Until the "gag" clause is removed, the Temple nursing strike IS about patient safety

"Patient care is our highest priority," Sandy Gomberg, RN, MSN and CEO of Temple University's Hospital said yesterday. Regarding the current stalemate in contract negotiations between the nurses union and her hospital, Gomberg stated, "We will not engage with this labor union in a debate about the quality of care we continue to provide."

According to the union leadership their main concern with the proposed contract is the disparagement clause that has been introduced. It state, in effect, "The Association, its officers, agents, representatives and members shall not publicly criticize, ridicule or make any statement which disparages Temple, or any of its affiliates or any of their respective management officers or medical staff members."

While it may not be apparent to the consumer why this kind of statement is so troublesome, patient safety experts understand that there is a direct correlation between reporting of events, health care professionals autonomy, and a sense of fear to the quality of care in the health care environment. Fran Charney, Education Director at The Pennsylvania Patient Safety Authority recently advised, "...the Authority wants to make sure all health care workers understand how important reporting is to patient safety and have the necessary conversations to prevent medical errors."

Anything that would limit  (including contractual clauses that prohibit discussion of certain entities in certain venues) open dialogue to investigate an individual health care professionals concerns for safe  care in their work environment will place patients in more risk.
 

Ms. Gomberg wrote an article supporting a  collaborative approach to decision making in health care in 1994. The academic article titled, "A collaborative interaction model and the implementation of shared governance" discusses the positive impact on collaborative decision making with nurses on a unit as well as what an organization needs to have in place to initiate such a positive model (Gomberg & Sinesi 1994).

In the article, Gomberg and her co-author write an organization which implements a shared governance model "demonstrates ......its recognition of professional nurses as a valued commodity. As frontline workers professional nurses are viewed as organizational heroes as they are regarded as experts in customer services, product quality, and cost management."

 A further study conducted at Temple University Hospital in 2004, strengthens Ms. Gomberg's statements of the relevance to nurses and patient safety issues. Project DISCLOSE was charged with understanding the rate of reporting of adverse events done by physicians and other health care professionals at Temple while also discussing how to get more physicians to disclose reportable events (as mandated by Pennsylvania law). According to the Project DISCLOSE report, "in 2004, Temple University Hospital received 10,020 incident reports of which only 96 (approximately 1%) came from physicians. The vast majority of incident reports came from nursing staff and other ancillary health professionals." (King, et al 2006)

Nurses reported "nearly 20-fold greater than physicians" during a three month period when the DISCLOSE study was conducted - and the study acknowledged this was "a rate that had been stable for some time" (King, et al 2006).
 

To the reporting challenge and the current contractual negotiation challenges, Gomberg's article would is relevant. "Organizational structures are undergoing almost continual redesign in response to external social, economic, and political forces in an effort to provide a total quality output. The vision and direction of a successful organization is not limited or driven solely by such external forces. 'Organizations should exist to enable ordinary people to do extraordinary things.' Nursing service administrators are strategically positioned to create a health care system that is technically excellent and humanly compassionate." (Gomberg & Sinesi, 1994)

Yesterday, Gomberg continued to focus statements on salary  within the contract. She said the hospital's proposal of 6.5 percent salary over four years (versus the union's demand for 14.5 percent over four years) is "fair, reasonable and competitive in the marketplace."

Until the disparagement clause is removed from the contract negotiations any discussion of pay rates and health benefits is secondary. This isn't about money right now. This is about patient safety.

 *Special  thanks to Lee Tilson, JD, who provided integral research assistance for this article. You can learn more about Mr. Tilson and his work here.

Gomberg S, Sinesi L. 1994. A collaborative interaction model and the implementation of shared governance. Holistic Nursing Practice. April 1994, pp 12-21.

King E, Moyer D, Couterie M, Gaughan J, Shulkin D. 2006. Getting doctors to disclose medical erros: Project DISCLOSE. The Joint Commission Journal on Quality and Patient Safety. July. Volume 32, Number 7, pp 382-392.