Friday Memo-August 30, 2019

Dear Team –

            Let’s begin with a shout out to our colleagues staffing Community Healthcare Network health centers tomorrow and Monday, Labor Day. Thank you.

            As summer unofficially ends, and some of us relax and others struggle to get children ready for the welcome (or dreaded) return to school, I want to pause and recognize Labor Day’s importance to CHN today.

            Most CHN staff members are part of the union 1199 SEIU United Healthcare Workers East, which I will just call 1199. Union-management relationships within mission driven, non-profit organizations, like CHN, are quite different from historic labor battles, say between mineworkers and corporate owners. Sure, there are occasional tussles and negotiations between 1199 and CHN, but we both strive successfully to collaborate for the good of workers and our patients.

            1199, founded in New York City in 1932 to organize pharmacy workers, remains committed to advocacy advancing social justice. Part of that reflects directly on CHN. Most recently, 1199 worked with the New York City Council to include Federally Qualified Health Centers in the City’s new funding to provide care to undocumented immigrants. If successful, that could help CHN.

            With a large financial war chest to support political candidates, 1199 fights to protect publically funded health care (maybe sometimes too closely with large hospitals, but overall, for the good!). This is essential, not just for New York but for CHN.

            The union sees its political role in other justice arenas as well. It fights for immigrant rights both locally and nationally, and it is a leading voice in environmental battles for clean air and water.

            My personal affection for the role of organized labor runs deeply. Going back to the Great Depression, my grandfathers were union men – one as a tailor in the garment industry, the other a boilermaker in the Brooklyn Navy Yard. My mother, a New York City Public School teacher, was a fervent retiree member of the United Federation of Teachers until her death at age 94. The first time I ever stood up in court as a lawyer, I was representing (pro bono, of course), the Council of Interns and Residents, a once activist union.

            Ten years ago when I was running the Medicare Rights Center, a non-profit dedicated to advancing health benefits for older Americans and those with disabilities, Andy Stern, then the dynamic president of the nation-wide SEIU, served on our board. More recently, I worked closely in Puerto Rico with my friend  Dennis Rivera, who served as president of 1199 from 1989 to 2007.

            Labor Day 2019 is a good moment to rededicate our entire organization to better working lives for our employees, union members or not. We know that happier workers make better workers who provide better care for patients.

            A decade ago, all the smart people in health care policy gathered around the Triple Aim: 1) improve the patient experience, 2) improve the health of populations, and 3) reduce the per capita cost of health care. This was the mantra, and who could object?

            You could object if you were in the health centers and hospitals actually providing health care, not just in a think tank conceptualizing the Triple Aim.

            This gave rise to the fourth leg on the stool – “improving the experience of providing care.”  There now is the Quadruple Aim, and it is the gold standard of what health care delivery and CHN require.

            This is that fourth aim, well described by three practitioners:  “The core of workforce engagement is the experience of joy and meaning in the work of health care. This is not synonymous with happiness, rather that all members of the workforce have a sense of accomplishment and meaning in their contributions.”

            We have come a long way since 1894, when Labor Day first became a federal holiday. That was the year of the Pullman strike, when train workers walked off their jobs, crippling the nation’s transportation. Federal troops replaced the workers and riots broke out, leaving a dozen strikers dead in Chicago. Congress created the holiday to lower the tension.

            No riots today, thankfully. This Labor Day we are recommitting ourselves to achieve, as much as humanely possible, the full meaning of the Quadruple Aim.