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.

A Theory of How the Brain Might Work

I wish to propose a quite speculative new version of the grandmother cell theory to explain how the brain, or parts of it, may work. In particular, I discuss how the visual system may learn to recognize 3D objects. The model would apply directly to the cortical cells involved in visual face recognition. I will also outline the relation of our theory to existing models of the cerebellum and of motor control. Specific biophysical mechanisms can be readily suggested as part of a basic type of neural circuitry that can learn to approximate multidimensional input-output mappings from sets of examples and that is expected to be replicated in different regions of the brain and across modalities. The main points of the theory are: -the brain uses modules for multivariate function approximation as basic components of several of its information processing subsystems. -these modules are realized as HyperBF networks (Poggio and Girosi, 1990a,b). -HyperBF networks can be implemented in terms of biologically plausible mechanisms and circuitry. The theory predicts a specific type of population coding that represents an extension of schemes such as look-up tables. I will conclude with some speculations about the trade-off between memory and computation and the evolution of intelligence.

SketchIT: A Sketch Interpretation Tool for Conceptual Mechanical Design

We describe a program called SketchIT capable of producing multiple families of designs from a single sketch. The program is given a rough sketch (drawn using line segments for part faces and icons for springs and kinematic joints) and a description of the desired behavior. The sketch is "rough" in the sense that taken literally, it may not work. From this single, perhaps flawed sketch and the behavior description, the program produces an entire family of working designs. The program also produces design variants, each of which is itself a family of designs. SketchIT represents each family of designs with a "behavior ensuring parametric model" (BEP-Model), a parametric model augmented with a set of constraints that ensure the geometry provides the desired behavior. The construction of the BEP-Model from the sketch and behavior description is the primary task and source of difficulty in this undertaking. SketchIT begins by abstracting the sketch to produce a qualitative configuration space (qc-space) which it then uses as its primary representation of behavior. SketchIT modifies this initial qc-space until qualitative simulation verifies that it produces the desired behavior. SketchIT's task is then to find geometries that implement this qc-space. It does this using a library of qc-space fragments. Each fragment is a piece of parametric geometry with a set of constraints that ensure the geometry implements a specific kind of boundary (qcs-curve) in qc-space. SketchIT assembles the fragments to produce the BEP-Model. SketchIT produces design variants by mapping the qc-space to multiple implementations, and by transforming rotating parts to translating parts and vice versa.