seek to provide structures for workers to have a voice in the workplace that is meaningful, nonthreatening, creative and informed so that together with management they can continue to build efficient, healthy and responsive organizations.


VIII. Conclusion

The changing nature of health care tests workers, managers and unions. A challenge is to find common ground where workers and managers can come together even on contentious and controversial matters. Management, workers, and unions often share similar goals—universal health care coverage, quality care, adequate wages, decent working conditions, an economically sound and viable institution, and a participatory workplace. It is how these goals are pursued or how they fit with other organizational priorities that can bring conflict.

Catholic health care is a gift of the Church and a service to society. It is carried forward in an increasingly complex and challenging health care and economic environment. This particular context does not relieve the leaders of Catholic health care of their responsibility to carry out the social teaching of the Church, but it acknowledges that complexity brings with it controversy and difficult choices. Faithfulness to mission and respect for workers are at the center of what it is to be Catholic health care.

Likewise, union leaders face their own difficult challenges, but in advocating rights of workers there must also be genuine respect for the mission, identity, and role of Catholic health care in our Church and society. For both management and labor, the status quo is not an adequate response to the challenges health care institutions and their workers face in this time of rapid change.

In sharing these reflections, we seek to promote the common good over the pursuit of narrow interests or economic advantage. What ought to unite all of us is a clear sense of mission and service. Catholic health care is not just another economic activity or product, it is a demonstration of our faith and a commitment to human life and dignity. A just and fair workplace is important not only as an expression of Catholic principles, but because it affects people, their livelihoods, and their families. Together we need to shape workplaces that not only follow the law, but reflect our values. We believe that fair wages, decent working conditions, and a real sense of participation—however they are realized—are not burdens for Catholic health care, but signs of a community which is serious about its Catholic identity and mission.

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Office of Social Development & World Peace
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August 25, 1999Copyright © by United States Catholic Conference