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IndustrialrelationsconflictinIrishhospitals-areviewofLabourCourtcases.pdf
Journal of Health Organization and Management Industrial relations conflict in Irish hospitals: a review of Labour Court cases
Jennifer Cowman, Mary A. Keating,
Article information: To cite this document: Jennifer Cowman, Mary A. Keating, (2013) "Industrial relations conflict in Irish hospitals: a review of Labour Court cases", Journal of Health Organization and Management, Vol. 27 Issue: 3, pp.368-389, https://doi.org/10.1108/ JHOM-11-2012-0223 Permanent link to this document:
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Industrial relations conflict in Irish hospitals: a review of
Labour Court cases Jennifer Cowman and Mary A. Keating
School of Business, Trinity College Dublin, Dublin, Ireland
Abstract Purpose – The purpose of this paper is to explore the nature of industrial relations (IR), and IR conflict in the Irish healthcare sector.
Design/methodology/approach – The paper is based on a thematic analysis of Labour Court cases concerning hospitals over a ten-year period.
Findings – The findings of the paper indicate that the nature of IR conflict is changing in healthcare. The paper suggests that alternative manifestations of IR conflict evident in the Irish healthcare sector include: absenteeism as a form of temporary exit; and resistance. The key groups in the sector are discussed in the context of their contrasting disputes. The themes which characterise negotiations are identified as precedent, procedure and partnership.
Research limitations/implications – The research was conducted in the healthcare sector, and thus its transferability is limited. Caution is also required as the research pertains to one national setting, which despite sharing some structural similarities with other health and IR systems, is a unique context. The paper highlights the importance of recognising IR conflict in its various forms. It is further suggested that managing the process of IR conflict may be significant in furthering change agendas.
Originality/value – The value of the paper centres on the investigation of alternative manifestations of IR conflict in the healthcare sector.
Keywords Human resource management, Employees behaviour, Health care, Ireland, Industrial relations, Industrial relations conflict
Paper type Research paper
Introduction It is widely acknowledged that human resource management (HRM) plays a central role in supporting service delivery (Harris et al., 2007, West et al., 2006) and change implementation (Conway and Monks, 2008) in healthcare organisations. However industrial relations (IR), defined as the rules and processes that govern the employment relationship and work relations, also have a critical role to play. The professional workforce (Bolton and Way, 2007), multiplicity of employee groups (Truss, 2003), high union density (Dobbins, 2009a) and resistance to change (Conway and Monks, 2008; Rigoli and Dussault, 2003) that are characteristic of healthcare organisations make managing IR a core feature of HRM in healthcare. In line with this view, McDermott and Keating (2011) found that IR dominates the practice of HRM in Irish hospitals. The Irish healthcare sector is popularly characterised as having adversarial relations and
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The authors would like to acknowledge the Irish Research Council for its financial support of this research, and the helpful comments of two anonymous reviewers. The authors would also like to acknowledge the use of graphs from the Central Statistics Office.
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Journal of Health Organization and Management Vol. 27 No. 3, 2013 pp. 368-389 q Emerald Group Publishing Limited 1477-7266 DOI 10.1108/JHOM-11-2012-0223
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high levels of IR conflict (Dobbins, 2006, 2009a; Wall, 2009). Further, it has been noted in the Irish setting that “industrial relations in the [Irish] Health Service are under continuous and sustained pressure” (Labour Relations Commission, 2001). Consequently the objective of this paper is to explore the nature of IR in Irish healthcare, and the range of ways in which IR conflict manifests. To achieve this, the paper begins by positioning IR as a key feature of HRM in healthcare, before considering the range of ways in which IR conflict can manifest. The methodology utilised to explore IR conflict in the Irish healthcare sector is then detailed, before core findings are presented and discussed.
HRM in healthcare: The challenge of IR The purpose of this section is to present the challenges that healthcare poses to HRM, and to position IR as a key feature of HRM in healthcare organisations. HRM plays a central role in supporting service delivery in healthcare organisations (Truss, 2003). This arises due to the labour intensive nature of the sector, noted by Buchan (2000) in the UK (Buchan, 2000), and evidenced in the fact that 70 per cent of costs in Irish hospitals are labour-related (McDermott and Keating, 2010). Thus, in healthcare, managing people and by extension HRM, is critical.
The [Irish] Health Service is one of the largest employers in the State with approximately 80,000 people involved in the provision of health care. It operates in an extremely complex and demanding environment where issues concerning human resource management [. . .] and industrial relations can become strained from time to time (Labour Relations Commission, 2001, p. 1).
In this paper, HRM is defined as the “management of people at work both as individuals and collectives, as well as the management of work” (McDermott and Keating, 2011, p. 678). The healthcare context presents key challenges to HRM professionals, discussed below.
Described as a professional bureaucracy (Mintzberg, 1980), healthcare is characterised by multiple professional employee groups (Bolton and Way, 2007) with an entrenched “tribal” culture (Davies et al., 2000, p. 113; Fitzgerald et al., 2002). Key challenges arise from these factors. First, in a professional bureaucracy, power is devolved to the operating core, where the professionals themselves control their work (Mintzberg, 1980). Owing to knowledge asymmetry between healthcare professionals and management, and the consequent autonomy healthcare professionals wield in the workplace, Mintzberg (1980, p. 334) notes that “managers in the middle line, in order to have power in the Professional Bureaucracy, must be professionals themselves”. The divide between healthcare professionals and management is further exacerbated by the largely external standardisation of professional skills in multiple functional specialities. Together these factors make managing professionals “akin to herding cats” (Mintzberg, 1997, p. 13) and pose specific challenges to HR managers. This contention is supported by Buchan (2004, p. 4) in the UK, who noted that “[t]he avowed first loyalty of those with sector-specific skills and qualifications (physicians, nurses, etc) tends to be to their profession [. . .] rather than to their employer”. These tensions in the manager-professional relationship are said to have contributed to a legacy of confrontation between management and medical professionals in the UK. This legacy, in turn, hinders the ability of HR to contribute (Hyde et al., 2006).
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A second challenge to HRM relates to the multiplicity of employee groups. It is argued that the existence of departmental and speciality divisions leads to “in-group favouritism” and “out-group discrimination” in hospitals (Michie and West, 2004). The multiple and often competing interests of distinct employee groups can contribute to “tribal” behaviour (Davies et al., 2000, p. 113), creating a “classic pluralistic domain involving divergent objectives” (Denis et al., 2001, p. 809). In the same vein, Mintzberg (1997) notes that the co-existence of different employee groups in a hospital context, and their contrasting professional perspectives, can create fragmentation. Further, because of the differing uniqueness and value of these employee groups to healthcare organisations (McDermott and Keating, 2011), different contracts of employment, and modes of employee engagement, can co-exist within the same organisation. Thus, while the existence of multiple groups has far reaching implications for organisational culture (Davies et al., 2000), it also has implications for HRM by creating multiple co-existing employment relationships among employees working in the same organisation.
Another challenge to the practice of HRM in healthcare organisations is the highly unionised nature of the sector. Healthcare consists not only of a multiplicity of employee groups but a multiplicity of trade unions and professional associations (Truss, 2003). This is evidenced in the Irish system, where coverage of collective bargaining is estimated at 100 per cent in public healthcare (Farrelly, 2009). Union density for the total healthcare sector is 86 per cent (Dobbins, 2009a) compared to a national average of 37.4 per cent (Dobbins, 2009b). Similar trends are noted in the UK by Bach (2004, p. 5) who stated that the influence of multiple unions and professional groups have remained a “long-standing feature of the NHS HR context”. In Ireland, the LRC stated that “[i]t appears [. . .] that industrial relations in the [Irish] Health Service are under continuous and sustained pressure” (Labour Relations Commission, 2001, p. 1). More recently, McDermott and Keating (2011) concluded that industrial relations were a dominant activity in the practice of HRM within Irish hospitals. Thus, managing multiple and collectivised employee cohorts is a significant challenge to HRM in healthcare.
The healthcare sector is also characterised by persistent reform efforts. Change implementation in healthcare tends to be researched from context (Pettigrew, 1992), structure (Denis et al., 2001), and agency (Buchanan and Boddy, 1992; Buchanan et al., 2007) perspectives. The IR perspective, given the highly pluralist and unionised nature of hospitals, is a notable absence. However, some attention has been afforded to the support HRM provides to strategic change initiatives by involving employees (Harris et al., 2007; Truss, 2003) and their representatives (Martineau and Buchan, 2000). Such employee involvement is often used to reduce resistance. This reflects the fact that employees are “strategic actors who can act individually or collectively to modify the governments’ projects, such as trying to impede budget cuts” (Rigoli and Dussault, 2003, p. 1478). This is supported with evidence from Ireland, where it was found that employee resistance to change was being addressed via the IR system. Specifically, Conway and Monks (2008, p. 81) note that “any questioning of change has resulted in labour court/labour commission proceedings”. Beyond resistance to change, Buchan (2000) identifies that unionisation can impose restrictions on the pace of change, due to the protection of employment conditions. Similarly, Martineau and Buchan (2000, p. 1) suggest that a unionised context poses “serious opposition” to the implementation of
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change. Therefore, while some authors focus on the relationship between HR and health sector reform (Conway and Monks, 2008; Bolton and Way, 2007), we can also identify a connection between IR and health sector reform. HR and IR each play critical influencing roles in reform and change processes. It appears from the literature that HR is viewed as an enabler of change, whilst IR is considered a constraining factor. However from a pluralist perspective it may be useful to consider IR as an intervening variable in the relationship between HRM and change, where IR can have enabling and constraining effects.
In sum, healthcare organisations are characterised by tensions between managers and powerful medical professionals (Buchan, 2004; Truss, 2003), multiple employee relationships (McDermott and Keating, 2011), highly unionised employee groups (Buchan, 2004), and resistance to change (Martineau and Buchan, 2000; Conway and Monks, 2008). Therefore, IR cannot be overlooked as a central activity in the practice of HRM in healthcare organisations. This is discussed in further detail below.
Industrial relations and conflict IR is defined here as the rules and processes that govern the employment relationship and work relations. Despite the acknowledgement that conflict is “the basic concept that should form the basis of the study of industrial relations”, there is no accepted definition of IR conflict. While authors diverge on its many characteristics (Lewicki et al., 1992), there is broad agreement that IR conflict is rooted in the employment relationship between employee[s] (or a representative thereof) and the employer (Roche and Teague, 2010), and is influenced by power asymmetry (Morrison and Robinson, 1997) and the interdependent nature of the employment relationship (Brett, 1984). In this paper, IR conflict is defined as the action, or collective actions, that arise in or relate to the work setting, when one party in the interdependent and power-asymmetric employment relationship perceives that another party in the relationship is frustrating, or about to frustrate, an important concern or goal relating to work, working conditions and/or the working environment.
Many authors have attempted to provide models that move beyond definitions of IR conflict and explain broader aspects of the phenomenon (Schmidt and Kochan, 1972). The input-output model (see Figure 1) consists of inputs, conversion and outputs in the form of regulation and rules regarding future exchanges. Created by Craig (1983; cited in Poole, 1984), in this model inputs refer to the goals, values and power of the parties, while outputs arising from a complex conversion process are the products of
Figure 1. The input-output model of
IR conflict – a focus on change
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interaction. In this model, outputs can refer to either the resolution of IR conflict and rules created for future disputes, or to effects on the future goals, values and power of the participants via a feedback loop. Sexton (1996, p. 272), adopting a similar process based approach, concludes that IR conflict is “unique in that it exists, expresses itself, takes place and is resolved in a context of interdependence between the parties”.
IR conflict in a changed context In Ireland a number of trends have emerged that have altered the IR landscape and the mechanics of the IR system. These include the juridification of the employment relationship (Browne, 1994), the individualisation of IR (Roche, 2001), the introduction of state-provided dispute resolution machinery (Roche, 2001), and the decline of voluntarism (King, 2007). Interestingly these trends are replicated internationally. Specifically, the European context has also exhibited a shift toward individualisation (Scheuer, 2006); the juridification of the employment relationship has been documented in the UK (Dickens and Hall, 2006), and Estreicher (2009) has commented on the demise of voluntarism in the USA, Germany and the UK.
Trends regarding the decline of strike activity have also been observed internationally: in Europe and the USA (Bordogna, 2010), the UK (Scheuer, 2006), and in Ireland (Roche and Teague, 2010). Scheuer (2006, p. 26) noted that strike action has “been declining markedly in most European countries since the 1970s”, with the decline in countries like Ireland and the UK “certainly much more dramatic”. The decline of strike activity in Ireland is illustrated in Figure 2. This shows a broad decline in working days lost[1] since 1985 (Central Statistics Office, StatBank[2]). The sharp increase in days lost evident in 2009 is attributable to the public-sector wide strike (Farrelly, 2011)[3].
Several authors have put forward explanations for the international decline in strike activity ranging from declining union density and coverage to changes in the employment relationship and broader changes in society (Scheuer, 2006). Importantly, in the UK Drinkwater and Ingram (2005, p. 393) warn that “the reduction of strike activity may [. . .] prove an erroneous measure of harmony at the [. . .] workplace”. Similarly, in Ireland Roche and Teague (2010) suggest that a decline in strike action may not indicate the absence of IR conflict. Reflecting this stance, Kornhauser et al. (1982, p. 13) note that often, “only ‘lip service’ is paid to the less spectacular manifestations of conflict”.
Thus, preoccupation with this singular measure (i.e. the strike) fails to capture the full range of potential manifestations of IR conflict which “may result in an incomplete understanding of the dynamics of conflict” (Hebdon and Stern, 1998, p. 204) and underestimation of economic and other impacts (Drinkwater and Ingram, 2005, p. 374). The impact of IR conflict can be evaluated in terms of its effects on productivity, stability and adaptability (Pondy, 1967). These important determinants of human capital performance can be affected by strike action, but alternative manifestations may also have significant effects (Abbott, 2007). Clarke et al. (2008) concur, arguing that the working days lost from absenteeism greatly exceed that lost from strikes even during peak activity. Therefore strike activity may not be the most accurate indicator of IR conflict in today’s environment. As a result, our ensuing subsection focuses on alternative manifestations of IR conflict.
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Alternative manifestations of IR conflict Although extant research focuses on the strike as “the traditional yardstick of workplace relations” (Drinkwater and Ingram, 2005, p. 373; Devereux and Hart, 2010) there is broad recognition that IR conflict manifests in several ways (Turkington, 1975; Bordogna, 2010). These other forms of IR conflict warrant attention in the healthcare context. A useful lens to review alternative forms of IR conflict is provided by Freeman and Medoff’s (1984) adaptation of Hirschman’s (1970) exit-voice model, which will be supplemented with a discussion of resistance.
Exit: the act of going out or away Freeman and Medoff defined (1984, p. 7) exit as “synonymous with quitting”. Within this framework employees respond to discontent in the workplace by choosing between exit and voice (Addison and Belfield, 2003), where “[i]n the job market, voice means discussing with an employer conditions that ought to be changed, rather than quitting the job” (Freeman and Medoff, 1984, p. 8, emphasis added). Freeman and Medoff (1984) argue that a union can lower turnover via the two faces of unionism. First the “monopoly face” of unions can establish bargaining power and secure higher wages, and second the “voice” or “institutional response” face of unions can contribute to the development of grievance and arbitration systems, and seniority based HR policies (Freeman and Medoff, 1984).
Quitting or turnover may be restricted due to a lack of available employment alternatives, and/or high psychological costs associated with retraining (Hammer and Avgar, 2007). In such circumstances a dissatisfied employee may seek other forms of exit. Therefore while classic understanding of exit is based on quit or turnover behaviour, this paper considers absenteeism (Knowles, 1952; cited in Sapsford and
Figure 2. Strike activity by year in
Ireland
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Turnbull, 1994) and tardiness (Bean, 1975) as forms of “temporary exit”. There are two types of absenteeism in the workplace:
. type 1 (T1) is involuntary due to genuine illness; and
. type 2 (T2) is voluntary (De Boer et al., 2002).
Bean (1975, p. 98) concurs, stating that whilst sickness absence is the primary contributor to absenteeism, absenteeism “can also be regarded as withdrawal from the work situation and a form of negative reaction to the employer”. Difficulty arises in research and management in distinguishing between voluntary and involuntary absence. We can, however, use frequency of absence (Luchak and Gellatly, 1995) or repeated uncertified absences as approximations of voluntary absence.
Voice The voice concept originally sought to establish the “fight or flight” response of dissatisfied customers (Lewin and Mitchell, 1992). Voice is defined as “opportunities for employees to convey their ideas and opinions” to their employer (Bagchi, 2011, p. 881) or “employee’s ability to express their views and to participate in decision-making” (Bishop and Levine, 1999, p. 213). It is said to include a wide variety of forms, ranging from suggestions regarding operations to mechanisms for complaint.
This contemporary view of voice or “soft voice” (Bagchi, 2011, p. 869), which includes any communication of employee ideas or opinions to employers, departs from Hirschman’s (1970), and later Freeman and Medoff’s (1984) focus on voicing discontent. This is reflected in the title of Hirschman’s work Exit, Voice and Loyalty: Responses to Decline in Firms, Organisations and States (emphasis added). Similarly, Freeman and Medoff (1984, p. 8) focus on discontent: “the use of direct communication to bring actual and desired conditions closer together. It means talking about problems”. This paper, focusing on IR conflict, adopts the traditional stance and views voice in terms of discontent.
Stemming from Freeman and Medoff’s (1984) assessment that “[c]ollective rather than individual bargaining with an employer is necessary for effective voice at the workplace”, union membership is often conceptualised as synonymous with voice. This perspective is evident where research is built on the assumption that the absence of a union creates the absence of voice – resulting in a vacuum. Benson (2000, p. 453) notes: “[f]or some commentators independent unions are the only source of genuine voice”. We can critique this approach based on emerging literature on non-union grievance systems (Lewin and Mitchell, 1992), and the existence of individual voice (Luchak and Gellatly, 1995). Consistent with this Luchak (2003) distinguishes between direct voice which entails employee efforts to mobilize change through communication with a supervisor, manager or employer, and representative voice which refers to indirect communication via a representative (e.g. union steward) or a process such as a grievance procedure.
Voice is often operationalised as grievance filing (Boroff and Lewin, 1997). Through a grievance procedure, internal or external, an employee has the opportunity to communicate and express their work related discontent. While this can pertain to issues outside the traditional parameters of IR conflict, it often concerns matters within the confines of the employment relationship. Cappelli and Chauvin (1991, p. 3) note
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“[t]he rate at which grievances are filed by employees is an important measure of the state of employee relations because it is indicative of the underlying level of conflict between workers and management”. In this context grievance filing can be conceptualised as a manifestation of IR conflict.
Resistance: the refusal to accept or comply with something Though not included in Freeman and Medoff’s (1984) framework, due to our focus on healthcare, resistance is identified as relevant. This is based on evidence in Ireland (Conway and Monks, 2008), the UK (Buchan, 2000) and the USA (Rigoli and Dussault, 2003), which suggests that IR poses a significant challenge to healthcare reform. Specifically, McDermott and Keating (2010, p. 63) that “Ireland has experienced sustained problems in attaining service improvement in health care”. Further, Freeman and Medoff (1984, p. 21) acknowledge that unionised organisations operate “by the book”, resulting in less flexibility. Therefore the authors include resistance as a form of IR conflict.
Some authors consider absenteeism, sabotage and voice as forms of resistance (Roscigno and Hodson, 2004). However, here we adopt a narrower conceptualisation. This paper views resistance as the “refusal to accept or comply”, where the focus of resistance may include a policy, management strategy, directions/orders of work, and resistance to change as a broader focus. However, Dent and Goldberg (1999) argue that people do not resist change; rather, people resist loss. Employees may resist loss of pay, status, autonomy, or loss of the familiar and its associated security. While resistance may be motivated by other aspects of change, there is broadly resistance to a changed outcome. Other language that may be used to discuss resistance in this context may include the withdrawal of cooperation (Harrison et al., 2001).
This section presented a review of literature pertaining to IR conflict with a view to establishing a justification for renewed investigation into the phenomenon. It has been shown that, whilst recognised as a multi-faceted construct, IR conflict is synonymous with the strike. However, due to changes in the IR landscape and declining strike activity the authors assert that the strike may not be the most accurate indicator of IR conflict. Thus the following section will detail an investigation of alternative manifestations of IR conflict.
Methodology The methodological approach consists of a thematic analysis of Labour Court cases concerning hospitals over a ten year period. The objective of this investigation is to explore the nature of IR, and IR conflict in the Irish healthcare sector.
Research context IR conflict manifests in a multiplicity of ways. Thus an investigation of IR conflict using an alternative to the strike metric provides value. The changes in the IR landscape provide further impetus for the investigation of alternative manifestations of IR conflict, and alternative arenas in which IR conflict can arise. These changes point to the value of using an IR institution as a milieu to explore IR conflict. This is based on the increasing importance of legislation and procedure in the resolution of employment disputes (King, 2007), and the rise of state-provided dispute resolution (Roche, 2001). It has also been noted (Labour Relations Commission, 2001, p. 1) that the Irish health
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service has a “disproportionately high level of usage” of the LRC and the Labour Court, which is “indicative of the extent of industrial relations activity in the Health Service generally”.
There are a variety of IR institutions in the Irish IR system. According to King (2007, p. 122) the Labour Court “is the most important industrial relations institution in Ireland” based on the “status of the Labour Court as a court of last resort” (Murphy, 1994, quoting Bonner[4]; cited by King, 2007, p. 122) and its involvement in the most significant IR events in the State over the last 60 years. The conceptualisation of the Labour Court as the “Court of Last Resort” stems from:
. its function as a Court of appeal via both the Rights Commissioner and the Equality Tribunal;
. the Court’s role in investigating disputes that pose a threat to national interest; and
. the notion that the Labour Court is the last point in the system before a strike action.
It is understood that parties to a dispute have an obligation to “exhaust the process” before strike action, where the Labour Court is viewed as the last step in the process. This is reflected by the Labour Relations Commission (2001, pp. 3, 24) which noted that “Labour Court recommendations must be the final step in the industrial relations procedures”, and that “[t]he Labour Court must be accepted as the Court of last resort and the end of the process”. The report also stipulates that prior to the end of the process, “no strikes, lock-outs or other action designed to bring pressure to bear on either party should take place” (p. 36). Thus, in selecting an IR institution in which to investigate alternative manifestations of IR conflict, the Labour Court is an appropriate setting.
Research design All cases relating to the Irish healthcare sector occurring between 2000 and 2010 were reviewed. This created a population of 992 cases. The initial cohort of cases was collected from the Labour Court database using the search terms “hospital” and “HSE” (i.e. Health Service Executive). A sample of 385 cases was retained based on the following selection criteria, which included cases falling within the unit of a hospital, or directly concerning a hospital or a number of hospitals where the employer was stated as the, Health Board, the HSE or the Health Service Executive Employers Agency (HSE-EA)[5].
Cases were examined and categorised under several headings. The second stage involved thematic analysis facilitated by NVivo, a qualitative data analysis software package.
Data analysis Thematic analysis which involves identifying, analysing and reporting patterns or themes of data was used to interpret the research data (Braun and Clarke, 2006). The research incorporated both the data-driven inductive approach of Boyatzis (1998), and the deductive theory-driven approach involving the use of a priori constructs as outlined by Miles and Hubberman (1994). The value of this approach was highlighted by Fereday and Muir-Cochrane (2006, p. 83) who noted that integrating these methods
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allows the study to draw on extant research and for themes to emerge directly from the data. In practice this required three iterative cycles of analysis. Firstly an inductive review of the data to allow for emergent codes was conducted. The second stage involved exploring deductive codes and the use of a priori constructs derived from existing literature. The final cycle involved reviewing the codes with their associated data, and clustering codes into themes.
Findings: exploring the nature of IR and IR conflict in healthcare Data analysis revealed findings in the following areas:
. the changing nature of IR conflict;
. alternative manifestations of IR conflict;
. healthcare as a pluralist context; and
. themes of negotiations.
The changing nature of IR conflict: the demise of the strike? A total of six out of 385 cases explicitly referenced the issue of industrial action. In one case concerning redeployment of ambulance staff (LCR16988), there was a threat of industrial action that led to national engagement via the National Implementation Body (NIB), where remaining issues were referred to the Labour Court. The Court commented:
Following a threat of industrial action by one of the Unions, the dispute was the subject of discussions between Senior Government Officials and the Social Partners under the auspices of the National Implementation Body of the PPF [Program for Prosperity and Fairness].
Despite the focus of extant research on strike activity, the Labour Court data contained very few references to strikes. Only two out of 385 cases contained direct references to strike action. In one case concerning St Ita’s Hospital (LCR16686), there was a “one day strike action” over issues pertaining to hours of attendance, uniform provision and the conditions of the working environment, while in a case concerning the Southern Eastern Health Board (AD0290) there was a reference to a national nursing strike in 1999. Interestingly, however, the Court itself described issues beyond the remit of traditional strike action or industrial conflict as “conflict”. This emerged in a case concerning HSE Dublin North East (LCR19645), which related to alleged workplace bullying between a manager and a subordinate. Whilst bullying is typically discussed in terms of HR/interpersonal conflict, an employer’s failure to investigate bullying and subsequent sick leave brings the issue into the IR domain. The Court noted that “a better management response would not have avoided the conflict giving rise to this claim”.
The limited references to strike action were accompanied by an increase in Labour Court cases for hospitals, with cases increasing from 21 in 2001 to 47 in 2009. When we exclude the outlier of the public-sector wide strike in 2009 (Farrelly, 2009), which may distort national figures due to the size of employment in the public sector (Eurofound, 2009), we can observe a decline in national strike activity for the same period. Within the Irish healthcare sector strike activity remained in line with comparator industries such as the Irish education sector, as is illustrated in Figure 3. As can be observed in Figure 4, there is a small difference in working days lost between the healthcare and
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Figure 3. Working days lost in the Irish healthcare and education sectors, 2000-2008
Figure 4. Working days lost in the Irish healthcare and education sectors, 2009
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education sectors in 2009. However this is attributable to the public sector strike and the differences in numbers employed (Boyle, 2011).
Despite this evidence, the sector continues to be described as “highly adversarial, traditional and defensive, with frequent disputes arising over any changes” (Dobbins, 2009b, p. 11). Further, when we review the top three sectors most affected by strike activity per year over the 2000-2009 period, Irish healthcare was cited less than the manufacturing and transport/communication sectors (Carley, 2008).
Alternative manifestations of IR conflict Based on the analysis of the Labour Court data, the most heavily referenced issues were pay and change. However, due to the scope of this study this paper will focus on change and resistance and absenteeism as alternative manifestations of IR conflict. While traditionally described in HR terms, these issues have presented in an IR forum. The Court made reference to non-traditional IR issues presenting in the Labour Court in a case concerning the conditions of the working environment, specifically security, clerical cover and the use of a prefab building in an Accident and Emergency department:
The Court has some doubts as to whether the matters raised in this claim could be properly classified as industrial relations issues. Nonetheless, they are the subject of dispute between the members of the INO [Irish Nurses Organisation] and their employer and it is in the interest of all parties that they be fairly addressed (LCR18681).
The theme of change was evident in many cases, with disputes between employer and employee relating to the classification of change, and whether such was within the parameters of “normal ongoing change” as established in national Social Partnership[6] agreements. In a case relating to the HSE, the union party stated that “[a] significant extension to the working day involving a late finish could not be characterised as normal ongoing change”.
The issue of resistance to change was also dominant in many of the cases. A number of cases exhibited resistance to change in an indirect way, and in line with Dent and Goldberg (1999) are better described by resistance to loss. Resistance to “loss of earnings” was heavily cited across the cases, while other losses such as the loss of “afternoon tea break” (LCR19751), “one days marriage leave” (AD0115), status (AD0734), a subsidised canteen (LCR16547), and free meals (LCR19506) were also referenced.
Despite the prominence of resistance to loss, 34 out of 385 cases related specifically to resistance to change. This issue is well illustrated in a case concerning the St Francis Private Hospital (AD0285), where management sought to change reporting structures. The union involved stated that “[t]he current reporting structures for laboratory staff has served our members, the hospital and its clients for over twenty-five years. There is no need to change them now”, and that “[c]hange for change sake is not always a good policy. No logical explanation has been given as to why this change should take place”. Thus rather than change being the norm it requires justification. Mr Sean McGrath, former Director of HRM in the HSE, stated that “[t]oo much time is spent explaining why the business needs to change [. . .] [w]e’re going to suffer the corporate equivalent of a massive coronary and we’ve no time for anaesthetic“[7]. Therefore, delays posed by IR in healthcare (Buchan, 2000) may be related to resistance to change, and pressure to justify change. Absenteeism, traditionally conceptualised as a HR
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issue, also presented as an IR issue in the Labour Court, and indeed as a manifestation of IR conflict. Owing to the ambiguity surrounding absences, it was difficult to distinguish between medically justified and unjustified absenteeism as discussed by De Boer et al. (2002). That said, the issue of uncertified absence, which is taken as a proxy for medically unjustified absences, arose in a number of cases. This was evident in the Mid Western Health Board (LCR17980) case, where management pursued disciplinary action regarding absenteeism. While the union acknowledged that when “a pattern of sick leave develops it must be dealt with”, it was the union’s position that a disciplinary approach is not suitable and instead warranted a “sensitive caring approach”. In response the employer stated that the employee was requested “to provide medical certification for any uncertified absences” after which “[h]e again had 2 episodes of uncertified sick leave in 2002 [where] no medical certificates were received by the Board”.
The above illustrates that absenteeism is an issue of management concern in the health domain. Similarly in the Southern Area Health Board (LCR17289) case, which related to a dispute over job rotation, management stated that “[n]on rotation can lead to increased levels of absenteeism”. The issue was also cited in a case concerning St Vincent’s Hospital (LCR18884), where management “made a decision to deal with what it believed were unacceptably high levels of absenteeism” by issuing letters to 54 staff. This resulted in a claim for compensation from four employees.
In addition to medically uncertified absences, the issue of stress-related absences arising from workplace problems was evident in many of the Labour Court cases. There were three forms of stress-related absences. The first concerned the employee response to disciplinary action. While the link between discipline and absenteeism was not explicitly made in the cases, a significant portion of cases concerning discipline referenced employee absenteeism, where absenteeism was not the issue of disciplinary action:
The disciplinary process concluded and the subsequent appeal found that the assistant directors should return to work on a given date, which did not happen. The two assistant directors who were suspended and an additional three assistant directors are currently on sick leave (LCR19571).
The remaining two types of stress-induced absenteeism related to bullying with a management “failure to investigate” (AD0445), and conditions of work where the “high levels of stress workers are under” were reflected by “high levels of sick leave which are a huge burden on hospital resources and staff” (LCR18684).
Absenteeism has been identified as a problem in Irish healthcare, with a rate of 4.8 per cent in 2012, 37 per cent over the HSE target of 3.5 per cent (Mitchell, 2013). Further, in 2011 15 per cent of all absences were uncertified (Health Service Executive, 2011). Thus, absenteeism is both a significant problem in Irish healthcare, and based on analysis of this data, a manifestation of IR conflict.
Healthcare as a pluralist context The parties in the employment relationship typically consist of three groups: employer, union and employee. The healthcare sector differs however comprising of a multiplicity of employee groups, and a multiplicity of unions (Truss, 2003). The case data was segmented according to employee group allowing intergroup comparison. It was found that there are a number of groups that persistently present in the Labour
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Court most notably nurse, non-consultant hospital doctors (NCHD), and laboratory staff, closely followed by porters. However, this may reflect the relative size of groups. Interestingly when we compare these groups to rates of absenteeism in the sector we find that the NCHD group exhibited the lowest rate of absenteeism of any employee group averaging between 0 and 1 per cent while nurses and general support staff exhibited the highest levels reaching rates of 16.08 per cent and 11.16 per cent, respectively (Health Service Executive, 2012).
The issues of conflict differed according to professional group with NCHD’s focusing on issues of working time and the implementation of the EU Working Time Directive, along with claims for contracts of indefinite duration. In contrast porters pursued claims relating to grading and parity with other groups.
The issue of multiple unions arose in a case involving the Eastern Regional Health Board (LCR16675) that explicitly referenced inter-union disputes. This case concerned the appointment of nurse management positions, where an agreement with one nursing union led to a dispute with two other health sector unions. The Court noted that “[m]anagement is not prepared to place itself in the midst of an inter-union dispute”. Consistent with Kearney et al. (2010) in the USA, this signifies the complexity of healthcare management, where HRM professionals face not only a multiplicity of collectivised professions and the dynamics between them, but also the dynamics of inter union competition.
The themes of negotiations Resulting from an analysis of the data three key themes emerged which characterised the negotiation of IR conflict. These were identified as precedent, procedure and partnership.
The theme of precedent, a classic feature of negotiation in IR, was referenced throughout the cases reviewed. There were three types of precedent issues:
(1) established precedent or “custom and practice”;
(2) precedent and parity; and
(3) precedent setting or “knock on effects”.
The first, established precedent, emerged as a theme of negotiation where the employer had allegedly breeched “custom and practice”. Often used as an argument to resist change, unions attempted to preserve the status quo, by identifying such as “custom and practice” and therefore an implied term and condition of employment.
The issue of precedent and parity was used as a means of securing improved terms where union representatives identified an example of desired practice applicable to another employee group, another part of the hospital or another hospital in the sector. Notably claims relating to parity extended beyond the boundary of the employer signalling the scope of precedent in the sector.
While the two types of precedent identified above centred on union argument, the third type related to the employer argument that concession of a claim would set precedent and lead to further claims or “knock on effects”. In a case concerning St Columcille’s Hospital (LCR16830) the employer stated that “any concession of the claim will lead to knock-on effects in other areas of the hospital”, while a case concerning St Vincent’s Hospital (LCR18327) referred to broader precedent setting “for health
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services providers in the Dublin area and throughout the country”. This highlights how connected the healthcare context is, and further signals the scope of precedent.
The issue of procedure was prominent in many cases. While the substance of the case often related to what might be termed “non-IR issues” such as bullying and interpersonal conflicts, IR conflict emerges when the procedure followed by the employer in addressing these issues was in some way perceived to be inadequate. This theme of procedure is evident in cases concerning discipline and in the management of employee grievances, where procedural inadequacy relates to an inconsistency between the course of action pursued by management and management’s own policy. This was evident in a case relating to the HSE (LCR0655), where the union claimed that “management at the hospital did not follow their own grievance and disciplinary procedures and the worker was sent home unfairly as a result”. This is reminiscent of Freeman and Medoff’s (1984, p. 21) description of unionised organisations as operating “by the book”, noting that a key aspect of a union’s “voice” face is the development of grievance and arbitration systems. Thus we can argue that maintaining grievance systems is also a key union role.
It was found in the cases reviewed that the tripartite structure that was Social Partnership acted as a context and rule maker in negotiations between employer and employee. In many cases a claim was challenged by the employer stating that it was in breach of the national agreement, while the issue of whether a change initiative was within or beyond the parameters of normal ongoing change was also determined by partnership. In a case concerning St Vincent’s Hospital (LCR18327), the employer rejected a claim for compensation, stating that it was “ccost increasing [. . .] and is thus precluded by Sustaining Progress”. The employer continued to state that “[c]ooperation and flexibility is an integral part of these deals”.
While Social Partnership has ceased to exist it is thought, on the basis of the above, that its processes are embedded in the Irish IR context, and that, in the context of the public sector, the Public Sector Agreement continues to act as a rule maker in the IR sphere.
Discussion The change in the nature of IR conflict in the Irish healthcare sector is illustrated by the inconsistency between the perception of Irish healthcare as conflict-prone (Dobbins, 2009a; Wall, 2009) and strike data for the sector. While the sector continues to be recognised as an exemplar of adversarial relations this is not reflected in strike data, which show that sectors such as education display comparable levels of strike activity, while manufacturing and transport/communication are more affected by strikes. It has been noted, however, that healthcare exhibits a disproportionate use of third-party institutions, including the Labour Court (Labour Relations Commission, 2001). This supports evidence in the UK suggesting that strike activity may not be the most accurate indicator of IR conflict (Drinkwater and Ingram, 2005).
Despite the focus of extant research on strike activity (Drinkwater and Ingram, 2005; Devereux and Hart, 2010) the findings of this study indicate that the nature of IR conflict in Irish healthcare is undergoing a transformation. The Labour Court, as the “Court of Last Resort” (King, 2007) hears disputes at the last point in the dispute process before industrial action (Labour Relations Commission, 2001). However, based on our analysis of 385 cases there were limited references to strike. This seems
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inconsistent with the use of strike, and its threat, to apply pressure (Clegg, 1976). Prominent themes that arose in the cases analysed related to issues not normally conceptualised as IR conflict. Issues such as absenteeism and resistance to change, typically considered within the HRM domain, were observed as falling within the Court’s remit defined as “the provision of fast, fair, informal and inexpensive arrangements for the adjudication and resolution of industrial disputes” (Labour Court, 2011). This finding is consistent with Goddard (2011, p. 283) who posited that IR conflict may have been redirected to alternative “less organised and less overt manifestations”, or repressed and therefore exhibiting itself in “various forms of dysfunctional behaviour not typically considered to reflect conflict”.
The findings of the paper indicate that absenteeism is a form of IR conflict, and a means to “exit” the workplace. This is consistent with De Boer et al. (2002), who noted that there are two ways that discontent in the workplace may contribute to absenteeism. Firstly, the “withdrawal” explanation of absenteeism indicates that an employee uses absenteeism to avoid the workplace and “aversive working conditions” (De Boer et al., 2002, p. 181). The second way that discontent can lead to absenteeism is through stress. The employee, stressed with the working environment or the conditions of work, may begin to exhibit physical symptoms/health problems, and absenteeism can result. We can argue that discontent, and subsequent stress, can arise from IR conflict. The issue of stress and its relationship with absenteeism was also heavily referenced, indicating that discontent in the employment relationship may lead to both voluntary and involuntary absences. This is supported by Tetrick and Fried (1993), who note the linkages between IR and stress due to the inherent tension between management and labour.
The multiplicity of professional groups and the themes of IR conflict negotiations provide further evidence on the complexity of the healthcare context, and specifically the IR challenge posed by the sector. It emerged throughout the cases that each group had differing issues and priorities. This is consistent with Mintzberg (1997), who noted the tendency of professional groups and their objectives to diverge. However, the pluralist context is further complicated when we consider the prevalence of precedent in the cases. McDermott and Keating (2011) found evidence suggesting that hospital HR departments, dominated by IR matters, focused efforts on providing services to groups with low strategic value and low uniqueness. The difficulty associated with correctly allocating employees to the quadrants of the uniqueness-value framework, particularly within the healthcare context, is noted (McDermott and Keating, 2011). Further challenges in this regard may be the employee’s assessment of their value and whether this conforms to that of HRM, and the employee’s assessment of their value relative to other employee groups, where issues of equity and the perception of fairness may arise. The issues of precedent and parity and knock on effects may be significant here, as the ability of HRM to differentiate practice according to employee group may be limited by a fear of precedent setting, and potential for claims relating to “like work” This was dominant in cases relating to the porter group. Mintzberg (1997, p. 7) identified the dangers of precedent, noting that delivering on a deal with one group “can be divisive in the system”.
The theme of IR conflict and change was evidenced throughout the cases. The findings point to change as an instigator of IR conflict. While Fox (1973) asserted that IR conflict arises from diverging interests, Barbash (1980) contended that conflict is a
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product of organisational tensions due economic insecurity. Thus, in line with Dent and Goldberg (1999), change, when threatening security, can engender resistance to loss. However, the data analysed here provided evidence relating directly to resistance to change. It may be, drawing on Craig (cited in Poole, 1984), that change is one input in the process of IR conflict.
We can consider the outputs of change related IR conflict as the impact of IR conflict, which as noted can be evaluated in terms of effect on productivity, stability and adaptability (Pondy, 1967). Buchan (2000) noted the potential for employee relations to limit the pace of organisational change, while Abbott (2007, p. 63) commented on what the authors term “managerial paralysis” whereby “securing industrial peace becomes a more important goal than achieving business objectives” (Abbott, 2007, p. 63). Managerial paralysis and precedent may be considered as elements of a feedback loop that influences future interactions between parties in the employment relationship. While Buchan (2000) noted in the UK that a key function of HRM is to manage employee relations to further change delivery in healthcare, the findings of this paper indicate that managing the process of IR conflict and the conversion of change into outputs might also be significant. This is illustrated in the data through the emphasis on precedent and procedure, combined with the prominence of change-related resistance as a manifestation of IR conflict. Thus, in line with Rigoli and Dussault (2003), who noted the centrality of the employee cohort in securing healthcare reform, the paper suggests that IR is central to change implementation in the sector.
Research limitations The limitations of this methodological approach centre on the specificity of the research context. First the data pertains to one national context and therefore transferability of findings to other settings requires some caution. Similarly, while the use of the Labour Court as a research setting provides value due to its proximity to strike action in the dispute process, it is one of many IR institutions in the Irish IR system. Thus, in line with Drinkwater and Ingram (2005) in the UK, we suggest the need for further investigation of IR conflict in IR institutions. We also suggest, on the basis that the workplace is central to IR, that the dispute process is more than likely within the bounds of the organisation. Thus in extending research on alternative manifestations of IR conflict, we emphasise the value in exploring hidden forms of IR conflict within the workplace setting.
Implications for research and practice Whilst the authors make no claims regarding the current or future demise of the strike, the findings indicate the value in researching alternative manifestations of IR conflict to the study of HRM in healthcare. With regard to the practice of HRM, the paper highlights the importance of recognising IR conflict in its various forms. However, this is a difficult task due to the often obscured nature of alternative IR conflict manifestations. Finally, we posit that HRM in Irish healthcare is largely influenced by the plurality of the context combined with the embedded interests of professional groups, and the focus on precedent.
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Notes
1. Working days lost is considered to be the most useful indicator of strike activity by capturing the duration of the strike, and the impact on the industry (Eurofound, 2009).
2. The CSO data must be viewed with caution due to the exclusion of work stoppages lasting less than one day (Dobbins, 2009b).
3. In 2009 public-sector wide strike action occurred due to a dispute over pay cuts.
4. Kevin Bonner, Former Secretary to the Department of Labour.
5. The HSE-EA is now the HSE Corporate Employee Relations Services (CERS).
6. Social Partnership was a system of national level pay bargaining between government, union and employer bodies. Created in 1987, Social Partnership collapsed in 2009 during a dispute over public sector pay cuts.
7. Presentation on change implementation in 2010, available at: http://per.gov.ie/wp-content/ uploads/Presentation_by_Se%C3%A1n_McGrath_Implementing_the_Change_Agenda_ in_the_Health_Service.pdf
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Corresponding author Jennifer Cowman can be contacted at: [email protected]
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