Photo: CEDRA

United, we stand strong!

How a Trade Union was Formed at Fresenius Medical Care in Slovenia

In December 2021, after an 18-month collaboration with Nefrodial – Fresenius Medical Care dialysis workers in Slovenia, CEDRA was able to form a representative trade union Nefrodial – Fresenius. The union joined the sectoral Health and Social Care Trade Union of Slovenia (hereinafter: SZSVS). The union is not profession-oriented as it unites nurses, medical technicians, servers, nursing assistants as well as healthcare administration workers. A month after its foundation, the new union already started negotiating with the management for wage system changes, higher pay, and changes in working hours. In the first month, the union has already managed to negotiate a starting salary increase for all employees and a 1.33% pay rise for each year of employment in Nefrodial – Fresenius. Depending on years of employment, the basic salary for some workers increased by up to 35 percent (EUR 600 gross). This agreement is an extraordinary success, and negotiations for other demands are in progress.

Despite the burnout and difficult conditions exacerbated by the COVID-19 pandemic, united workers have succeeded: they have successfully overcome fragmentation – internal as well as between different dialysis centers – and general mistrust. Due to the existing fragmentation, most of the meetings and conversations took place via Zoom and telephone, which allowed all interested workers to participate. After more than 20 years, they have come together to prove that organized and united they can achieve positive change in their workplaces. The SZSVS trade union, which responded swiftly to the workers’ call, offered all the necessary support and assistance to the newly emerging union and together with the union’s workers’ committee began preparing for negotiations with the management in January.

Furthermore, more than 50 percent of the members participated in the February meeting, where they decided to join the health and social care sector strike. The union president Gregor Zagorc concluded this meeting with the words: «The more members we have, the stronger we will be!»

Fresenius – a Multinational Healthcare Company Operating as a Concessionaire in Slovenia

Fresenius is a leading multinational company in the field of medical technology and healthcare. The company produces its own medical equipment and provides dialysis services. In addition to that, they manage hospitals and clinics. Fresenius employs around 294.000 workers in more than 100 countries around the world (56% in Europe, 26% in North America, and is active in Asia, South America, and Africa). In 2019, the company had a turnover of EUR 35.5 billion, while the profit before taxes amounted to EUR 4.6 billion. According to the company, this was their 16th consecutive record year!

Fresenius strives to become the world’s leading provider of products and therapies for chronic patients and is known for an aggressive performance on the international market. The company is taking advantage of the increasing need for health services – especially since those needs are not followed by existing public services, and are thus left to private capital, which is, due to neoliberal policies, imposed upon that sector by most countries. Healthcare needs are an increasing source of profit that can be exploited by international capital. In Slovenia, Nefrodial – Fresenius became one of the largest private concessionaires in the healthcare sector. Their six dialysis centers treat more than a quarter of all dialysis patients in the country.

Fresenius’ strategy of rapid growth and high profits is based on taking over other powerful companies. They are strategically implementing «vertical integration», which means that they produce everything they need for their operation – machines, equipment, and all types of services. Such a model doesn’t need external producers and suppliers, as subsidiaries trade with each other, creating several synergy effects for the whole company. They strategically invest in parts of the world where they already have a strong position, and the market is not yet saturated by their competitors. Among other things, Fresenius is represented in 16 of the world’s 20 largest tax havens. The company is also known for lowering labor standards, not only salaries and working conditions, but also patient safety, especially in countries with no industry-wide collective agreements.

Initial Steps in Organizing a Union at Nefrodial – Fresenius

The Center for Social Research (CEDRA) was contacted by the Nefrodial – Fresenius workers in 2020 and thus began intensive research into the existing situation and working conditions at Nefrodial’s dialysis centers in Celje, Ljubljana, Krško, Naklo, Dragomer, and Maribor. By conducting research and interviews with the workers, CEDRA was able to identify key problems and acquire new contacts. Working together with the two most active workers, CEDRA managed to establish an informal workers’ committee. All of this took about a month. The committee consisted of dedicated and experienced nurses, each representing their center. Workers’ committees are the central organizational form that takes decisions collectively, including determining the next steps in the organizational process. It is important to quickly identify workers who can address their colleagues in the fastest and most efficient way and unite them in a single movement – they are the best candidates for committee membership.

Committee meetings were held regularly every two weeks. On the meetings, committee members reported on the events in the centers and jointly made the decisions on further steps. They were the «eyes and ears» of the future union.

Together with the committee, CEDRA decided to take a common approach: to establish an inclusive, democratic trade union, with the objective of improving working conditions in Nefrodial – Fresenius and, at the same time, generally improving the situation in public healthcare. The workers reported on the accomplished tasks and improvements in the field at the committee meetings. With the help of the mapping method, they strategically started analyzing their centers, highlighting common and specific problems, and identifying employees who would be most willing to join the union.

What is mapping? Mapping is a basic organizational tool. It enables committee members to strategically list all the jobs, relations between workers, and the biggest problems workers encounter. They obtain their co-workers’ phone numbers and emails and rank them according to their willingness to join the union, their views on the union – who is neutral, who is outright against it, etc. Based on this, the committee can adopt different methods of communicating with co-workers. Committee members also exchange experiences, and further steps or tasks are planned accordingly. Through this process, workers are increasingly becoming union organizers themselves, and they start to perceive it as their organization – they start to understand that they are the union. Individual problems and problems specific to certain jobs, departments, or centers are also mapped. The identification of the most common problems that most workers are faced with enables us to plan the most appropriate strategy for solving them. With the help of mapping, the committee can quickly identify next steps, which departments or centers are strong and united, and where more engagement will be required.

The example of mapping that does not end even after the formation of the union. With the help of the constant mapping, the union can be more successful in building of organizational strength.

At Nefrodial, the committee representatives proved to be exceptional organizers, convincing as much as 61 percent of their co-workers to join the new union. CEDRA established a common communication channel (Google Groups) and prepared a survey for potential members.

With the help of the survey, the following main problems were identified:

  1. high intensity and volume of work, burnout;
  2. inappropriate standards and norms;
  3. reduced work schedule from 7 to 6.5 hours per day;
  4. poor position of the servers (earning only minimum wage – while performing tasks outside of their competence);
  5. unpaid overtime;
  6. almost no chance of promotion;
  7. bad interrelationships, disconnect.

By establishing a common communication channel, workers started to share information among themselves, and through that same channel CEDRA was able to share the survey. The workers were therefore involved in joint activities for the first time and their opinions and interests were heard and considered. Surveys enabled committee members to approach their co-workers more effectively and explain why their membership in the union is critical to their success.

The committee has produced a leaflet that was distributed by the representatives of the committee to the workers. It was produced on the basis of information gathered through questioners and one on one interviews.

Organizational Setback

In June 2021, the organizational project in Nefrodial – Fresenius experienced a setback because the representatives of the committee changed their minds. Although everything was going smoothly until then, the committee decided to cancel the inaugural assembly and reschedule it for after the summer holidays. Despite the good work and exceptional engagement, further organizational activities were stopped, as no one was prepared to formally assume the role of the official trade union representative (shop floor steward). The key political issue also has not been solved: which sectoral trade union should the new union join? In a joint debate, the committee decided whether to join the general or the professional trade union. All these questions could not be solved in the middle of summer, so we agreed to restart the activities at the end of summer.

Turnaround – the Formation of a New Trade Union

CEDRA resumed their activities after the holidays. A single conclusion was reached: it was decided to establish a trade union unit within the SZSVS, open to all professional profiles so that the unity and solidarity among all workers employed in Nefrodial – Fresenius could be preserved. Mapping, research interviews, as well as collecting application forms, handing out leaflets, and other activities resumed as before. New members joined the workers’ committee, and deputies were chosen to help with the mobilization efforts. After five weeks of fieldwork, the representatives gathered 50 application forms from 130 workers. However, CEDRA still did not have a candidate to take on the union representative role.

By mid-November, the committee found an appropriate candidate – deputy committee member from the Krško center, Gregor Zagorc. He was willing to get more involved in union activities and represent his co-workers. Subsequently, preparations for the union-founding assembly proceeded smoothly.

On December 12th, 2021, the founding assembly which took place via Zoom gathered 30 workers, representatives of the SZSVS trade union, and members of CEDRA. The program, the statute of the trade union, and the action plan were adopted. Members also elected members of the executive committee and opened a discussion on the importance of further organizing actions. All the workers who signed the application forms were collectively enrolled in the union. Collective enrollment (into a workers’ organization) allows workers to defend themselves from intimidation or disciplinary actions at an early stage.

New Year – Negotiations, First Union Victory, and a Strike

With 36 percent of workers joining the union at the founding assembly, the union started implementing the action plan immediately after the New Year. At the first meeting with the management, a contract concerning the conditions of operation of the trade union was signed. The union representative was now able to visit all the Nefrodial – Fresenius dialysis centers, where he held meetings with the workers. According to the collective agreement, the union representative is entitled to a certain number of hours of union work – depending on the number of members. The union decided to divide these hours between the union representative (7 hours per month), the vice-president (8 hours per year), and the members of the executive board (each member 7 hours per year). Members also decided to meet regularly once a month via Zoom, and more often if certain activities are taking place (e.g., negotiations). This way, the trade union strives to have the most organized, informed, and qualified membership possible. By introducing democratic and inclusive practices, union members created conditions that enable workers to participate and collaborate in preparing common goals, tactics, and strategies. Such an approach is necessary if we want to build an active membership that will participate in protests, strikes, or other actions.

On February 6th, 2022, a ground-breaking meeting took place in which 30 members unanimously decided to adopt the agreement negotiated with the management of Nefrodial – Fresenius, more specifically:

  • a higher starting salary bracket for each position;
  • a 1.33% pay rise for each year of employment in the company for all workers;
  • retaining additional payment for additional tasks;
  • limiting the basic gross salary according to the pay scale;
  • maintaining the existing level of travel expenses and lunch cost reimbursements.

Negotiations have proceeded quickly, as Nefrodial – Fresenius, as a concessionaire, has not thus far complied with the minimum wage standard established by the Health Services Act and the Collective Agreement for the Health and Social care sectors. In the new year, the union’s membership has grown further. The February 6th meeting was concluded with these words from the union representative Gregor Zagorc: «Some of us have worked at the company for 20 years and many were afraid to speak up. But now we know: united, we stand strong!»

The success of the Nefrodial – Fresenius trade union has been remarkable. Even though the dialysis centers are scattered throughout the country and regardless of the difficult working conditions, the workers started to act as a collective within a short time. Union member Nevenka pointed out: «Given what has been achieved, I can say that I am very sorry that we have not organized and established a union before. As individuals, our struggle was the same as Don Quixote’s struggle with the windmills, but as a union we are strong, and they (the management) can no longer shut down our objections with empty words and promises.»

«After a bad experience with a union years ago, I was initially skeptical about joining another union,» said Vlasta, a member. «But after my first conversations with CEDRA, I realized that things were different this time, our goals were clear. My co-workers were also immediately ready to join the union. Things have gone in the right direction – the success is already evident. However, we still have a hard fight ahead of us!»

But the current success does not mean it is time to rest. The union is constantly being tested. In certain centers, the management puts pressure on workers not to join the union or even to cancel their membership. That is an attack on the constitutionally guaranteed right to trade union organization. The membership is determined to exercise this right in practice and to prevent any harassment.

Joining the Strike

Until now, Nefrodial employees have not been involved in wider trade union activities, but soon after the new union was formed, they joined the strike in the health and social care sector. The strike took place on February 16th and the main demands were the adoption of new standards and norms, better working conditions, and higher salaries. The membership voted on joining the strike, and on the day of the strike the work in the clinics was interrupted. Membership has also been asked to raise awareness about the strike with a clear message: «I care for you – but today I am on strike!»

Workers on strike in one of the dialysis centre of Nefrodial, February 16th 2022.

The Wider Importance of Labor Organizing

In cooperation with the Rosa-Luxemburg-Stiftung Southeast Europe and UNI Global (UNI Care), the members of CEDRA, together with the workers, developed a strategy that includes various organizing methods and tools. The key step for success was the identification of the most active workers with whom CEDRA established a strong workers’ committee. Workers are the key to strengthening and implementing further organizational work – patient and extremely persistent committee members can successfully reach out to their co-workers and engage them in their common struggle, despite the initial hesitation.

Our project with Nefrodial – Fresenius is a small step toward improving working conditions and establishing a better health and social care system. Organized workers in Nefrodial – Fresenius’ dialysis centers have succeeded in equalizing their standards and norms with the public sector. The downward spiral of lowering standards and norms by international multinationals has been stopped. They also actively participated in the sector-wide strike and gained invaluable experience – it must be underlined that strikes are the most important tool of the working class in the fight against capital and its representatives.

In a capitalist society, where everything is subject to the logic of profit, the health and social care sector is also under attack. This whole sector is gradually being privatized, which means that those services are becoming less and less accessible for most of the population. The pursuit of profit contributes to higher prices of services, which means less access to health care for the majority of the population. Moreover, more care work falls on the shoulders of working-class households, and older generations are exposed to extreme survival insecurity. Financial cuts leading to a decrease in the numbers of public servers and the neglect of the real needs of public institutions (outdated standards and norms, lack of staff, low salaries) make it impossible for workers in the health and social care sector to do their jobs properly.

The February 16th strike was only the beginning of the escalation of activities for an accessible and quality health and social care system. The lessons workers have learned from the strike are: firstly, capital and political representatives will never agree to raise wages and update existing standards and norms as this would mean less profit. Secondly, only a strong and united working class can realize its interests and threaten the interests of international capital. Only a well-organized working class can create accessible and quality public services, which will lead to a better standard of living for the entire society. Our struggle is a common one, it is the struggle of workers of all sectors, nationally and internationally, and the struggle of local communities for a better society.

CEDRA – Centre for Social Research Society is a Slovenian NGO primarily engaged in trade union organizing.