Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

Tubular Organization of SnO₂ Nanocrystallites for Improved Lithium Ion Battery Anode Performance

Porous tin oxide nanotubes were obtained by vacuum infiltration of tin oxide nanoparticles into porous aluminum oxide membranes, followed by calcination. The porous tin oxide nanotube arrays so prepared were characterized by FE-SEM, TEM, HRTEM, and XRD. The nanotubes are open-ended, highly ordered with uniform cross-sections, diameters and wall thickness. The tin oxide nanotubes were evaluated as a substitute anode material for the lithium ion batteries. The tin oxide nanotube anode could be charged and discharged repeatedly, retaining a specific capacity of 525 mAh/g after 80 cycles. This capacity is significantly higher than the theoretical capacity of commercial graphite anode (372 mAh/g) and the cyclability is outstanding for a tin based electrode. The cyclability and capacities of the tin oxide nanotubes were also higher than their building blocks of solid tin oxide nanoparticles. A few factors accounting for the good cycling performance and high capacity of tin oxide nanotubes are suggested.