Unions seeking to organize at hospitals run up against special obstacles--they must confront the public's reluctance to see any kind of agitation become connected with the places where it seeks calm, well-ordered care. It is one thing to seek to join workers together in steel mills or auto factories, which deal with heavy technology and machinery. In these industries, unions fighting for more employee rights are working squarely on the side of humanity. They try to improve the place of the individual in a monolithic business that usually resembles a large, impersonal machine more than it does any sort of communal human effort. Unions organizing among clerical and office workers are often bucking a similarly monolithic "system," in which the needs of individuals all too often take a back seat to the requirements of a bureaucratic structure.

But a hospital is a special kind of business. Its output is measured in terms of a nebulous quantity called health, and its production process involves humans caring for humans. There is a strong, traditional ethic asserting that unions have no place in hospitals.

Clearly, that idea is a throwback to days when hospitals were smaller, when they not only doled out mercy as health care agents, but also provided maintenance and housekeeping jobs to people who might otherwise be out of work. Today urban hospitals, from the perspective of lower-echelon employees, are so big that they resemble any other business. The worker in a hospital laundry, the man who keeps a floor buffed, the employee who washes pots in the basement--none have a very strong sense that they are part of an organization ultimately devoted to making the sick feel better. Most hospital service employees punch in and punch out on any given day without even talking to any patients.

But there are sick-care relationships all around--even if only doctors and nurses are involved in them--and when a union starts organizing a hospital it can easily arouse fears that these delicate relationships might be upset. Factory unions may stand in clear opposition to dark forces of exploitation and concentrated economic power, but few people like to think that hospitals, agents of aid and mercy, could be harsh employers. The prospect of a labor-management struggle when management is in the business of nursing sick people back to health is very disturbing to many. And the prospect of raising already incredible hospital bills still higher to cover increased labor costs is not an enchanting one.

Into this touchy scenario, in the past ten years, have walked a number of hospital unions, most notably local sections of the Service Employees International Union (SEIU), a subdivision of the AFL-CIO. The SEIU today boasts some half a million members; hospital workers comprise about 200,000 of that number. The union has made its major advances in cities like New York, San Francisco, Los Angeles and Philadelphia, organizing in major hospitals. But until about five years ago the union did no organizing in Boston--a city with a rather conspicuous concentration of hospitals. It wasn't until 1972 that Local 880 of the Massachusetts Hospital Workers Union first started operating in an area that includes Harvard's prestigious teaching hospitals, including the Massachusetts General, the largest hospital in New England.

The union's progress has been slow. It scored some early successes among Cape Cod hospitals, and as of last week it had successfully negotiated two contracts for workers in the Harvard Community Health Plan, a progressive health care system founded eight years ago by forward-thinking doctors at the Harvard Medical School. But the union encountered no opposition from the plan's management when it decided to organize there. The plan's president at the time of Local 880's initial unionizing drive was a former official in the United Auto Workers. It is in the union's efforts to represent workers in its big targets, the Harvard-affiliated teaching hospitals, that a wall of opposition from the hospitals' management has developed. Last year, before workers were to vote on the question of union representation at affiliates Beth Israel Hospital and Boston Hospital for Women, administrators at those institutions brought into play a high-powered anti-union consulting firm, operating out of Chicago, going by the ominous name of Modern Management Methods, Inc. There are federal laws forbidding employers from hiring this kind of firm to persuade workers directly, but there is no law saying consultants cannot work with lower-level hospital administrators to help them most effectively represent to workers the hospital's opposition to unionization. When Congress belatedly placed hospital workers under the protection of the National Labor Relations Act in 1974, it intended that the law should aid unions' efforts. But unfortunately most of the lawyers are on the side of the hospitals.

Beth Israel in particular has made use of the courts to tie up the hospital workers union. Last year during Local 880's unionizing drive the hospital brought the union's staff director, Gerry M. Shea, to court on trumped-up charges of trespassing and assault and battery. Shea filed counter-claims, and when the case finally came to trial the judge threw out all of the charges. No one was convicted of anything, but by bringing the charges to court the hospital took union staffers' time away from their organizing efforts.

Those efforts were unsuccessful last year. In an NLRB election last winter, held eight months after the union requested it, Beth Israel workers voted decisively against the union. But the outcome must be viewed cautiously in light of the hospital's intensive efforts to dissuade workers from supporting the union and the small scale of the union's campaign. Local 880 had one full-time organizer dividing his time between Beth Israel and Boston Hospital for Women, where the union was also defeated. Estimates have placed the number of Modern Management Methods consultants working at Beth Israel just before the election as high as four.

And while the hospital administration reached workers through hospital newsletters as well as through talks delivered by middle management personnel, the union's forum for presenting its argument was effectively limited to two small locker rooms where workers spend little time. The hospital forbade workers from soliciting support for the union in the hospital's cafeteria, where they spend much of their off time, because it claimed pro-union arguments might damage patients' confidence in the hospital and therefore the likelihood of their getting well.

An administrative law judge in the National Labor Relations Board ruled this limitation to be an unfair labor practice last year, during the organizing drive, but the hospital has simply tied the issue up in court, appealing it through successive levels, receiving a series of unfavorable decisions, and now finally seeking to bring it before the Supreme Court. The Court may choose to hear the case, because it breaks some new ground in labor law and because a federal court in the Midwest has issued a ruling at variance with the ruling of a Boston court on the Beth Israel case. The Boston court supported the NLRB. But most watchers expect that the Supreme Court will not hear the case, and will simply let the lower court's decision stand. A year after it was issued, the NLRB ruling that the union should be allowed to organize in the cafeteria will probably finally go into effect. But in the meantime the hospital has continued to ban pro-union solicitation there, and the union has lost an election.

By taking on the legal battle, though, the NLRB has guaranteed that in any further drives the hospital will not be able to use legal appeals as a delaying tactic. The Massachusetts Hospital Workers have made the way that much easier for the next unionizing drive.

The union is also seeking to restrict the hospitals' ability to bring in consulting firms to fight the union. Working with State Rep. Barney Frank, Shea has succeeded in having introduced in the State legislature a bill that would prevent hospitals from using federal funds like Medicaid to pay firms like Modern Management Methods. Beth Israel did so during an unsuccessful unionizing drive in 1974, and a State regulatory agency for hospitals required that the hospital return the money to Medicaid because the expense was not related to patient care. The union's bill has encountered some resistance in the legislature, so Shea and Frank have put off efforts to pass the bill until next year, when they hope to enlist the lobbying support of the AFL-CIO to secure the bill's passage.

In the meantime, the union is holding back and assessing its position. It now represents workers at about 20 hospitals and nursing homes in eastern Massachusetts. In the nursing homes, conditions for patients as well as workers are worse than in the hospitals.

Local 880 has hardly given up on the Harvard teaching hospitals. It is simply waiting until the time is right to begin mounting a third unionizing drive at Beth Israel, and once the union gains workers' support at one of the major hospitals Shea is convinced that others will quickly come under Local 880's representation. The big target ultimately eyed by the union is Mass General, the bastion of the Eastern medical establishments, with an estimated 3000 service employees compared to about 900 at Beth Israel. When Local 880 goes after Mass General, there will be a big fight. Shea says simply, "When we start organizing there, you'll know." But for now the union is trying to tackle lesser opponents, wearing them down, year by year.