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.
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Notes
- 1.
Definitions vary but often include sub-baccalaureate positions and jobs regarded as semi- and unskilled.
- 2.
There are also unions for nurses and for workers in public hospitals and healthcare centers. To learn more about SEIU affiliated healthcare unions, visit www.1199seiu.org, www.seiu.org as well as www.doctorscouncil.org and www.cirseiu.org.
- 3.
Prior to federal New Deal and Great Society social assistance programs, local taxes funded poorhouses that warehoused the orphaned, the homeless, the disabled, and the elderly. Residents were forced to work at nearby establishments (like rock quarries) to generate revenue as taxpayer dollars did not cover all their operating costs (see Eubanks 2018 for a brief history).
- 4.
For example, as part of its expansion in 1913, Mount Sinai authorized the construction of a dorm for 240 of its employees, including nurses (Hirsh and Doherty 1952).
- 5.
Even in 1969, workers like Mrs. Mozell Smith, a 50-year-old food preparer at Hospital for Joint Diseases, recognized that winning $107 a week is “not a lot of money, but it’s a lot if you’re used to getting $65” [14].
- 6.
To learn more, visit www.1199seiubenefits.org/.
- 7.
Evelyn Harris, an emergency room liaison at Niagara Falls Memorial Hospital in Buffalo, NY reported: “Fifty percent of our service and maintenance workers at Niagara Falls Memorial [Hospital] go without healthcare coverage because they can’t afford it.” “Profits Before Patients: Many HMOs earn billions while cutting services and increasing premiums.” 1199SEIU Our Life and Times. May 2007: 7.
- 8.
See Destina Garcia’s story profiled by Kevin Carey in The New York Times. The Apprenticeship Program is a partnership between 1199SEIU Training and Employment Funds, Bronx-Lebanon Hospital Center, 1199SEIU United Healthcare Workers East, LaGuardia Community College, and the New York Alliance for Careers in Healthcare. “Trump’s Apprentice Plan Seems to Need a Mentor,” Kevin Carey September 28, 2017. https://nyti.ms/2yuszuY.
- 9.
See Walker, Andrea K. 2014. “Union wants hospitals to disclose employees on public assistance.” The Baltimore Sun. May 21. www.baltimoresun.com/health/blog/bs-hs-union-hscrc-20140521-story.html.
References
Vail B. Striking workers shame prestigious Johns Hopkins hospital over low pay [Internet]. In: In These Times. 2014 April 10 [cited 2017 Dec 3]. Available from: http://inthesetimes.com/working/entry/16541/striking_workers_shame_prestigious_johns_hopkins_hospital_over_low_pay
Centers for Medicare and Medicaid Services (US). Historical national health expenditure data [Internet]. Washington, DC. 2018 Jan. Available at https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html
Glenn EN. Forced to care: coercion and caregiving in America. Cambridge: Harvard University Press; 2012. p. 272.
Gascon C. US healthcare and future job growth [Internet]. St. Louis: Federal Reserve Bank of St. Louis. 2018 May 21 [cited 2018 Sep 15]. Available from: https://www.stlouisfed.org/on-the-economy/2018/may/health-care-future-job-growth
Hartocollis A. Bellevue Marks 275 years of taking care. The New York Times. 2011. Dec 15.
Wall BM. History of hospitals [Internet]. Philadelphia: University of Pennsylvania School of Nursing. Nd [cited 2017 June 25]. Available from: www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-hospitals/index.php
Foundation Aiding the Elderly. The history of nursing homes [Internet]. Nd [cited 2017 June 25]. Available from: http://www.4fate.org/history.pdf
Eubanks V. Automating inequality: how high-tech tools profile, police, and punish the poor. New York: St. Martin’s Press; 2018. 265p.
Knights Jr. M.D., EM. Bellevue hospital. History magazine [Internet]. Issue 2. Nd [cited 2017 Dec 3]. Available from: www.history-magazine.com/bellevue.html
Pritchett WE. A northern civil rights movement: community race relations in Brooklyn and the beth-el hospital strike of 1962. Labor’s Heritage. 2000;10(Fall/Winter):4.
Hirsh J, Beka D. The first hundred years of the mount sinai hospital of New York, 1852–1952 [Internet]. New York: Random House. 1952 [cited 2017 June 25]. Available from: https://archive.org/stream/firsthundredyear1952jose/firsthundredyear1952jose_djvu.txt
Weissman E. Non-profit hospitals and labor unions. 8 Cleveland-Marshall Law Review 482. 1959 [cited 2017 June 5]. Available from: www.engagedscholarship.csuohio.edu/clevstlrev
Fink L, Greenberg B. Upheaval in the quiet zone: 1199SEIU and the politics of healthcare unionism. Urbana: University of Illinois Press; 2009. second edition [1989]. 392p.
Raskin AH. A union with a ‘soul’. The New York Times. 1970 Mar 22 [cited 2017 June 1]. Available from: https://nyti.ms/1H0fqYm.
Health Policy Advisory Center. Hospital unions: a long time coming. In: Health/PAC Bulletin. 1970 July–August. New York: Health Policy Advisory Center. Available from: www.healthpacbulletin.org.
Boris E, Klein J. Labor on the home front: unionizing home-based care workers. New Labor Forum 2008 Summer. 17(2): 32–41.
Caress B. Home is where the patients are: New York home care workers’ contract victory. Health/PAC Bulletin 1988 Fall 18(3). 4–14. Health Policy Advisory Center.
Flack A. 50 who carried the 1199 torch: profiles of our pioneers. In: Our life and times: a journal of 1199SEIU. New York: 1199SEIU; 2009.
Mount Sinai 150th Anniversary Committee. 1852–2002: the sesquicentennial [Internet]. New York: Mount Sinai Hospital: New York. 2002 [cited 2017 May 31]. Available from: https://icahn.mssm.edu/files/ISMMS/Assets/About%20the%20School/Academic%20IT%20(AIT)/Levy%20Library/Sesquicentennial.pdf
Peterson RR. Balancing priorities and resources at Johns Hopkins [Internet]. Commentary/Op-ed. Baltimore Sun. 2014 Apr 11 [cited 2017 Dec 3]. Available from: http://www.baltimoresun.com/news/opinion/oped/bs-ed-jh-labor-dispute-20140410-story.html
Williams IV JJ. Thousands gather to protest pay at Hopkins hospital [Internet]. Baltimore Sun. 2014 May 10 [cited 2017 Dec 3]. Available from: http://www.baltimoresun.com/health/bs-md-hopkins-protest-20140510-story.html
McFadden RD. Leon Davis, 85, Head of Health-Care Union, Dies [Internet]. New York Times. 1992 Sep15 [cited 2017 June 22].
Baltimore Sun. A win-win for Hopkins [Internet]. Editorial. 2014 July 8 [cited 2017 June 4]. Available from: http://www.baltimoresun.com/news/opinion/editorial/bs-ed-hopkins-20140708-story.html
Robbins K. Struggling Hopkins workers need better wages, not unusable benefits [Internet]. Letter to the Editor. Baltimore Sun. 2014 April 15 [cited 2017 June 13]. Available from: http://www.baltimoresun.com/news/opinion/readersrespond/bs-ed-hopkins-worker-letter-20140415-story.html
Reutter M. Victor in Hopkins labor dispute is not your granddaddy’s union [Internet]. Baltimore Brew. 2014 July 8 [cited 2017 June 3]. Available from: https://www.baltimorebrew.com/2014/07/08/victor-in-hopkins-labor-dispute-is-not-your-grandaddys-union/
Hudson G, Caress B. New York’s 1199 in 1989: rebuilding a troubled union. Labor Research Review. 1991;1(17):6.
North D, Foner M. Celebrating the life of Leon Davis. New York: 1199 New York’s Health and Hospitals Union. (Publication for Davis’ memorial tribute at Lincoln Center’s Avery Fischer Hall.) 1992 Oct 5. P. 19 On file with author.
Saigo, M. Interview. Home Health Aide and 1199 member. 2017 April. (Interviewed by Sandi Vito).
Ducey A. Never good enough: health care workers and the false promise of job training. New York: Cornell ILR Press; 2008.
Boris E, Klein J. Frontline caregivers: still struggling. Dissent Magazine. 2017 Spring.
Conliffe, L. Interview. Care Manager and 1199 member. 2017 January. (Interviewed by Sandi Vito).
Findley S, Sergio M, Hicks A. et al. community health worker integration into the health team accomplishes the triple aim in a patient-centered medical home: a Bronx tale. Jnl Amb Care Mgmt 2014 (37):82–91. Available from: http://www.blhfamilymed.com/Scholarly-Activity/presentations-posters-and-conventions
Carey K. Trump’s apprentice plan seems to need a mentor. New York Times. 2017 Sep 28 [cited 2017 Dec 3]. Available from: https://nyti.ms/2yuszuY
McDaniels AK. Some Johns Hopkins nurses trying to unionize. Baltimore Sun. 2018 Mar 19.
Richman T. Johns Hopkins graduate students announce unionization plans [Internet]. Baltimore Sun. 2018 Sep 26 [cited 2018 Oct 2]. Available from: http://www.baltimoresun.com/news/maryland/education/higher-ed/bs-md-ci-hopkins-union-20180926-story.html
Nayak Z, et al. Hopkins should support its employees [Internet]. Letter to the Editor. Baltimore Sun. 2014 April 7 [cited 2018 Oct 2]. Available from: http://www.baltimoresun.com/news/opinion/bs-ed-hopkins-letter-20140407-story.html
Frank T. Straight into the fox news buzzsaw: why elite, billionaire liberalism always backfires [Internet]. Salon. 2014 April 20 [cited 2017 Aug 2]. Available from: www.salon.com
Halbfinger DM. Dr. Martin Cherkasky, 85; led expansion of Montefiore. New York Times. 1997 September 8.
Clark C. Berwick Names 11 Monsters Facing Hospital Industry [Internet]. Health Leaders Media. 2013 July 29.
Gawande A. Big Med. New Yorker. 2012 August 13.
Acknowledgments
Heartfelt thanks to Sandi Vito (Executive Director, 1199SEIU Training and Employment Funds) who conducted interviews with 1199SEIU members, Lloyd Conliffe and Melisa Saigo. Sandi, along with Yvonne Armstrong (1199SEIU Senior Executive Vice President for Long Term Care), provided critical early support and feedback. Barbara Caress’s erudition on health policy and 1199 history is unsurpassed, and she guided me to the Health Policy Advisory Center archives. Virginia Eubanks, Heidi Hamilton, and Catherine McLaren also provided close readings and insights.
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Appendix
Appendix
In the Classroom
We need healthcare practitioners with the skill to build a robust and just health system. Classroom activities can include:
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Guest speakers: To build awareness of workforce relations and the social dimensions of medical care. Seek multiple perspectives on the same issue.
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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.
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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.
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Training funds: They critically analyze industry trends and work with both management and labor to offer relevant interventions. See, for example, www.1199seiubenefits.org.
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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/).
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Administrators: Their mindsets and decisions affect thousands of workers and patients. Include “middle managers” responsible for implementation on the ground.
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Trailblazers: Institutions that have implemented innovative workforce or care delivery changes at scale, like Kaiser Permanente.
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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/.
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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.
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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.
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Historical cases:
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Johns Hopkins Medical Center Strike 1969 and 2014
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Video of Annie Henry talking about Coretta Scott King at Johns Hopkins strike in 1969. http://hardshipathopkins.org/coretta-scott-king-at-hopkins/
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2014 accounts of the Johns Hopkins strike. Available at www.hardshipathopkins.org
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1969 Hospital Strike in Charleston, SC
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Documentary: I Am Somebody (30 min), directed by Madeline Anderson, a trailblazing African American female director. http://icarusfilms.com/if-iams
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Primary sources including audio clips of interviews – http://ldhi.library.cofc.edu/exhibits/show/charleston_hospital_workers_mo/sources_3
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Health Policy Advisory Center
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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.
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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
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Podcast on history of Bellevue Hospital as almshouse hospital – http://boweryboys.libsyn.com/-152-bellevue-hospital
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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/.
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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.
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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/).
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Jones, A. (2019). Agents of Change: How Allied Healthcare Workers Transform Inequalities in the Healthcare Industry. In: Hansen, H., Metzl, J. (eds) Structural Competency in Mental Health and Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-10525-9_16
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