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.

Applying the Lessons of “Lean Now” to Transform the US Aerospace Enterprise

Lean is common sense and good business sense. As organizations grow and become more successful, they begin to lose insight into the basic truths of what made them successful. Organizations have to deal with more and more issues that may not have anything to do with directly providing products or services to their customers. Lean is a holistic management approach that brings the focus of the organization back to providing value to the customer. In August 2002, Mrs. Darleen Druyun, the Principal Deputy to the Assistant Secretary of the Air Force for Acquisition and government co-chairperson of the Lean Aerospace Initiative (LAI), decided it was time for Air Force acquisitions to embrace the concepts of lean. At her request, the LAI Executive Board developed a concept and methodology to employ lean into the Air Force’s acquisition culture and processes. This was the birth of the “Lean Now” initiative. An enterprise-wide approach was used, involving Air Force System Program Offices (SPOs), aerospace industry, and several Department of Defense agencies. The aim of Lean Now was to focus on the process interfaces between these “enterprise” stakeholders to eliminate barriers that impede progress. Any best practices developed would be institutionalized throughout the Air Force and the Department of Defense (DoD). The industry members of LAI agreed to help accelerate the government-industry transformation by donating lean Subject Matter Experts (SMEs) to mentor, train, and facilitate the lean events of each enterprise. Currently, the industry SMEs and the Massachusetts Institute of Technology are working together to help the Air Force develop its own lean infrastructure of training courses and Air Force lean SMEs. The first Lean Now programs were the F/A-22, Global Hawk, and F-16. Each program focused on specific acquisition processes. The F/A-22 focused on the Test and Evaluation process; the Global Hawk focused on Evolutionary Acquisitions; and the F-16 focused on improving the Contract Closeout process. Through lean, each enterprise made many significant improvements. The F/A-22 was able to reduce its Operational Flight Plan (OFP) Preparation and Load process time of 2 to 3 months down to 7 hours. The Global Hawk developed a new production plan that increases the annual production of its Integrated Sensor Suite from 3 per year to 6 per year. The F-16 enterprise generated and is working 12 initiatives that could result in a contract closeout cycle time reduction of 3 to 7 years. Each enterprise continues to generate more lean initiatives that focus on other areas and processes within their respective enterprises.