Municipal Public Health Service Establishment City Clinical Hospital
MUNICIPAL PUBLIC HEALTH SERVICE ESTABLISHMENT‘CITY CLINICAL HOSPITAL’.
Brief characteristics of the organization
Municipal public health service establishment‘City Clinical Hospital’is one of the oldest hospitals in Perm Krai and was established in the 1950s. It is a multi-disciplinary medical establishment and includes out-patient and clinical divisions. It includes 3 polyclinics, 3 maternity welfare centres, a multi-disciplinary hospital including therapeutic branches: cardiology, intensive therapy, gastroenterology, surgical branches: scheduled and emergency surgery, proctology, 2 branches of urology: male and female, a maternity hospital, gynecology and an eye branch. The hospital is municipal property and is accountable to the administration of Perm city. The Clinical Hospital is the leading medical establishment in Perm’, serves inhabitants not only of the neighbouringdistrict, but also other areas of the regional center. The staff list comprises 2773 people, but the number employed is 1555.
Structure of the hospital for the period 01.06.06 to 15.06.06г.
Category of peoplenel Physical peopleStaff list
On 15.10.06г.
Doctors 429 578.75
Nurses 681 1161.00
Orderlies 254 636.00
Office staff 191 398.5
The Clinical Hospital actively participates in implementation of the national project "Health" and was one of the first to implement single-channel financing: today the hospital and polyclinics are being separated. During a visit of the Minister of Health and Social Development of the Russian Federation to medical establishments of Perm Krai (June, 2006) the hospital was included in the schedule of the visit as an indicative example of the implementation of the national project, in one of polyclinics of the hospital in a modethere was an online conference involving the Minister of Health and Social Development of the Russian Federation, the governor of Perm Krai, head physicians, ordinary employees of treatment-and-prophylactic establishments and the President of the Russian Federation.
Description of the trade-union organization
The trade union as in all medical establishments has worked since Soviet times. The work of the trade union is headedby the trade union committee, the supreme body is the conference of members of the trade-union organization. The trade union committeeis made up of 9 people. Meetings are held on a regular basis, once a month. The range of issues considered is traditional: from participation in strikes up to the resolution of personal problems of members of the trade union. The structure of the trade-union organization comprises 61 primary organisations. The trade union has 1300 members people,which amounts to 95 % of the total number employed. According the chairman of the trade union committeemembership before the realization of the National project (2005-6) was higher.«Well, some peoplestarted to leave, after thedivisional salary was added, well this extra payment of 10 thousand roublesalso increased the union dues. At first we did not pay attention, then we began to get into it, as they say, already we are looking to see who is not a member. We constantly check the records which the accounts department gives us, andwe lookat the applications, someone may have written one without our knowledge».To hold on to its members the trade union began to adopt a more differentiated approach in rendering assistance, measures for those who are not members of the trade union have been toughened. For example, they have ceased to advise non-members of the trade unionon any questions:
« And we see that it is necessarysomehow to improve the position, they start to write, either they need material assistance, or something else, I thought, there is some kind of consultation, to helpthemthere, but they write, leave, and then they joinagain, well, something is required, they feel that they need some kind of help».Only thus was it possible to stop the outflow from the organization.
The collective agreement
The collective agreement is for the period from 2005-2006, and recognized as the best among collective agreements of treatment-and-prophylactic establishments in the Perm region in 2005. The collective agreement includes 13 sections and 10 Appendices.
1. General provisions
2. Working hours; time of rest
3. Wages
4. Protection and working conditions
5. labour safety of women
6. Health protection of workers and members of their families
7. Domestic service
8. Financing actions of the collective agreement
9. On the implementation of the collective agreement
10. Responsibility for violation of provisions of the collective agreement
11. Labour and legal guarantees to members of the trade union committee and trade-union activists in the performance of public duties in the interests of the collective
12. Informing workers
13. Methods for the resolution of labour disputes.
From the list of sections it can be seen that, alongside the traditional items, additional sections (5,8,11,13) are provided. The collective agreement is the basic document in which the rights determined by the legislation of the Russian Federation are fixed, and it is especially important that the collective agreement also contains additional guarantees on wages and labour safety which are financed with the funds of the hospital. Additional benefits include: a fortnight additional holiday, which under the law is provided only for medical employees, in City Hospital is provided for all employees,«i.e. all office staff, who do not receive it by right, under the collective agreement receive 6 additional days holiday».
The trade union committeewas able to include a number of items in the collective agreement concerning not only holidays, but also additional payments to workers which are not stipulated by statutory acts (see section of the report: Forms of work of trade union on increase of wages). It is notable, that some of the positions of the collective agreementon additional benefits and guarantees are realized by mutual agreement of the administration and the trade union committee. So, as agreed with the trade union committee,the head of the establishment pays additions to the basic salary for particular categories of workers for complexity, pressure and intensity of work, and also for the introduction of new, modern, high technologies (items 3.6; 3.9 of the collective agreement). The prioragreementof the trade union committeeis necessary for the introduction of flexible working hours at the hospital (item 2.20).
Among the achievements of the trade union committeeare regulations about guaranteed average earnings to trade-union activists. The administration guarantees average earnings to members of the trade union committee andtrade union group organisersduring performance of work in elective bodies in the hospital for up to 8 hours a month, and also during participation in trade-union conferences, trade-union congresses, seminars, trade-union training in higher trade-union bodies and the regional educational center of the trade union (item 1.14 of the collective agreement). In the collective agreement additional labour and legal guarantees are provided for members of the trade union committee, a trade-union activists are also given rights in conformity with the Labour code of the Russian Federation. The administration restores to their former post full-time members not re-elected to the trade union committeefor a new term, they retain the right to remain on the list for improvement of living conditions in their former workplace, and also retain the privileges and payments connected to the continuous labour service (item 11.3 of the collective agreement).
At the same time, there are itemsin the collective agreement restraining the rights of the trade-union organization. For example, the participation of the trade union in management of the collective is limited to article 1.14 in which the administration retains the exclusive right to engage in current operational and forward planning, management of productive activity and provision of production with the necessary resources.
In the text of the collective agreement regulations about the creation and work of some of the commissions are included. In item 3.12 operating conditions ofthe tariff commissions are stipulated. The commission of the trade union committeeon wages monitors the observance of labour legislation and items ofthe collective agreementon questions of working hours and wages (item 3.17 of the collective agreement). The collective agreementstipulates the creation of a commission on labour safety which involves representatives of the administration and the trade union committee on an equal basis (item 4.7 of the collective agreement). State insurance in the hospital is carried out by the administration and the trade union committeein conformity with «Regulations on the commission on social insurance» (item 6.1. of the collective agreement).
Certainly, positive characteristics of the collective agreement of the hospital include items 8.1 to, 8.2 in which the need to provide accounts of expenditure on each section of the collective agreement. Appendix №10 contains authorized accounts of spending on the collective agreement. (Unfortunately, this appendix was not givento the researchers).
According to the head physician, the draft of the collective agreement is always prepared bythe trade union committee, then it is brought for discussion with the head physician who is the sole representative of theadministration on the commission for the development and conclusion of the collective agreement. The administration of the hospital does not propose the text of the collective agreement.
Gathering of proposals for the collective agreement is carried out traditionally: workers in branches are invited to make proposals«there they write everything, and we choose, and we work on the basis of these proposals, we make the collective agreement».Two times a year at a conference of the labour collective theimplementation ofthe collective agreement is reviewed, and changes and additionsare made.
The collective agreement includes an item on additional measures of responsibility for failure to implement terms of the collective agreement which oblige the guilty official to pay sums of money to the budget of hospital as compensation the for moral loss, and court costs are also included in the budget of the hospital (item 10.4 of the collective agreement). Sanctions for violation of provisions ofthe collective agreementare also applied to the chairman of the trade union committee. In case of infringements by the trade union committeeof points ofthe collective agreementfalling within its competence, the head of the establishment proposes to the trade-union conference of the hospital the termination of the powers of the trade-union committee and its re-electionahead of schedule (item 10.4 of the collective agreement). In the collective agreement the method of resolution of individual labour disputes through the commission on labour disputes in a case of unregulatedconflict is stipulated. Its composition is prescribed, with three people from the trade-union and administration on an equal footing.
Relations with the administration of the hospital
Members of the trade union committeeestimate relations with the administration of the hospitalhighly. Even after changes in the Labour code of the Russian Federation, the administration makes decisionswith the consent of the trade union committee:
«We work very closelywith our administration, they do not disregard any responsefrom the trade union committee, even after the introduction of the new labour code, which only prescribes that their opinion should be taken into account, yes, before it was agreement but now only opinion, that means, reasonable opinion. They always sentus documents so that we can express an opinion, sign, schedule»
Work on all directions is arranged with the administration: the conclusion of the collective agreement, work incentives for workers beyond the normative documents,«we work pretty successfully with the administration on the improvement of the professional skill of the younger personnel»,«we could agree concerning labour safety ».
The City Hospital is one of the few medical establishments in which mutual understanding of the trade-union organization with the head physician is achieved. So, for example, the head physician supported the participation of employees in the All-Russia protest actions (in 2004-2005):
«We gave notice to the head physician and he said: «OK, I shall give you legal help so that nobody picks on you». Well, basically he helped us»(chairman of the trade union committee).
The attitude of the head physician is: «trade unions do not help and do not hinder, they tried to get into financial affairs, somehow to distribute funds, but that failed … I think, that we have foundarapport with the trade union». The head physician sees in the trade union, first of all, an organization which helps to carry out mass-cultural actions. The help of the trade union in the organization of pre-election campaigns is especially appreciated:«the organization of work in polling districts is their work». The head of the establishment considers that the trade union is necessary only at the primary level, he has doubts about the need for a branch trade union.
The chairman of the trade union committeeattends the weekly planning meetings withthe head physician. Meetings with the head of the hospitalare channels for the receipt of information. Even, if the opinion of chairman of the trade union committeeis not taken into account, at least, she has an opportunity to be informed about the situation in the hospital.
Active actions of the trade union
The trade-union organization of the City Hospitalunder the leadershipof the trade union committeewas the only participant among medical institutions of the Perm region in the All-Russia protest actions organized in 2004-2005. In other medical establishments the trade union did not manage to bring the workers out on strike. Among active actions, members of trade union identified participation in meetings and in pickets at the building of the Legislative assembly of Perm Krai.
The initiator of the participation of members of the trade union of the hospital in the All-Russia protest action was the trade-union committee. Actions of the trade union committeewere determinedby instructions from the regional committee of the trade union of public health service workers. On the trade union committeeеit was decided to carry out meetings in divisions in order to vote on the question of the organization of the strike. For an explanation of the rights of workers about participation in the strike, the trade union committeereproducedleaflets with the relevant paragraph from the Labour Code of the Russian Federation. At meetings in primary organisations theycollected signatures of the employees, and the minutes were handed over tothe trade union committee. Having collected 807 signatures (from 1300 members of the trade-union organization), the chairman of the trade union committeesubmitted the notice to the head physician. The head physician supported the labour collective -«since people have decided to participate in the strike ». For the correct organization of the strike they conculted the lawyer of the regional union committee. All the deputiesof the head physician met and discussed the work of the polyclinic: For the period of the strike a doctor on duty and a dispatcher provided services to visitors: gave out prescriptions, for example, to patients with bronchial asthma. The population wasnotified beforehand of the stoppage of the work of the hospital. In the hospital the branch of emergency surgery and resuscitation worked.
The attitude of members of the trade union to the strike movement was skeptical:
«There was not much sense in it, and we, by and large, did not achieve anything. Everything, that we have achieved, once again I repeat, all this has been predetermined and programmed from above. We go by a schedule that has pretty much been outlined in advance from above» (rank-and-file member of trade union).
Forms of work of trade union on increase of wages.
The activity of the trade union committeeon increasing the level of payment of employees of the hospital is part of their current work. The payment sheets are regularly examined. Workers, if they have questions, appeal both in written, and in oral forms to the chairman of the trade union committee. If an employee has not understood something about the calculation, in the trade union committeeеthey carry out explanatory work with him. The chairman of the trade union committeesupervises the calculations through the accounts department and arranges random inspections. Besides monitoring wage increases, the trade union committeealso usesother possibilities. For example, the trade union committee made an official inquiry about the possibility of increasing the wages of deputies of the Legislative assembly. Documents detailing the salaries of employees were sent tothe Legislative assembly. In responseto the tax inspectorate’s inquiry of deputies a report on wages in the hospital was submitted, taking into account all incomes, i.e. in view of work on 1.5 and double rates, and for additional jobs. Therefore, the salaries of employees reported were much higher than the official level of the average salary of medical workers in the Krai. In this case the trade union committeeon its own was not able to oppose thelawmakers. In a situation of inactivity of the local authorities,the trade union committeeuses other tactics: it agrees with the head physician about inclusion of additional payments in the collective agreement.