Agents of Change: How Allied Healthcare Workers Transform Inequalities in the Healthcare Industry

Abstract

This case offers a “bottom-up” view of the healthcare industry through the voices of workers essential to the industry’s operations, including unskilled and semiskilled titles. Allied healthcare workers are often invisible members of the healthcare workforce, revealing the industry’s own internal hierarchies of class, race, gender, and status. This case illuminates their struggles, successes, and challenges to end structural inequality in the workplace as they fight to transform low-wage, exploitative jobs into dignified, fairly compensated careers. Nonclinical members of the team are essential to improving patient care and obtaining structural change. Their knowledge and insight as partners are central to new innovations in care delivery. The case concludes with four ways to forge effective ties with worker and labor organizations to deepen structural competency within healthcare organizations.

Appendix

In the Classroom

We need healthcare practitioners with the skill to build a robust and just health system. Classroom activities can include:

• Guest speakers: To build awareness of workforce relations and the social dimensions of medical care. Seek multiple perspectives on the same issue.

  • Unions and worker organizations: Their elected officers, activist workers, and their policy, research, communications, and organizing staffs can offer valuable perspectives. For worker experiences, arrange for guest speakers (workers need an honorarium for these visits) or create “a day in their shoes” experiences shadowing community health workers, home care workers, and other key allied health workers. Use documentaries and videos to bring worker experiences into the classroom.

  • Worker organizations: Home care worker growth outpaces all other categories in the next decade. The national campaign, Caring Across Generations, seeks to build a true system of affordable long-term care and build a culture of care.

  • Training funds: They critically analyze industry trends and work with both management and labor to offer relevant interventions. See, for example, www.1199seiubenefits.org.

  • Employer and industry organizations: They negotiate with unions and represent multiple employers. In New York City, it is the League of Voluntary Hospitals and Homes (www.lvhh.com) and the Greater New York Hospital Association (www.gnyha.org/).

  • Administrators: Their mindsets and decisions affect thousands of workers and patients. Include “middle managers” responsible for implementation on the ground.

  • Trailblazers: Institutions that have implemented innovative workforce or care delivery changes at scale, like Kaiser Permanente.

  • Network and capacity builders: Building a better future for healthcare with community partners takes deep skill to avoid typical pitfalls and to identify grounded and sustainable innovations. Ideas, resources, and tools are available from www.communitycatalyst.org/ and www.interactioninstitute.org/.

  • Academics: To build a conceptual vocabulary and critical analysis that integrates historical, economic, and sociological dynamics with healthcare delivery. See the citations in the “Agents of Change” chapter.

  • Patients: To excavate the range of interactions they have beyond the clinical encounter. In addition, seek nursing home and home care patients as well to engage questions of continuity of care and of the social factors that influence the receipt of care and adherence to treatment plans.

• Historical cases:

  • Johns Hopkins Medical Center Strike 1969 and 2014

    • Video of Annie Henry talking about Coretta Scott King at Johns Hopkins strike in 1969. http://hardshipathopkins.org/coretta-scott-king-at-hopkins/

    • 2014 accounts of the Johns Hopkins strike. Available at www.hardshipathopkins.org

  • 1969 Hospital Strike in Charleston, SC

    • Documentary: I Am Somebody (30 min), directed by Madeline Anderson, a trailblazing African American female director. http://icarusfilms.com/if-iams

    • Primary sources including audio clips of interviews – http://ldhi.library.cofc.edu/exhibits/show/charleston_hospital_workers_mo/sources_3

  • Health Policy Advisory Center

    • From 1968 to 1994, the Health Policy Advisory Center provided critical analysis of the medical industrial complex, a term they coined. Their articles and books investigate the industry’s structure as well as grassroots community-based efforts to combat inequality. There archives are accessible and searchable online at www.healthpacbulletin.org.

    • Cartoons on the healthcare industry by award-winning illustrator Bill Plympton www.healthpacbulletin.org/wp-content/uploads/2013/02/H-PAC-Bill-Plympton-Drawings-Scanned_007.png

  • Podcast on history of Bellevue Hospital as almshouse hospital – http://boweryboys.libsyn.com/-152-bellevue-hospital

• Read healthcare worker contracts: Learn the concerns of workers and the benefits and protections negotiated. For example, see 1199SEIU’s master contract with the League of Voluntary Hospitals and Homes of New York at lvhh.com/current-agreements/.

• Write accessible pieces like letters to the editor and op-eds: Choose an issue and write it. Sending is optional but practicing helps. Given today’s technology, op-docs, blogs, and other vehicles for sharing perspectives also matter. See, for example, “Invisible Colleagues” by Benjamin Oldfield, MD in The New England Journal of Medicine August 27, 2015. www.nejm.org/doi/full/10.1056/NEJMp1506873.

• Awareness and reflection: It’s disturbing and disruptive to learn we have blinders. Build awareness and the capacity to hold uncomfortable truths and contradictions via workshops and exercises with partner organizations dedicated to such learning. Class action’s workshops and resources on class (classism.org) and racial justice trainings (this is not diversity training) (https://www.raceforward.org/trainings; http://interactioninstitute.org/trainings/).