In Chapter 5 the structure of organizations was discussed in detail. That description emphasized management and only briefly alluded to labour/management relationships. The largest and most complex organizations in society are governments, the military, big business, religious orders and health and educational institutions. Each of these have their own characteristic labour/management relationships. Nonetheless, within each of these arrangements the well-being of the individual worker must be safeguarded.
Generally speaking, workforces are either unionized or not. Sometimes there is a mixture of both as when a union represents some workers but others in another division or job are not organized. It is beyond the scope of this discussion to delve into the many subtleties and varieties of work organization and labour relations. This discussion will focus only on the principles of the unionized versus non-unionized arrangements with an emphasis on how these differences affect occupational health services. Each has its strengths and weaknesses depending upon the specific nature of the organization and its economic and political environment. Ideally in either arrangement effective policies and procedures to protect employee well-being should be in place. These should be based on a moral commitment that protecting employee well-being is a fundamental principle of doing business.
The negotiated collective agreement between an employer and its union (or unions) sets the tone of the relationship and lists many of the rules of behaviour for the workforce. While the collective agreement in no way removes the employer's right to run its affairs, it very definitely binds management and the workforce to a contractural arrangement that will be upheld by the courts. These rules are in force for the life of the collective agreement, which includes an arbitration mechanism for settlement of disputes. Issues concerning the well-being of workers, individually and as a group, have traditionally formed an important and often controversial part of collective agreements. Sometimes the terms of the agreement contain only broad standards but others set down very specific policies and procedures. Many such agreements have broken important new ground in occupational health and safety. All insist upon some form of worker participation in programs that deal with worker health and safety. A common form of involvement is the joint health and safety committee. In some jurisdictions such committees are even mandated by the laws of the state; in others legislation merely suggests that they be formed. The powers of these committees also varies greatly, ranging from total control of health and safe matters to merely serving as discussion groups. Some unions have even negotiated the right exclusively to provide occupational health services to the workforce and sponsor their own facilities or plan.
If both the union and management agree that the organization is ultimately responsible morally and legally to protect its workers, then a mutually agreeable approach can be negotiated. For this to work management must acknowledge its responsibilities and the union must believe that management is able and willing to fulfill its responsibilities. If an environment of trust and cooperation can be established, health and safety will enjoy a uniquely neutral place in the labour/management relationship and the well-being of workers will be ensured. Unfortunately, many aggrements falter because health and safety issues become swept into and confused with other often controversial labour/management matters.
Today society demands that workers not be maimed, killed or diseased, and to ensure this, labour, health and human rights laws have been enacted. While many employers clearly do have enlightened management, technical knowledge is advanced, and professionally trained individuals are available, workers in many organizations are still not properly protected. Thus unions should and will remain vigilant. Management's role is to establish the policies and programs necessary to protect employees, while the union's role is realistically and constructively to ensure that these policies and programs are fair, appropriate and accessible. Unions and management should both be equally concerned with safe work practices, safe work environments, health surveillance examinations, fitness-to-work procedures, confidentiality of health records, freedom of choice, alcohol and drug abuse programs. Their interests in these issues should be identical. Conflict arises if management believes the union makes unreasonable demands or when the union believes that issues are not being addressed, or are being addressed in an unfair, incompetent, or unethical way. In some cases the actions of occupational health professionals are the cause of this mistrust.
The responsibility for protecting worker health rests squarely with management. In the non-unionized setting, management must fulfill this obligation with no less diligence than when it has a union looking over its should and it must do so in a non-patronizing manner.
Prudent non-unionized employers encourage worker involvement in health and safety strategies. Voluntary joint health and safety committees are frequently the vehicle for this, although in such situations they are usually called just "safety or health and safety committees". These tend to be most successful where trust has already been established with the workforce. While the employer ultimately writes the rule book, creative ways must be found to involve the work force in writing and in implementing the health and safety rules. Employee welfare is one of the areas where an attitude of creative cooperation really works well. Fortunately, organizations which tend to mismanage employee health issues usually tend to mismanage other critical areas in their business as well, and in the long run will be more likely to fail and disappear. The enlightened ones will prosper because they recognize the need to be consistent with social change.
Boden LI, et al. The impact of health and safety committees. J Occup Med 1984; 26:829-834.