Health Clinic Organizing

Todd Hamilton's account of building committees and acting on grievances through direct action in health clinics.

Submitted by Juan Conatz on December 4, 2011

Workers have been organizing at a low income reproductive health clinic for the past few months. It all began when the company, which was on solid footing, had gone on a hiring spree and improved a lot of working conditions. The federal government began requiring any recipient of aid (the majority of our patients) to prove citizenship. Undocumented workers don't actually need to strangely, all they need is to indicate that they're permanent residents. The net effect on the industry has been to cut 30% of the funding to all low-income clinics generally. That is the real target of this federal assault, to cut social funding under the guise of racially based nationalist sentiments.

Management's response was mass layoffs of departments, internal restructuring, productivity increase measures, and a hiring freeze. The workers responded actively and vocally. At first the resistance was individualized, emails and phone calls to management expressing agitation. As this method was fairly ineffective, workers began using staff meetings and other such channels to confront management in spontaneous groupings around the natural social circles at work. As the heat continued to escalate, management rolled over on a number of demands. The hiring freeze was lifted, yearly raises were returned, and management made an effort to meet with workers to hear concerns and supposedly to incorporate ideas for solving problems. Part of this came from the fact that management is split by their commitment to serving patients as people, but without organization these demands were systematically ignored.

The spontaneous groups were easily distracted by small concessions (e.g. changing the color of toilet seats), divided by quibbling, and diffused by management. Management began engaging in a propaganda campaign to try and win the hearts and minds of workers, who are vocally angry and resistant. Many of the senior staff quit, leaving a fresh workforce who are largely ignorant of the context of struggles going on. Amidst this, workers at two clinics organized as a group, and demanded a meeting with the CEO in order to air grievances. These ended up with management dodging demands (when workers, ill-prepared, fragmented during the meetings) and focusing on the easy-to-fix trivial demands.

Conditions at clinics vary wildly as well, and despite general anxiety over layoffs and restructuring, not all clinics feel the same level of frustration. At my clinic a similar meeting was friendly with management to the point of offering personal sacrifices (such as paying more for health insurance). This is in part due to turn over (90% of the workers have been at my clinic less than two months), and also due to the beliefs and positions carved out by the one or two senior staff.

The most successful was a meeting with a clinic where a small committee had been built with myself and two IWW sympathizers who have been organizing. A one page list of demands was prepared, and the clinic as a whole endorsed it. The organizers in the shop inoculated their coworkers about management's potential responses, and got together to make sure everyone stayed on their collective message. Their crucial demand was more staff at their horribly understaffed clinic. The meeting went well with management taking their demands seriously.

After the meeting more staff were hired, and the way staffing is allocated was modified somewhat. The workers feel like they got what they wanted, but the systemic issues remain untouched. They decided that they needed to next time be less conciliatory, and to have a plan to escalate actions if they don't get what they demand.

Management's strategy has been to try to listen to worker concerns, without giving a place to actually be able to implement them, and to roll over on the easier demands that improve the business anyway. For example, our use of the internet had been taken away from all staff on a whim citing a few individuals using myspace too much. Widespread protests about needing such basics as maps and bus schedules for patients eventually won back full internet usage rights. Likewise protests over a bizarre rule to do pelvic exams on all women who enter the clinic, quickly overturned the policy.

The most hopeful turn of events is the building of a cross-clinic organizing committee, which has workers from four of the five greater metropolitan area clinics. The first meeting was held recently, where it was decided to build an organizing committee, map all the clinics, identify leadership, begin pushing demands across the company, and eventually have an independent workers organization that implement and negotiate our grievances directly. As management has caved on our demands so quickly, and turn-over is so high, we've exhausted much of our agitational issues. For this reason the committee decided to begin building the relationships and solidarity through social activities and education that will provide a foundation for the next grievances that surface. With a committee already in place, and a structure to work with, we can prepare to act collectively and implement our desires.

Originally appeared in the February 2008 Industrial Worker