Patterns and issues in health care collective bargaining

Unionization of health care facilities has grown significantly over the last twenty years. More than 20 percent of American hospitals have one or more union contracts and an equal percentage of the industry's labor force is represented for collective bargaining purposes. Union membership is concentrated in the Northeast, Upper Midwest and Pacific Coast and is to be found particularly among large metropolitan hospitals. Although many different unions are actively organizing in the health care industry four labor organizations predominate: American Federation of State, County, Municipal Workers; Service Employees International Union; National Union of Hospital and Health Care Workers - District 1199; and the American Nurses Association.

One of the obstacles to union growth for many years was the absence of Federal legal regulation of labor relations. In 1974 Congress amended the so-called Taft Hartley Act to cover private nonprofit hospitals, the largest component of the industry. Since 1974 the application of Federal labor law has resolved old problems that arose from the lack of a basis to handle recognition disputes but at the same time created new issues. Among these issues are such legal questions as the legitimacy of the ANA to act as a labor organization, the proper bargaining classification for registered nurses, and the proper role in labor relations for hired consultants.

The growth of unions in health care raised concern that collective bargaining would impose onerous new burdens on an industry already hard pressed financially. Research indicates, however, that the impact on hospital costs have not been great -- perhaps on the order of an increase of 10 percent over what would be the case in the absence of unions. The greatest effects seem to be in the area of fringe benefits, working conditions, and the provision for grievance machinery.

Special problems have arisen in conjunction with the unionization of registered nurses. This particular category of health care workers occupies a strategic position in the hospital's work force. After a slow start nurse bargaining activity has come rapidly particularly as nonnursing unions such as 1199, SEIU, and the American Federation of Teachers have forced the ANA to respond to their efforts to make inroads among nurses.

Union growth in the industry seems to have stabilized for the time being without the prospect for much change in the remaining years of the decade. Incidence of conflict has been relatively low compared to other industries and this also shows little likelihood of change. While some visible signs of conflict over representation rights still remain collective bargaining is moving rapidly into an era of mutual accommodation.     

Fertility,development, and family planning

Earlier studies by Tsui and Bogue (1978) and Mauldin and Berelson (1978) suggested that family planning efforts account for 3-4 times the variance in fertility than is explained by indicators of socioeconomic development. This paper replicates, extends, and revises these analyses. Selection of a different set of countries for sampling was found to have little effect on the earlier results. In addition, neither factor scaling nor the addition of distributional variables had a substantial effect. However, weighting countries by population size was found to produce a decline in explained variance. It was found that although family planning has a stronger direct effect on fertility than any other variable when countries are considered, the effect of education is stronger when people are considered. When more developed countries were included in the analysis, the combination of prior fertility and mortality explained almost all the variation in current fertility. This finding suggests that fertility is more responsive to longterm, stabilized changes in mortality than to short-term changes. 4 methodological conclusions are derived from these analyses: 1) unless a sample of countries is overtly biased, the selection of a sample on the basis of available data has little impact on the results; 2) stepwise methods can be utilized to avoid the inclusion of a large number of variables in a regression equation; 3) weighting of cases has a substantial impact on results; and 4) since most variables have little direct influence on fertility change, analysis should be extended to examine indirect influences. These results suggest a policy which invests economic resources in education and mortality reduction as well as family planning efforts. Investments in primary and secondary education may reduce mortality as well as fertility.     

The evolution of planning: Exploring strategic linkages and developing action guidelines for public administrators

The need for public administrators to develop meaningful and implementable planning documents to guide the development of their agencies is increasingly important as society sprints from simple static environments to complex, dynamic environments. This escalation of future uncertainty suggests that the public administrator find an approach to planning that is both conceptually sound and adaptable to the cultural nuances of the organization. Understanding strengths and weaknesses of past approaches to planning and anticipating the next advancement, i.e. “transformational planning” facilitates the effectiveness of the public administrator.     

The politics of family planning in the Maghrib

This article uses a comparative case study approach to relate policy outcomes in terms of family planning to the patterns of political forces observed in the 3 Maghrib states of Algeria, Morocco, and Tunisia. It is suggested that official support for a strong family planning program may be linked to recognition of the problem of low labor absorption and to concrete steps taken to counter the problem. The article discusses different vantage points for approaching the political context of family planning and distinguishes between the use of family planning as an instrument of social policy and as an instrument of economic policy. Ideological reasons for opposition to or support of family planning are then outlined. The colonial experience of the 3 states is differentiated and a chronological account of their family planning programs is provided. The political systems and leadership of the 3 countries are separately discussed in greater detail, after which the influence of elite groups on family planning programs and activities in each country is assessed. Developments in the 3 countries since 1978 are then sketched. The author concludes that the relative importance of policies toward employment and women's status in connection with support for family planning has probably varied over time, with economics playing a greater role in the 1970s. The activities of non-regime political actors were found to be very significant in formulation of population policies in Algeria and Morocco but less so in Tunisia.     

Fertility,family planning,and development: Indirect influences

This paper focuses on the indirect influences on changing fertility and on the direct and indirect influences on family planning effort. Complete data on the variables under consideration were gathered from a variety of sources for 65 developing countries. The results here should be generalized only to high fertility, high mortality, low education, and low per capita gross national product nations. 1) Some social variables, like education, are more important than others for explaining fertility and family planning effort. The treatment of social setting as a single variable obscures the importance of lower level education (literacy, primary, and secondary school enrollment) for fertility and family planning. 2) Ignoring the indirect influences on fertility may lead us to understimate the importance of some variables on fertility, and perhaps to overestimate the importance of others. When both direct and indirect effects (the latter through family planning effort) are examined, the impact of education increases to nearly equal that of family planning effort in 3 of the 4 models developed here. 3) Program effort can be explained at least as well with a single variable (literacy or female school enrollment) as with the composite variable "social setting." 4) In addition to its importance in explaining fertility, education may also be important in explaining mortality. 5) It appears that the absolute and relative status of women may be an important variable which has not yet been adequately measured. Overall, the results of this study lend additional support to the position that, in addition to family planning effort, education may play a more crucial role than is obvious in fertility reduction in developing countries.     

The relative importance of family planning and development for fertility reduction: Critique of research and development of theory

3 recent studies about the relative effects of family planning and development are reviewed in an effort to point out their limitations and to augment them. A tentative theoretical framework is presented from which the problem of fertility reduction may be viewed. Also presented is an analysis of the "outliers" in 1 of the 3 studies. This analysis involves consideration of macrosocial and contextual aspects of different nations as a supplement to other analyses. Mauldin and Berelson (1978) and Tsui and Bogue (1978) used indicators of social setting and family planning effort to explain declines in, respectively, crude birthrate between 1965 and 1975, and total fertility rates between 1968 and 1975. The 2 studies used nearly identical sets of explanatory variables. With both studies using the same indicators, except for "labor force," it is not surprising that the results were the same. The results were previously obtained by Freedman and Berelson (1976), who also used the Lapham Mauldin index of planning effort along with similar indicators of social setting. Freedman and Berelson found that birthrate declines could be explained better by program effort (which independently explained 17% of the variance in crude birthrate (CBR) declines) than by social setting (which independently accounted for 7% of that variance), and that the 1972 birthrate itself was similarly explained (15% of the variance attributed to program effort alone, 5% to social setting alone). Mauldin and Berelson obtained nearly identical results. In the Tsui and Bogue study, the contribution of the 1968 level of fertility was the dominant influence on the 1975 total fertility rate. The standardized regression coefficient indicated that previous fertility explained 50-60% of subsequent fertility by direct relationship, a figure comparable to the social setting family planning interaction effects (44-58%) in the 2 other studies. Much of this discussion is devoted to an analysis of the "outliers" in the exploratory data analysis done by Sykes for Mauldin and Berelson (1978). The outliers in Sykes' exploratory data analysis were divided along 2 dimensions. The first involves the relationship between predicted and actual reductions in fertility. The 2nd dimension refers to the independent variables used to predict the fertility declines. This analysis involves analysis of contextual variables and an analysis of distributional variables. It is limited by missing data, but the analysis of Freedman and Berelson (1976), Mauldin and Berelson (1978), and Tsui and Bogue (1978) is plagued by missing variables: contextual variables; distributional variables; and unique national, regional, or local circumstances. These can only be adequately revealed by case studies and may be important influences on fertility behavior. Effects of family planning and social setting may be conditioned by contextual variables (e.g., island status as in Taiwan), or unique circumstances (e.g., coercion as in India), and distribution appears to have an effect of its own.     

The effects of family planning effort and development on fertility: An intervening variables framework

To pinpoint the intervening variable that transmit the impacts of development and family planning effort on fertility, a modified proximate determinants model was applied to data from 59 developing countries. The intermediate variable included level of exposure to sexual intercourse (the percentage of women 20-24 years old in a union), deliberate marital fertility control (the percentage of married women of reproductive age who were using contraception), and natural marital fertility (operationalized as average per capita calorie consumption). The regression equations indicated that both social development and family planning effort can influence fertility levels substantially through their association with higher levels of contraceptive use. Interestingly, the direct effects of family planning and social development on the crude birth rate became insignificant when the intermediate variables were included in the same equation. Path analysis revealed that social development has an indirect effect of -0.083 via its influence on marriage patterns and of -0.316 due to its effect on contraceptive usage. Family planning has a lesser indirect impact on fertility (-0.487), and -0.111 of this effect reflects program effort's dependence on the level of social development. Economic development is positively linked to fertility, and future research should assess whether this factor is partially counterbalancing the fertility-reducing impact of social development and family planning programs. Although this analysis confirms that delayed marriage and widespread adoption of contraception are key intervening variables, they cannot influence fertility in societies where there are social or cultural impediments to such changes.     

Formalized Policy Entrepreneurship as a Governance Tool for Policy Integration

Policy entrepreneurs and their role for policy change, policy integration and cross-cutting governance has been thoroughly investigated. Here, focus is on a previously neglected aspect of policy entrepreneurship: the tendency to employ public bureaucrats with formal positions to act as policy entrepreneurs for policy integration. Based on 34 interviews with these actors in the Swedish local and regional government, three versions of this formalized policy entrepreneurship are identified: Informal compensation for formal vertical flaws, Making others do things and Integration in the vertical formal organization. These versions of formalized policy entrepreneurship brings a deeper understanding to the development of governance for policy integration, and also to the policy entrepreneurial role in the political-administrative organization.     

Policy Relations and Policy Subsystems: Financial Policy in Hong Kong and Singapore

Existing studies of Hong Kong’s and Singapore’s success as leading Asian international financial centers (IFCs) have largely focused on economic structural factors at the neglect of political economic contextual variables. Taking a policy subsystems approach and based on extensive field research, this article attempts to address this shortcoming by conceptualizing the “policy relations” that exist between state, industry, and other non-state actors in the two IFCs and delineating the “division of policy roles” among these actors. In the process, this article contributes toward the existing IFC literature and conceptualizes the sociopolitical relations that exist among financial sector actors.     

Village politics: Heterogeneity,leadership and collective action

When comparing stratified Fulani village societies, little direct relationship between the degree of heterogeneity and the success in collective action was found, except when heterogeneity among leadership and elite groups was compared. Small size and homogeneous groups do not seem to be general preconditions for stronger ability to perform collectively. First, it was found that homogeneity among elite groups enhanced capacity for collective action. Second, it was when heterogeneity in economic interests between elite groups intensified and coincided with other dimensions of heterogeneity that collective action became difficult to achieve, such as heterogeneity in economic wealth, access to land and common‐pool resources, and agreement over authority of the leadership. Third, collective action was enhanced by political elites and leaders being a bit better endowed and a bit wealthier than the average community members, but not when their assets were mobilised against the economic interests and sense of fairness of other social groups. Fourth, the coordination power of the leadership related to the management of common‐pool resources was undermined when leadership had extensive recourse to state officials external to the village community, underscoring the importance of autonomy.     

Policy analysis for local government

This paper considers the impact of quality approaches within the personal social services over the last decade. In particular it examines how applicable private sector approaches to quality, such as Total Quality Management, are in the public and personal social services. Both the hard and soft tools of Total Quality Management are critically considered in terms of their relevance and ability to modernise service provision. In the context of the managerial discourse presently dominating the public sector, it is argued that the hard tools of Total Quality Management, such as performance measurement and review, will only add to managerial control; whilst the soft tools of empowerment and cultural change will lose their critical effect. It is the contention of this paper that unless the current Labour government's Modernising Services Policy succeeds in democratising the process of developing quality then it will only add to the managerial agenda at the expense of improving service provision.     

Evaluation, Policy Learning and Evidence-Based Policy Making

The increasing emphasis on the need for evidence-based policy indicates the continuing influence of the 'modernist' faith in progress informed by reason. Although the rationalist assumptions of evidence-based policy making have been subject to severe challenge from constructivist and post-modernist perspectives, it is argued that the attempt to ground policy making in more reliable knowledge of 'what works' retains its relevance and importance. Indeed, its importance is enhanced by the need for effective governance of complex social systems and it is argued that 'reflexive social learning' informed by policy and programme evaluation constitutes an increasingly important basis for 'interactive governance'. The expanded use of piloting of new policies and programmes by the current UK Government is considered to provide limited scope for evaluation to derive reliable evidence of whether policies work. There is a need for greater clarity about the role of evaluation in situations where piloting essentially constitutes 'prototyping'. More emphasis should be placed on developing a sound evidence base for policy through long-term impact evaluations of policies and programmes. It is argued from a realist position that such evaluation should be theory-based and focused on explaining and understanding how policies achieve their effects using 'multi-method' approaches.     

Policy Networks and Policy Learning UK Economic Policy in the 1960s and 1970s

Policy networks are advanced as an alternative to the Westminster model of the UK polity but the theory lacks an internal dynamic and has typological problems. This article applies Peter Hall's (1993) concept of 'social learning' to policy networks and maps the networks found in two case studies of British economic policy making: Hall's own study of the shift from Keynesianism to monetarism in the 1970s and the author's research on the advent of 'Keynesian-plus' in the early 1960s. The article advances three main propositions. Firstly, that integrating the concept of social learning can dynamize the policy network model. Secondly, the case studies suggest that different network configurations are associated with different orders of policy change but that Hall's definition of 'third order change' may be too restrictive. Thirdly, policy networks can be much more complex and fluid then is generally claimed, sometimes becoming so extensive that they might be termed a 'meta-network'.     

Pride and shame in collective memory of Russian and American youths

This article examines collective attitudes of American and Russian students toward national historical events that elicit pride or shame. The authors use the results of a quantitative questionnaire and analysis of in-depth interviews among students of leading American and Russian universities to identify the temporal localization, the content structure, and the prevalence of either hard or soft power in students’ attitudes of pride or shame. The authors argue that perceptions of the past have been a core component of national identity and may have an impact on citizens’ political behavior in the present. The authors also stress that major differences in young people’s understanding of the past may influence future US–Russia relations.     

Preparing public service agencies for strategic planning

This paper examines the reasons why public sector organizations may not be ready for traditional private sector strategic planning techniques and suggests a typology for diagnosing the CBO's position in relation to planning efforts. It identifies the need for interventions appropriate to the organization climate and begins to explore mechanisms which can be used to facilitate the strategic planning process in public service agencies.