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.

Benefits of Implementing Lean Practices and the Impact of the Lean Aerospace Initiative in the Defense Aerospace Industry and Government Agencies

In the 1980’s, many United States industrial organizations started developing new production processes to improve quality, reduce cost, and better respond to customer needs and the pressures of global competition. This new paradigm was coined Lean Production (or simply “Lean”) in the book The Machine That Changed The World published in 1990 by researchers from MIT’s International Motor Vehicle Program. In 1993, a consortium of US defense aerospace firms and the USAF Aeronautical Systems Center, together with the AFRL Materials and Manufacturing Directorate, started the Lean Aircraft Initiative (LAI) at MIT. With expansion in 1998 to include government space products, the program was renamed the Lean Aerospace Initiative. LAI’s vision is to “Significantly reduce the cost and cycle time for military aerospace products throughout the entire value chain while continuing to improve product performance.” By late 1998, 23 industry and 13 government organizations with paying memberships, along with MIT and the UAW were participating in the LAI.

Model Order Reduction for Determining Bubble Parameters to Attain a Desired Fluid Surface Shape

In this paper, a new methodology for predicting fluid free surface shape using Model Order Reduction (MOR) is presented. Proper Orthogonal Decomposition combined with a linear interpolation procedure for its coefficient is applied to a problem involving bubble dynamics near to a free surface. A model is developed to accurately and efficiently capture the variation of the free surface shape with different bubble parameters. In addition, a systematic approach is developed within the MOR framework to find the best initial locations and pressures for a set of bubbles beneath the quiescent free surface such that the resultant free surface attained is close to a desired shape. Predictions of the free surface in two-dimensions and three-dimensions are presented.

The Japanese Business System: Key Features and Prospects for Change

This paper argues that the Japanese business system cannot be adequately understood without extending the focus of analysis beyond the individual firm to the vertical keiretsu, or business group. The vertical group or keiretsu structure was first identified and studied in the auto and electronics industries, where it is most strongly marked, but it characterizes virtually all sectors, service industries as well as manufacturing. Large industrial vertical keiretsu are composed of subsidiaries engaged in three distinct types of activities (manufacturing, marketing, and quasirelated business). The coordination and control systems are built on the flows of products, financial resources, information and technology, and people across formal company boundaries, with the parent firm controlling the key flows. The paper examines the prevailing explanations first for the emergence and then for the persistence of the vertical group structure, and looks at the current pressures for change and adaptation in the system.