Communicating in a Perfect Storm

Updated on December 17, 2021
Team of doctors working together on patients file in medical office

Cool Photos from Depositphotos

By Nick Kalm and RJ Bruce

With union activities expected to pick up steam at hospitals and health systems in the coming months and years, strong and persuasive communications efforts can help lessen the impact of those activities.

However, many health systems struggle to effectively communicate with employees on a regular basis, and most are not prepared for the nuance and speed needed to communicate during a union vote or contract negotiations. This article details how health systems should structure their efforts to effectively communicate with their employees before and during a union challenge. A health care system is like a ship that is constantly at sea. Unlike other “businesses” that choose to, or must, periodically come into port (shut down), that’s never an option for a health system. 

Some periods of time are more challenging for health systems than others. Consider the very choppy waters they are sailing in today: a long-term, nationwide shortage of nurses and other health professionals, with thousands leaving the profession every day. Waves of COVID cases (with the fourth wave now cresting). A variety of financial challenges, ranging from the loss of many elective procedures during the pandemic to continued pressure on reimbursement costs from governmental and non-governmental payors. 

Last but certainly not least, we must consider that national labor unions are enjoying the highest level of public support in 20 years, a presidential administration that has openly declared its support for labor, and the possibility of the most sweeping change to national labor law in several generations. It is truly a perfect storm.

This confluence of factors is especially challenging for hospitals and health systems seeking to remain entirely non-union or to minimize the presence or disruption of unions if labor has already established a foothold. Even in ordinary times, it takes a concerted effort to develop and align communications to help achieve these goals. Communicating with health care employees today involves more complexity than ever before.

This means that too often, many health systems’ employee communications simply aren’t set up to win. There are important building blocks every health system should have in place well before challenges from unions emerge. These include:

  • Help employees understand the business of health care. It would be a mistake to simply assume your employees understand your business model – especially if you don’t explain it to them. Employees need to know these factors before a union broadly challenges health system spending or asserts that you “can afford to spend more” on staffing, wages, or benefits.
  • Track and share benchmarking data. Too often, health systems struggle to consider, let alone show, how the wages and benefits they offer their employees compare with other health systems in their region. Accessing this kind of data is not only important in making sure your employees are fairly compensated, but it also serves as proof of how much you value them. (Of course, if you find the data isn’t favorable, prioritize addressing this as soon as possible). All of this can play an important role in addressing the crucial recruitment and retention challenge, especially as hospitals around the country are experiencing an average 9.9% RN vacancy rate and an RN turnover rate of 18.7% (NSI, 2021). Similarly, it’s important to know and tell your employees how your health system is performing in other key metrics, such as mortality, safety of care, readmission, patient experience, and timely and effective care (CMS, 2021). After all, employee actions (and inaction) – and, therefore, communications play a role in all of them.
  • Take stock of your existing vulnerabilities. Unfortunately, unions and many others will look for places where a hospital or health system is most vulnerable and seek to exploit those vulnerabilities for their own benefit. These include patient advocacy groups, plaintiffs’ attorneys, and investigative journalists, to name a few. The list of potential vulnerabilities is long, comprising safety, wage disparities relative to peers, level of charity care, executive compensation, etc. Savvy health systems should take a hard look at their vulnerabilities and make changes where they can, before a union or other critics point those out, and then tell positive stories about the changes that have been made. Where that isn’t possible, health systems should develop strong fact-based messages in advance to defend themselves or provide context if/when a union or other entity highlights those issues.
  • Make sure your employee communications vehicles actually work. It sounds so simple, but too often, health systems haven’t stopped to assess whether their workforces actually read or value the employee communications they produce. And, trying to assess and improve those during a labor situation can be extremely challenging. Questions to ask yourself include:
    • Can busy caregivers regularly and easily get the information they need to do their jobs AND the information the administration wants them to know?
    • Are the communications that employees receive useful and/or interesting to them?
    • Are the communications short and to the point, or do they take a long time to wade through?
    • Does the health system just talk “at” employees through their communications, or are employees given a real voice, where their views are heard and their ideas acted upon?

Establishing or enhancing effective employee communications vehicles should always be based on knowledge gleaned from surveys or focus groups with the employees you are trying to reach. 

  • Celebrate your caregivers. It’s not that health systems don’t value their employees. Instead, there are often other things they are more eager to talk about such as innovative treatments, the nationally recognized physician they just recruited, state-of-the-art equipment, or other projects such as new wings or clinics. Find and share the stories about your employees and teams going above and beyond to serve patients. Praise from supervisors and leadership is important, but be sure to consistently celebrate them in internal and external communications too.
  • Elevate the visibility and relatability of leadership. To be sure, employees relate most to their immediate supervisors (who themselves need to be trained and equipped as the key communicators they are), and a supportive relationship between the two is an important factor in determining employee job satisfaction (McKinsey, 2020). But key leaders, including the hospital and health system president, the CNO, and others, need to establish and maintain their own ongoing visibility and relatability as well. Communicating to employees to show that you understand and are committed to addressing their challenges and struggles is key and can help create a positive workplace culture (Institute for Public Relations, 2020).
  • Remind your employees they have a great place to work. If a health system’s pay and benefits are competitive, then it’s the intangibles that make a difference in hiring, retaining, and motivating the best people. What is your health system’s culture? Is leadership visible and respected? Is your health system admired in the community (University of Pennsylvania, 2017)? How do you know? What do surveys show about how the health system is viewed by its competitors? Have you received any awards or other external recognition for your employment practices or contributions to the community? Does your health system’s marketing feature and celebrate employees? These all can and should be communicated to employees regularly.
  • Make friends before you need them. Many elected officials like to weigh in during labor disputes or other controversies. Whether they receive campaign support from unions or not, legislators often like to be seen as the champions of employees (voters). With these politicians, the most you can often hope for is muted pressure or neutrality. With other elected officials, if they know you and your health system and can be helped to understand the challenges you face, they will not only avoid criticizing you, but they might also defend you in front of the media and their constituents.

You also want to make sure you have other friends in the local community – civic organizations, high schools and colleges, clergy, and other prominent or influential individuals. Chances are, you’re the largest private sector employer in town. Act like the leader that you are. Invite groups in to see the new wing. Work with the colleges and universities to try to establish or strengthen a recruiting pipeline. Ensure you have a strong track record of charity care within the community. 

Hopefully, your hospital or health system has done most or all of these things before you face a union challenge. If so, you’re that much more ahead of the game. But if a union launches a corporate campaign or organizing effort, or they are already on the property, and you’re heading into difficult contract talks, there are other key steps to take. These include: 

Become The Preferred Source of Information

Unions, especially in organizing situations, often like to play “fast and loose” with the facts. They can – and do – make promises they can’t keep when they’re trying to organize employees. This also holds true during contract talks. What can health systems do to combat this? Become a consistent and credible source of information for employees and other interested parties. Communicate frequently and, whenever possible, first. Use data to bolster statements. Make sure you’re updating your employees after each bargaining session. Talk to the local news media before and during negotiations to frame the discussions (which isn’t “negotiating through the media”). Use specialty websites/pages, social media, and speeches to educate the community.

Whoever communicates first sets the tone, and it’s much better to be in the driver’s seat than trying to play catch-up. It’s not just about speed, though, it’s also about credibility. The union is going to say whatever its going to say, but as a savvy health system, you can become the reliable source for the truth. Part of being that credible source of truth 

means not “whitewashing” information that isn’t necessarily favorable. If you can transparently talk about where you’re struggling, such as maintaining staffing levels or other challenges that impact operations, you will earn and keep the respect of employees as the situation unfolds. 


The union is probably going to say ugly things about the health system, about your leadership, and so on. It will be tempting to respond in kind – especially if the union really steps out of bounds. Don’t do it. You won’t win by trying to make the union look worse than they’re trying to make you look. You will win by creating and sustaining strong bonds of trust with your employees. Instead, express disappointment with the union for “trying to tear down” the institution and then discuss the positive steps you’ve taken to help your employees. 


One of the most potent weapons unions have is the ability to speak simply, directly, and evocatively. In war parlance, they call this “winning hearts and minds.” Many employers struggle to match this in their messaging, which is one of the reasons why they often lose. If you are a communications target inside or outside a health system, who are you going to be most persuaded by? The organization that really seems to speak to what you’re thinking and feeling? Or the one that communicates in more cold, clinical, and “corporate” terms? 


All messaging should be fully designed to help achieve the health system’s priorities visà-vis the union. This could be as broad as discouraging a unionization vote from taking place or as specific as driving support for improving attendance or disciplinary policies before and during contract negotiations. In either case, it’s important that you know what your priorities are from the very beginning of your efforts, rather than trying to identify those while attempting to fend off, respond to or stay ahead of the union. The most effective communications during a labor dispute are ones that build on and amplify the messages that have already been delivered. If you don’t know where you want to end up until the end of negotiations or once a vote has occurred, you’re already too late. 


Throughout the course of negotiations, it will become clear which issues the union will fight for until the bitter end and which they are willing to let go. Staffing (which equals membership and membership dues to them) will be a perennial “hot button” issue. Talk to the media (and post on social media) about all that you’re doing to address your staffing challenges. The union is also likely to talk about how the health system “doesn’t care” about or “respect” employees. Show them that’s not true. Celebrate and honor employees who go above and beyond to deliver outstanding patient care. All of this can be turned to your advantage. 


No, this doesn’t mean “surveilling,” which will get you in trouble with the National Labor Relations Board. What it means is listening to your employees by giving them ample opportunities to be heard. Look at what employees are posting on public social media channels. Hold regular employee focus groups and surveys (outside of certain time periods, known as laboratory conditions, when such solicitation is not allowed). Use front-line supervisors as a key resource to gather insights about rank-and-file employees’ perceptions, concerns, and wishes at all times. Though much of what unions do on social media is intentionally private, track what they are saying on their own public channels – and yours. Survey the public and key influencers regularly. There is a reason the old phrase “knowledge is power” exists. Don’t assume what your employees are thinking before and during a challenging situation with the union. 

Unions that focus on health care are some of the most sophisticated communicators in organized labor, and the challenges resulting from the ongoing COVID pandemic only serve to reinforce their arguments. If health systems hope to not only compete effectively but win, they must ensure their communications efforts are effectively engaging with caregivers and can rapidly shift to support the system’s priorities if and when a union decides to take action or contract negotiations begin. That’s one way you’ll come through this perfect storm on the other side.

  • Nick Kalm is a nationally recognized labor communications consultant who has over 30 years of experience consulting hundreds of Fortune 500 corporations, non-profits, hospitals and healthcare systems on labor/union topics.
  • RJ Bruce serves as an Account Director, Crisis & Issues for Reputation Partners, supporting and leading strategic communications programs for the firms Crisis Communications and Employee & Labor Communications practices.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.