Healthcare Provider Strike Preparedness and Response: Lessons Learned From Physician Strikes in New York City

Abstract

Labor actions by healthcare workers are increasing in frequency and quantity, particularly throughout the United States. Regardless of their cause and size, these strikes could disrupt normal hospital operations and impact patient access to care, quality of care, and costs. Strikes resemble other large-scale incidents like natural disasters, pandemics, or terrorist attacks by shrinking a hospital’s capacity to care for patients, forcing hospitals to pursue logistically complicated actions such as finding replacement providers, and impacting nearby facilities due to patient offloading. In contrast to these incidents, however, strikes are unique because they come with advance notice, reduce capacity by precise amounts with predictable provider losses, occur during defined periods, and do not necessarily increase demand for patient care. To maximize efficiency and minimize disruption in response to strikes, hospitals must properly plan ahead and successfully execute their plans. In this article, we recount the experience of a 2023 resident strike at NYC Health + Hospitals/Elmhurst in New York City and describe 6 core strategies that the facility implemented to maintain quality care: strike aversion and planning, increasing coverage, decreasing demand, internal and external messaging, external partnerships, and demobilization. We also provide a planning template that other hospitals can use to prepare for and respond to healthcare provider strikes.

The information in this article was first presented as a poster, “Healthcare Labor Action Preparedness and Response” at the Preparedness Summit, March 25-28, 2024, in Cleveland, Ohio.

Introduction

Healthcare worker strikes present a particularly challenging problem because they have the potential to directly impact the lives of patients. The special concern for patient care is unique to healthcare is the reason why employees of nonprofit hospitals were left out of the 1947 Taft-Hartley Act¹ (also Labor Management Relations Act), amending the National Labor Relations Act,² which reformed collective bargaining laws.³ It was not until the 1974 Nonprofit Hospital Amendments⁴ to the Taft-Hartley Act that the 1.5 million employees of the 7,000 private, nongovernmental hospitals in the United States were covered and offered the same privileges as other workers.

Healthcare strikes have been studied across North America⁵ and internationally for decades, including reports on Chilean doctors’ strikes in 1972,⁶ healthcare strikes throughout the United Kingdom in the 1970s,⁷ strikes in Germany in 2006,⁸ strikes in Israel in 2011,⁹ and widespread healthcare strikes in the United Kingdom in 2023, which resulted in over 1 million rescheduled appointments by September 2023 and included the longest physician strike in National Health Service history.^10,11 In the United States, similar examples include a 3-day strike by 75,000 healthcare workers in the Kaiser Permanente healthcare system in October 2023.¹²

Since the 1970s, support for physician strikes has been growing. The COVID-19 pandemic amplified a variety of factors, which lead to an increase in healthcare strikes by nurses and physicians. During the first year of the pandemic, 3,913 occurrences of protests—many of which were strikes—were executed by healthcare employees.^13,14 In 2022, there was a 50% increase in strike activity overall, with one-third of those strikes in healthcare.¹⁵ Notably, strikes with fewer than 1,000 workers are not reported by the US Bureau of Labor Statistics, so smaller-scale strikes might not have factored into that proportion. The growth in healthcare strikes might reflect an underlying sense of dissatisfaction among providers, with strikes historically reflecting concerns over unsafe working conditions, unfair pay, improper staffing ratios, or other issues.^5,16

Regardless of the underlying cause, current conditions have led to an increase in unionization by healthcare workers in the United States, expanding the scope of institutions that may be affected by strikes. Efforts led by the US Committee of Interns and Residents and the Doctors Council, which are affiliates of the Service Employees International Union (SEIU), have helped residents at large training hospitals such as Mass General Brigham and physicians at large health systems such as Alina Health to form their own unions.^17,18 Increased unionization and strike activity mean that more hospitals should expect to face operational consequences if negotiations are unsuccessful.

The consequences of such strikes could include appointment cancellations, delayed access to care, increased costs, and reduced quality of care. Impacts can also extend beyond the healthcare facilities directly affected by a strike to include hospitals nearby, which might receive increased quantities of patients. The evidence for some of these consequences is mixed. For example, a review of the literature on doctors’ strikes and mortality showed that mortality stayed constant or decreased during strikes but noted that explanatory factors could include the reassignment of staff, maintenance of emergency care capabilities, and curtailment of elective surgeries, which may carry risk.¹⁹ Similar studies have repeated these findings, with emphasis on the importance of continued emergency care as a potential mitigating factor^20,21 while others have shown little impact on patient morbidity²² and reiterated that they did not show significant increases in mortality during strikes, regardless of the striking profession, country, duration, or number of facilities.²³

In contrast, 1 study of nursing strikes in New York State suggested that in-hospital mortality grew by 19.4% and hospital readmissions grew by 6.5% during strikes, with additional notes that replacement workers did not improve outcomes compared with hospitals that hired no replacements and that sicker patients consistently fared worse during strikes.²⁴ Still, a scoping review concluded that the impacts of strikes can vary, with overall mixed results dependent upon affected services and with the note that patient behaviors in response to strike actions could not be deciphered from the literature.²⁵

Concerns about the outcomes of healthcare strikes on patient outcomes have generated discussions about whether it is ethical for providers, who may have a perceived duty to “do no harm” to their patients, are justified in striking.^26-28 One proposed framework, for example, concluded that strike action is justifiable if (1) demands or grievances pertain to unfairness or health threats and (2) strike risks are proportionate to demands, along with considering characteristics and sociopolitical context around the strike.²⁹ Other perspectives have offered advice to both striking providers and employers on how to balance a fundamental right to strike with the needs of patients, such as encouraging workers to make realistic demands and suggesting that employers offer timely collective bargaining agreements while avoiding mass firing or excessive disciplinary actions.²⁶ The experience of striking providers is yet another area of exploration in the literature, with at least 1 study interviewing junior doctors in England's National Health Service about a 2015-2016 contract dispute, finding that strikes led to a reworking of their professional identity, and outlining 3 “identity threat alleviation” strategies that doctors constructed.³⁰

While the consequences of strikes can vary, alongside their causes, politics, and ethics, they will generally cause some disruption to normal operations, and the more pertinent discussion for the emergency management communities is how to prepare for and respond to such strikes. This point is especially critical given the aforementioned assessment that emergency care continuity is a significant mitigating factor when it comes to morbidity and mortality risks during strikes. In this article, we propose a strike planning template (see Supplemental Materials, www.liebertpub.com/doi/suppl/10.1089/hs.2024.0095) for hospitals to use when facing a provider strike of any kind, using insights gleaned from the management of a resident physician strike in a hospital of New York City’s municipal hospital system.

Background: Residents’ Strike at NYC H+H/ELMHURST

The leadership of the Committee for Interns and Residents informed Mount Sinai that the NYC Health + Hospitals (H+H)/Elmhurst resident strike would begin at 7 am on Monday, May 22, 2023, and continue until 7 am on Saturday, May 27, 2023. The stated motivation for the labor action was the wage disparity between NYC H+H/Elmhurst residents and other Mount Sinai residents at Manhattan hospitals. While NYC H+H staff are prohibited from striking by the Taylor Law,³¹ these residents were employed by Mount Sinai.³² The strike would primarily affect the behavioral health, pediatrics, and medicine services involved, but secondary effects would also occur in the pediatric emergency department, neurology department, and coronary care unit due to rotating residents. Furthermore, because pulmonary/critical care fellows who work in the medical intensive care unit participated, there were concerns over potential impacts on that unit, too. This strike was the first one by NYC physicians in 30 years, and it ended on Thursday, May 24, 2023, after an agreement was reached.³³ In preparing for and responding to this crisis, the leadership at Central Office Emergency Management (COEM) and NYC H+H/Elmhurst pursued several avenues of effort, translated into 6 core strategies: (1) strike aversion and planning, (2) increasing coverage, (3) decreasing demand, (4) internal and external messaging, (5) external partnerships, and (6) demobilization.

Six Core Strategies

Strike Aversion and Planning

The first and most impactful strategy for responding to a strike is to avert the strike while still preparing for it to occur. For example, while 34,000 healthcare workers went on strike in 2022 in the United States, approximately 58,300 more threatened to strike before they were averted with settlements, excluding smaller strikes not tracked by the US Bureau of Labor Statistics.^15,34 In NYC, a strike by Mount Sinai Morningside and West residents was previously averted after 6 months, but a nursing strike at Mount Sinai Hospital and the resident strike at NYC H+H/Elmhurst were not averted.³⁵ By engaging in negotiations, the hospital can potentially avoid any impacts on patient care or provider experiences, in addition to potentially saving costs if compliance with strike demands is less expensive than the costs of responding to a strike.

In the case of the strike at NYC H+H/Elmhurst, the hospital was not a primary party in the negotiations because the negotiations were between the residents and Mount Sinai. However, the second aspect of this strategy is preplanning for a potential strike, as COEM and NYC H+H/Elmhurst’s leadership team did throughout negotiations. Such planning began on May 2, 2023, when rumors began spreading that a house staff labor action was possible before 10 days’ notice was formally given on May 12, 2023. After an initial gathering of the hospital’s Medical Executive Board Committee with the service line directors, the preplanning stage consisted of daily meetings between the deputy chief medical officer at NYC H+H/Elmhurst, who served as the eventual incident command center lead, and the COEM senior director of clinical operations. The small size of these meetings was essential to create a skeleton framework plan to build on as more individuals were engaged and as the prospect of a strike approached.

This planning stage must be multifaceted, consisting of plans for multiple scenarios. In this instance, plans were drafted for a 1-day strike, 3-day strike, 1-week strike, and 2-week strike, even though the stated aim of the strike was to end after 5 days. As the start date of a proposed strike approaches, other meetings should be established 2 to 3 times a week with larger groups of stakeholders in the hospital to get input from a larger cohort and to disseminate information effectively. NYC H+H/Elmhurst senior leadership—including the chief executive officer, chief medical officer, and deputy chief medical officer—met with central office key leadership from Emergency Management; the system chief medical officer; Labor; Regulatory; Office of Labor Affairs; Communications; and Human Resources. Additionally, separate meetings were arranged at NYC H+H/Elmhurst with the same frequency involving facility leadership from affected departments and senior executive leadership.

Once the strike began, clinical, operations, and executive leadership from the facility met every morning, afternoon, and evening to ensure clinical coverage of units, report census and boarding patients, troubleshoot operational and clinical workflows, and update human resources for labor negotiations. Central Office leadership also met with these NYC H+H/Elmhurst senior leaders to monitor strike response, assess needs from a systemwide perspective, and offer support. With aversion failing, subsequent strategies were pursued, starting with increasing coverage.

Increasing Coverage

Internal Providers

To adjust for the loss of striking providers, facilities should evaluate all mechanisms for increasing their supply of caretakers. Initially, this requires a complete understanding of how many providers will be lost, but more effectively, it means knowing how many shifts need coverage. Rather than focusing on just provider numbers alone, facilities should look at the schedules within affected service lines and work to cover the lost shifts, rather than getting 1-for-1 coverage of striking individuals because each individual may have been assigned to work a different amount that given week. Furthermore, facilities should plan based on the maximum number of striking providers, even though some may cross the picket line.

At NYC H+H/Elmhurst, these numbers were identified in early May 2023 for each service area. Striking personnel included 78 medicine residents, 40 pediatrics residents, 40 behavioral health residents, and 6 pulmonary/critical care fellows. In the end, 14 providers from medicine crossed the picket line to work, leaving a gap of 64 residents. These provider gaps were translated to more usable shift numbers to understand coverage needs.

Once all shift gaps were identified, the focus was placed on internal coverage. Hierarchically, current clinical providers other than rotating residents, including physician assistants and nurse practitioners, should be offered overtime to fill gaps first, followed by attendings with administrative responsibilities who still perform clinical work. For this latter group, just-in-time training in electronic medical record (EMR) usage, advanced care life support, cardiopulmonary resuscitation, and other internally used provider applications should be performed.

At NYC H+H/Elmhurst, refresher EMR training modules were created for patient admitting and note writing, since some attendings had not done this since their training days because it is often a resident responsibility. Additionally, a virtual EMR playground was made available for those providers to practice using EMR. Live 1-on-1 tutorial sessions with EMR analysts were established and training videos on the emergency, ambulatory, inpatient, and behavioral healthcare provider applications were rapidly recorded and shared. In hindsight, facilities should prerecord such videos before the threat of a strike or other emergency is present, so the videos can be easily distributed without using human resources to record them during the preparatory stages.

After the recruitment, up-training, pay adjustment, and scheduling of internal providers, facilities should create a boarding care swing team to care for admitted patients who are pending assignment of an inpatient bed. This team ensures that admission orders are placed and that patients are always cared for with medical provider oversight. At NYC H+H/Elmhurst, this swing team provided 24 hours a day/7 days a week coverage during the strike and communicated closely with inpatient providers to oversee patients when admission caps were reached. Closing outpatient clinics and reassigning nurse practitioners and physician assistants to inpatient floors was another option considered but not implemented at NYC H+H/Elmhurst, which opted to keep clinics optimized for inpatient and emergency department discharged patients.

Affiliated Providers

While optimizing the use of internal providers is a primary effort, surging with affiliated providers is an effective next step. Rather than immediately going to external support, this option focuses on pulling in providers who do not work at the striking facility but are credentialed within the same health system at another site. In the case of NYC H+H, this meant pulling in providers from other NYC H+H acute care facilities including Queens, Jacobi, Kings County, and Harlem Hospital. Additional fellows, residents, physician assistants, and nurse practitioners were also recruited from other Mount Sinai sites given that the NYC H+H/Elmhurst facility employed Mount Sinai residents. Elmhurst’s connections to both the NYC H+H and Mount Sinai systems enables 2 sources of surge personnel whose preexisting ties to those systems make onboarding more efficient than recruiting unaffiliated providers. Like internal providers, these additional staff should be integrated into the existing schedule to minimize disruptions.

External Providers

While internal and affiliated providers should be evaluated first, facilities must also look at locum tenens providers through staffing agencies, which can be particularly helpful when needs are targeted. In the case of NYC H+H/Elmhurst, this route was used to find more pediatric providers. This effort included conversations with the staffing agency 1 week before the planned start of the strike. As with other recruited providers, special pay rates must be established and additional providers must be scheduled into the existing schedule. NYC H+H collected a list of external volunteer providers who were willing to assist with coverage on top of their full-time jobs. Over 100 physicians were emergency credentialed to work at NYC H+H/Elmhurst in the event of a longer strike.

An important takeaway from the process of recruiting external providers was that facilities should keep an open mind about using external vendors because they are often accustomed to the rapid pace of response necessary in a strike. Recruiting external providers enables facilities to accelerate the process of supplying providers, helps with the credentialing process, and targets providers who might already be affiliated or who recently had affiliations that could be easily reopened. Other facilities should contact external staffing agencies alongside their internal and affiliated provider recruitment efforts even for short-term strikes—at NYC H+H/Elmhurst, voluntary staff were tired by the third day of the strike. Once there is a need for additional providers, starting the recruitment process from scratch would take too long, so establishing relationships with vendors early is key. Additionally, another strategy that NYC H+H/Elmhurst used to quickly onboard clinical support was to identify established locums providers hired throughout the system who were available to pick up extra shifts. Because they were already cleared to work in the system, the NYC H+H/Elmhurst onboarding process was even more streamlined.

Decreasing Demand

In addition to boosting provider numbers, another way to minimize the supply and demand mismatch is to safely reduce the number of patients seeking care.

Patient Transfers

To safely diminish demand for care during the strike, patient transfers into NYC H+H/Elmhurst that were not surgical emergencies or trauma cases were suspended starting on Friday, May 19, 2023, in advance of the predicted start of the labor action on Monday, May 22, 2023. These patients were instead prioritized for transfer to NYC H+H/Bellevue Hospital, which helped reduce patient bed requirements in advance. This practice continued throughout the strike.

Rapid Patient Discharge

Another method for reducing demand is rapid patient discharge (RPD) for relatively healthy patients. This includes both patients who are waiting to be discharged, but are held up by administrative procedures, and healthy patients who do not require care urgently, using a benchmark of whether they need critical interventions within the next 96 hours.³⁶ Fortunately, NYC H+H had recently developed a systemwide RPD protocol for use across its facilities.³⁷ Between May 17 and 27, 2023, this RPD plan was used to quickly discharge 311 patients, averaging 28 patients daily and reaching a high of 44 on May 18. The RPD plan was used for several days even after the strike ended on May 23, 2023, to provide some operational flexibility to Elmhurst as it resumed normal operations.

In addition to using the RPD plan and directing social work teams to support discharged patients with follow-up care, the NYC H+H Office of Community Care looked at the capacity of local home care agencies to determine which agencies might be able to support discharged patients who still had pressing medical needs during the strike period. Three local agencies were identified but not utilized.

Optimizing Patient Admissions and Follow-Ups

Additional strategies used once the labor action began were related to changes in the admission of new patients. One approach was to admit some traditional medical admission patients directly to surgical services rather than to medicine floors if they had qualifying diagnoses, such as nonsurgical abdominal pain and cellulitis. This allowed for the level-loading of patients within the facility, particularly to reduce the patient load on medicine floors that lost the bulk of striking residents. Furthermore, follow-up appointments for patients were scheduled beyond the strike timeframe unless it was necessary to have them within the week. Some patients were also directed to call NYC H+H Virtual Express Care for a follow-up appointment on a specific date to relieve the follow-up burden of the short-staffed clinics so they could accommodate the RPD patients during the strike timeframe.

Level Loading

Whereas the admission and discharge decisions were focused on the internal facility, level-loading is a strategy that requires coordination with external hospitals or organizations. Level-loading, which involves moving patients to alternative care facilities, covered both newly admitted and previously admitted patients.

Possible level-loading locations were determined based on distance and initial capacity. This analysis showed that pediatric patients should be transferred to either NYC H+H/Kings County Hospital Center in Brooklyn or NYC H+H/Bellevue Hospital in Manhattan, and adults should be transferred to NYC H+H Metropolitan, Bellevue, or Harlem hospitals. Because these facilities are all run by NYC H+H, it enabled easier identification of primary points of contact for communication. With points of contact and plans in place, the central office distributed a document of level-loading tips and triggers to the attending providers at NYC H+H/Elmhurst.

A clinical leader from the NYC H+H/Central Office Clinical Leadership Fellows program was then assigned to oversee the level-loading process. On a daily basis, this lead would evaluate the capacity of the preferred sites and coordinate the transfer of any patients who needed to be moved. This lead also leveraged the care experience team to explain the hospital’s situation to patients boarding in the emergency department or located in the inpatient step-down unit to identify any patients willing to be transferred to one of the identified facilities. For all facilities, we recommend that an RPD plan be established to prepare for any emergency scenarios that present and that facilities using RPD plans track the outcomes of all discharged patients. Furthermore, facilities should familiarize themselves with local home care agencies and develop relationships that can be valuable during crises. They should reconsider admission decisions, level load patients in collaboration with local facilities, and communicate with contracted ambulance agencies regarding patient transport before and during a labor action.

Internal and External Messaging

Communication is an integral component during successful preparation and response to labor actions. Internal and external messaging begins before the start of a labor action when the communications team should be prepared to make press statements and answer questions from all internal or external stakeholders. At NYC H+H, this involved the production of a frequently asked questions document for residents who may choose to participate in the strike, which is an approach that may be useful at other facilities.

Continued internal messaging during the labor action involved daily messages through the Alertus Mass Notification System, daily webmaster and webmail email servers, daily screensaver updates, and daily text messages to staff. Additionally, specific instructions were written for emergency department providers and other departmental staff regarding changes to admission plans during the strike period, as described above. Furthermore, the NYC H+H chief wellness officer conducted rounds during and after the labor action to ensure staff felt engaged and heard.

External messaging was particularly important during interactions with the Community Advisory Board, the New York City Department of Health and Mental Hygiene (NYC Department of Health), and The Joint Commission, which inquired about Elmhurst’s plans to ensure high-quality patient care during the labor action. For the NYC Department of Health, daily staffing and census data were obtained and communicated to keep citywide health leaders informed, and for The Joint Commission, an extensive planning document was released that outlined most of the mitigation strategies discussed in this article.

External Partnerships

Navigating a labor action response successfully requires collaboration with local government organizations and private-sector entities. The largest government collaborator for NYC H+H/Elmhurst was the NYC Department of Health, which had requested a prestrike assessment from NYC H+H/Elmhurst and 5-page Health Emergency Response Data System assessments to outline census, staffing, and occurrences during the strike and sent 4 surveyors to evaluate patient care delivery and interview staff daily until the strike concluded. The NYC Department of Health also provided guidance for facilities, which overlapped with actions at NYC H+H/Elmhurst, and included a list of steps for requesting temporary suspensions or changes to regulations due to labor action interferences.

The largest private-sector collaborators were the locums tenens agencies, who were engaged early in the process to ensure they could provide supplemental staff if needed. Other entities that lent support and guidance during this crucial time were NYC Emergency Management, the Greater New York Hospital Association, and other hospital systems that had recently gone through healthcare strikes or threats of strikes. Input from these agencies and knowledgeable healthcare systems proved invaluable during the planning and execution of the strike response.

Demobilization

After negotiations had resolved the labor action at NYC H+H/Elmhurst early, the final stage—demobilization—began. This stage involved the gradual return to normal operations for the facility to prepare for a regular supply of providers and demand for care. A key component was transitioning coverage, ensuring the continued support of supplemental providers who were recruited to assist during the strike while the resident house staff returned to work. Communication with those providers and the locums agencies occurred daily until the residents were fully returned to duty.

In parallel, communications were sent out to inform all staff, local elected officials, governmental collaborators, and news media sources of the labor action’s end, and crisis communications efforts were concluded. An exit conference was held with the DOH before they concluded their onsite presence, during which NYC H+H/Elmhurst was praised for its uninterrupted delivery of quality, safe care; the NYC Department of Health review of occurrence reports across the 3 days of the labor action offered the conclusion that no occurrences were directly attributed to the labor action. Further demobilization activities included (1) the discontinuation of an emergency declaration, the removal of emergency credentials, EMR accounts, and identification badges; (2) the retrieval of supplies provided to temporary workers; (3) the restoration of shuttle service to normal routes; (4) the closure of staff sleeping areas; (5) the closure of operational and clinical command centers; and (6) the resumption of normal admitting patterns and transfer protocols. Demobilization concluded on May 30, 2023, as normal hospital operations fully resumed.

Discussion

The labor action at NYC H+H/Elmhurst presented challenges that other hospitals facing similar situations should anticipate. It is crucial to understand the similarities and differences between strikes and other crises, such as natural disasters, pandemics, or mass casualty incidents.

Both strikes and other crises involve a loss of capacity to care for patients, leading to a mismatch where demand exceeds the available supply of providers. This could stem from a loss of staff, as seen in strikes or pandemics, or a surge in demand, as with mass casualty incidents. Strikes and other crises also require similar efforts to onboard additional staff rapidly—either to replace lost providers or to meet increased demand. The effects of such events often ripple beyond the affected facility, impacting nearby hospitals or entire regions.

While these similarities allow for skill translation by experienced emergency preparedness personnel, strikes have unique aspects that can make preparation and response more manageable. Strikes involve predictable provider losses, with the number and types of staff involved typically decided in advance. The worst-case scenario might not occur, as some providers may cross the picket line. Additionally, the timing of strikes is often predetermined, with the action ideally ending when an agreement is reached, rather than at an undetermined moment beyond the hospital’s control. Strikes also offer advance notice, often months in advance, unlike sudden events like mass shootings or human-made disasters, where planning is for an indeterminate future.

The strategies outlined above are not without limitations or downsides. Important considerations to mention include that replacing striking physicians with midlevel providers and locums tenens physicians or providers from outside institutions introduces challenges beyond filling personnel gaps. While such staffing measures are imperative to maintain operational capacity, they present potential drawbacks that may impact patient care quality. Locum and midlevel provider staff are often unfamiliar with the institution’s policies and processes, electronic health records, and, importantly, the unique needs and complexities of the patient population. Unfamiliarity can affect the continuity and depth of care, especially in cases requiring nuanced understanding of a patient’s medical and social history or the hospital’s care pathways and workflows.

Further, midlevel providers and locums might lack the specific, specialized experience and training required for certain patient demographics or complex cases typically managed by hospital-affiliated physicians. Adjustments to these providers’ orientation and integration can also tax the hospital’s permanent staff, as they may need to supervise, train, or provide more oversight, which can lead to increased workload and potential oversight gaps. These factors together could introduce a quality-of-care and patient safety differential, underscoring the critical balance between capacity maintenance and care consistency during a strike.

Additionally, these strategies represent a departure from the status quo for facilities. Such changes, either due to the labor action on its own or the responses to such an action, may negatively impact patient care. Research should therefore be done to understand how strike response strategies, such as rapid discharge planning, can affect patient outcomes, alongside continued efforts to elucidate the costs of strikes and their potential impact on care quality and safety.

Conclusion

Labor actions have long occurred in healthcare and become more common post-COVID-19. While they share similarities with other crises, such as the mismatch between provider supply and patient demand, the need for surge providers, and the spread of impact beyond the facility, labor actions differ in their predictability and specific impact on timeframe and provider losses. In response to a May 2023 labor action, NYC H+H/Elmhurst implemented 6 core strategies to maintain quality care: (1) strike aversion and planning, (2) increasing coverage, (3) decreasing demand, (4) internal and external messaging, (5) external partnerships, and (6) demobilization. The strategies and lessons detailed in this article and in the Strike Planning Template (available in Supplemental Materials, www.liebertpub.com/doi/suppl/10.1089/hs.2024.0095) can guide other healthcare facilities. Further efforts should refine and test these strategies in different geographic settings while studying patient outcomes from both the strikes and the strategies used to address them.

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