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Cleaning Up

Cleaning Up: How Hospital Outsourcing Is Hurting Workers and Endangering Patients

Dan Zuberi
Copyright Date: 2013
Published by: Cornell University Press,
Pages: 184
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  • Book Info
    Cleaning Up
    Book Description:

    To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. In Cleaning Up, the first book to examine this transformation in the healthcare industry, Dan Zuberi looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. Drawing on years of field research in Vancouver, Canada as well as data from hospitals in the U.S. and Europe, he argues that outsourcing has been disastrous for the cleanliness of hospitals-leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death-as well as for the effective delivery of other hospital services and the workers themselves.

    Zuberi's interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. Zuberi also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. He makes the case that hospital outsourcing exemplifies the trend towards "low-road" service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.

    eISBN: 978-0-8014-6982-4
    Subjects: Health Sciences, Political Science, Sociology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-xiv)
  4. 1 “STUFF GETS MISSED”: An Introduction to a Growing Health Care Crisis
    (pp. 1-18)

    Tracy Melucci cleans a hospital for a living.¹ Well, sometimes clean is a strong word. More realistically, she makes her hospital less dirty than it was before. Short on time, short on resources, and long on responsibilities, she cleans what she can. And she knows it’s not enough. “Basically, you do the big stuff and then you start cutting corners,” she says. “You just cannot get it all done. And when I say ‘cutting corners’ that means bathrooms, offices, hallways. Stuff gets missed.”

    Stuff gets missed. Hospitals across the United States, Canada, and much of Europe have dramatically changed their...

  5. 2 GERMS, BLOOD, AND COST-CUTTING: The Daily Struggle to Keep Hospitals Clean
    (pp. 19-35)

    If you want to find the most germ-ridden building in any city, head straight for the hospital. Not even the grungiest day care center or locker room can match the bacteria and viruses that float through hospital hallways, cafeterias, and even operating rooms. After every major outbreak, microbiologists and infection-control specialists descend on the scene to find the source of the infections. Time after time, they reach same conclusion: the hospital simply isn’t clean enough.

    Experts in public safety have recognized for years that hospitals have a serious hygiene issue. They have interviewed doctors, provided extra training for nurses, and...

  6. 3 COMPROMISING CLEANLINESS: How Outsourcing Keeps Hospital Workers from Doing Their Jobs
    (pp. 36-50)

    The more time I spent with hospital workers, the more I realized that the impacts of outsourcing went far beyond a hospital bottom line. The people cleaning the floors and preparing meals suffer at both work and home. But their stories also point to a much bigger problem, a problem that has the potential to affect the health of the entire community. Simply put: outsourcing has made hospitals less clean and more vulnerable to outbreaks of infectious pathogens. Whether they originate in the community or an ER, these pathogens pose a grave threat to patient safety once they contaminate the...

    (pp. 51-66)

    For all their hard work, cleaners and cooks know they are not doing a good job. In fact, they are surprisingly open about the kinds of shortcuts they feel forced to make.² Juan Laguatan, housekeeper, says, “It’s screwed, of course. Quality of service? Only just on paper. But in reality it is not. Just like maybe on bulletin boards and elevator: ‘We are at your service.’ But in reality it is not.” The risks to patients of cutting corners and improper cleaning are high because contaminated surfaces can serve as a vector for the spread of infection. Veronica Sendal, an...

    (pp. 67-80)

    Prior to outsourcing, hospital support workers were part of the health care team. They might have been on the bottom rung, but they were still on the ladder connecting cleaners and cooks to doctors and nurses. But not anymore.

    Outsourcing has fundamentally compromised the teamwork required for effective infection control.¹ Even if workers still had the benefits and wages they enjoyed prior to outsourcing, they still would be facing an uphill battle in their efforts to keep the hospital clean and safe. In a major survey, U.S. hospital administrators listed the loss of control and teamwork as a major downside...

  9. 6 DOWN AND OUT IN VANCOUVER: Struggling, Stressed, and Exhausted Hospital Support Workers
    (pp. 81-104)

    Hourly wages, injury rates, staffing levels—statistics can tell us a lot about the struggles of hospital support workers in the aftermath of outsourcing. But, as I talked to housekeepers and dietary aides, it became clear to me that their daily experiences tell the real story. These workers aren’t complainers or malcontents; they are people trying to get by in incredibly difficult circumstances. And because their work directly affects hospital hygiene—and thus a patient’s risk of coming down with a hospital-acquired infections—their plight should be everyone’s concern.

    Their lives mirror the plight of a growing number of workers...

    (pp. 105-126)

    In the early afternoon of April 29, 2007, after my spouse went through thirty-six hours of labor and a caesarean birth, I held our beautiful baby girl in my arms. As I looked down at this little bundle swaddled in a yellow towel, I realized that she was more important to me than anything in the world. Looking back, I think about all the people behind the scenes. Somebody had to clean that room—the very first room that my daughter would ever see.

    Thousands of nervous, excited dads have stood in my exact place in that recovery room, and...

  11. Notes
    (pp. 127-148)
  12. References
    (pp. 149-174)
  13. Index
    (pp. 175-182)