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.

Review of Artificial Muscle Based on Contractile Polymers

An artificial muscle with strength and speed equal to that of a human muscle may soon be possible. Polymer gels exhibit abrubt volume changes in response to variations in their external conditions -- shrinking or swelling up to 1000 times their original volume. Through the conversion of chemical or electrical energy into mechanical work, a number of devices have already been constructed which produce forces up to 100N/cm2 and contraction rates on the order of a second. Through the promise of an artificial muscle is real, many fundamental physical and engineering questions remain before the extent or limit of these devices is known.

Contextual models for object detection using boosted random fields

We seek to both detect and segment objects in images. To exploit both local image data as well as contextual information, we introduce Boosted Random Fields (BRFs), which uses Boosting to learn the graph structure and local evidence of a conditional random field (CRF). The graph structure is learned by assembling graph fragments in an additive model. The connections between individual pixels are not very informative, but by using dense graphs, we can pool information from large regions of the image; dense models also support efficient inference. We show how contextual information from other objects can improve detection performance, both in terms of accuracy and speed, by using a computational cascade. We apply our system to detect stuff and things in office and street scenes.