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.

The institutional environment and its influence on political options to Protect Winnipeg’s Female garments Workers against the impact of globalization

The principal objective of this paper is to identify the relationship between the re­sults of the Canadian policies implemented to protect female workers against the impact of globalization on the garment industry and the institutional setting in which this labour market is immersed in Winnipeg. This research paper begins with a brief summary of the institutional theory appro­ach that sheds light on the analysis of the effects of institutions on the policy options to protect female workers of the Winnipeg garment industry. Next, this paper identi­fies the set of beliefs, formal procedures, routines, norms and conventions that cha­racterize the institutional environment of the female workers of Winnipeg’s garment industry. Subsequently, this paper descri­bes the impact of free trade policies on the garment industry of Winnipeg. Afterward, this paper presents an analysis of the ba­rriers that the institutional features of the garment sector in Winnipeg can set to the successful achievement of policy options addressed to protect the female workforce of this sector. Three policy options are considered: ethical purchasing; training/retraining programs and social engage­ment support for garment workers; and protection of migrated workers through promoting and facilitating bonds between Canada’s trade unions and trade unions of the labour sending countries. Finally, this paper concludes that the formation of isolated cultural groups inside of factories; the belief that there is gender and race discrimination on the part of the garment industry management against workers; the powerless social conditions of immi­grant women; the economic rationality of garment factories’ managers; and the lack of political will on the part of Canada and the labour sending countries to set effective bilateral agreements to protect migrate wor­kers, are the principal barriers that divide the actors involved in the garment industry in Winnipeg. This division among the prin­cipal actors of Winnipeg’s garment industry impedes the change toward more efficient institutions and, hence, the successful achievement of policy options addressed to protect women workers. 

Labor's shares - aggregate and industry: accounting for both in a model of unbalanced growth with induced innovation

The relative stability of aggregate labor's share constitutes one of the great macroeconomic ratios. However, relative stability at the aggregate level masks the unbalanced nature of industry labor's shares – the Kuznets stylized facts underlie those of Kaldor. We present a two-sector – one labor-only and the other using both capital and labor – model of unbalanced economic development with induced innovation that can rationalize these phenomena as well as several other empirical regularities of actual economies. Specifically, the model features (i) one sector ("goods" production) becoming increasingly capital-intensive over time; (ii) an increasing relative price and share in total output of the labor-only sector ("services"); and (iii) diverging sectoral labor's shares despite (iii) an aggregate labor's share that converges from above to a value between 0 and unity. Furthermore, the model (iv) supports either a neoclassical steadystate or long-run endogenous growth, giving it the potential to account for a wide range of real world development experiences.

Productivity growth in electric energy retail in Colombia. A bootstrapped malmquist indices approach

This paper offers a productivity growth estimate for electric energy commercialization firms in Colombia, using a non-parametric Malmquist bootstrap methodology. The estimation and methodology serve two main purposes. First, in Colombia Commercialization firms are subject to a price-cap regulation scheme, a non-common arrangement in the international experience for this part of the industry. Therefore the paper’s result suggest an estimate of the productivity factor to be used by the regulator, not only in Colombia but in other countries where commercialization is a growing part of the industry (renewable energy, for instance). Second, because of poor data collection from regulators and firms themselves, regulation based on a single estimation of productivity seems inappropriate and error-prone. The nonparametric Malmquist bootstrap estimation allows an assessment of the result in contrast to a single one estimation. This would open an opportunity for the regulator to adopt a narrower and more accurate productivity estimation or override an implausible result and impose a productivity factor in the price-cap to foster the development of the industry.

Chronic pesticide poisoning from persistent low-dose exposures in Ecuadorean floriculture workers: toward validating a low-cost test battery

Chronic pesticide poisoning is difficult to detect. We sought to develop a low-cost test battery for settings such as Ecuador’s floriculture industry. First we had to develop a case definition; as with all occupational diseases a case had to have both sufficient effective dose and associated health effects. For the former, using canonical discriminant analysis, we found that adding measures of protection and overall environmental stressors to occupational category and duration of exposure was useful. For the latter, factor analysis suggested three distinct manifestations of pesticide poisoning. We then determined sensitivity and specificity of various combinations of symptoms and simple neurotoxicity tests from the Pentox questionnaire, and found that doing so increased sensitivity and specificity compared to use of acethylcholinesterase alone – the current screening standard. While sensitivity and specificity varied with different case definitions, our results support the development of a low-cost test battery for screening in such settings.

Undulation instability in block-copolymer lamellae subjected to a perpendicular electric field

We examine the stability of lamellar stacks in the presence of an electric field, E-0, applied normal to the lamellae. Calculations are performed with self-consistent field theory (SCFT) supplemented by an exact treatment of the electrostatic energy for linear dielectric materials. The calculations identify a critical electric field, E-0*, beyond which the lamellar stack becomes unstable with respect to undulations. This E-0* rapidly decreases towards zero as the number of lamellae in the stack diverges. Our quantitative predictions for E-0* are consistent with previous experimental measurements by Xu and co-workers.

Women, other "fresh” workers, and the new manufacturing workforce of interwar Britain

Structural, organizational, and technological changes in British industry during the interwar years led to a decline in skilled and physically demanding work, while there was a dramatic expansion in unskilled and semiskilled employment. Previous authors have noted that the new un/semiskilled jobs were generally filled by “fresh” workers recruited from outside the core manufacturing workforce, though there is considerable disagreement regarding the composition of this new workforce. This paper examines labour recruitment patterns and strategies using national data and case studies of eight rapidly expanding industrial centres. The new industrial workforce is shown to have been recruited from a “reserve army” of workers with the common features of relative cheapness, flexibility, and weak unionization. These included women, juveniles, local workers in poorly paid nonindustrial sectors, such as agriculture, and (where these other categories were in short supply) relatively young long-distance internal migrants from declining industrial areas.

‘In the air’ and below the horizon: migrant workers in UK construction and the practice-based nature of learning and communicating OHS

Local, tacit and normally unspoken OHS (occupational health and safety) knowledge and practices can too easily be excluded from or remain below the industry horizon of notice, meaning that they remain unaccounted for in formal OHS policy and practice. In this article we stress the need to more systematically and routinely tap into these otherwise ‘hidden’ communication channels, which are central to how everyday safe working practices are achieved. To demonstrate this approach this paper will draw on our ethnographic research with a gang of migrant curtain wall installers on a large office development project in the north of England. In doing so we reflect on the practice-based nature of learning and sharing OHS knowledge through examples of how workers’ own patterns of successful communication help avoid health and safety problems. These understandings, we argue, can be advanced as a basis for the development of improved OHS measures, and of organizational knowing and learning.

Building networks to work: an ethnographic study of informal routes into the UK construction industry and pathways for migrant up-skilling

The UK construction industry labour market is characterised by high levels of self-employment, sub-contracting, informality and flexibility. A corollary of this, and a sign of the increasing globalisation of construction, has been an increasing reliance on migrant labour, particularly that from the Eastern European Accession states. Yet, little is known about how their experiences within and outside of work shape their work in the construction sector. In this context better qualitative understandings of the social and communication networks through which migrant workers gain employment, create routes through the sector and develop their role/career are needed. We draw on two examples from a short-term ethnographic study of migrant construction worker employment experiences and practices in the town of Crewe in Cheshire, UK, to demonstrate how informal networks intersect with formal elements of the sector to facilitate both recruitment and up-skilling. Such research knowledge, we argue, offers new evidence of the importance of attending to migrant worker’s own experiences in the development of more transparent recruitment processes.

Implementation of Video Monitoring In Aluminium Industry

The aim was to evaluate results and experiences from development of new technology, a training program and implementation of strategies for the use of a video exposure monitoring method, PIMEX. Starting point of this study is an increased incidence of asthma among workers in the aluminium industry. Exposure peaks of fumes are supposed to play an important role. PIMEX makes it possible to link used work practice, use of control technology, and so forth to peaks. Nine companies participated in the project, which was divided into three parts, development of PIMEX technology, production of training material, and training in use of equipment and related strategies. The use of the video exposure monitoring method PIMEX offers prerequisites supporting workers participation in safety activities. The experiences from the project reveal the importance of good timing of primary training, technology development, technical support, and follow up training. In spite of a delay of delivery of the new technology, representatives from the participating companies declared that the experiences showed that PIMEX gave an important contribution for effective control of hazards in the companies. Eight out of nine smelters used the PIMEX method as a part of a strategy for control of workers exposure to fumes in potrooms. Possibilities to conduct effective control measures were identified. This article describes experiences from implementation of a, for this branch, new method supporting workers participation for workplace improvements.

Aligning sustainability and corporate strategies: the case of hybrid-electric vehicles and Fiat-Chrysler Automobiles

Este estudo analisa a integração da sustentabilidade ambiental na estratégia das empresas no contexto da indústria automobilística. A implementação de estratégias de sustentabilidade e o desenvolvimento de veículos híbrido-elétricos são investigados com referência ao caso de um ator principal na indústria. Entre as aplicações de mobilidade eléctrica, que irá aumentar a presença no mercado nos próximos anos devido às regulamentações rigorosas e as preferências dos clientes, a pesquisa está focada em veículos híbrido-elétricos. As estratégias de sustentabilidade das grandes fabricantes de automóveis e as implicações subsequentes em termos de desenvolvimento de produtos, com uma atenção especial aos veículos elétricos híbridos, foram analisados através de dados secundários. Além disso, os dados primários foram coletados sobre a estratégia de sustentabilidade de um ator importante na indústria e usados para realizar um estudo de caso. A análise incidiu sobre os fatores críticos e os aspectos que têm impacto sobre as estratégias de sustentabilidade, que visam reduzir o impacto ambiental da indústria automobilística, e sobre o desenvolvimento de veículos híbridos. A análise dos dados mostrou que a Fiat-Chrysler Automobiles (FCA) teve uma ênfase menor na mobilidade eléctrica em termos de relatórios de sustentabilidade. A conclusão apresenta uma avaliação da estratégia corporativa da FCA, em termos de sustentabilidade ambiental, e apresenta um quadro para o desenvolvimento de veículos híbridos com quatro abordagens diferentes que têm impacto sobre a estratégia de sustentabilidade de uma montadora.

Environmental regulation, technology adoption and structural transformation: evidence from Brazilian sugarcane industry

We estimate the effects of the adoption of mechanized agriculture led by a new environmental regulation on structural change of local labor markets within a large emerging country, Brazil. In 2002, the state of S\~{a}o Paulo passed a law outlying the timeline to end sugarcane pre-harvest burning in the state. The environmental law led to the fast adoption of mechanized harvest. We investigate if the labor intensity of sugarcane production decreases; and, if so, if it leads to structural changes in the labor market. We use satellite data containing the type of sugarcane harvesting -- manual or mechanic harvest -- paired with official labor market data.%, also geomorphometric data base for our instrumental variable correction. We find suggestive evidence that mechanization of the field led to an increase in utilization of formal workers and a reduction in formal labor intensity in the sugarcane sector. This is partially compensated by an increase in the share of workers in other agricultural crops and in the construction and services sector. Although we find a reduction in employment in the manufacturing sector, the demand generated by the new agro-industries affected positively the all sectors via an increase in workers' wage.

Sleep complaints and polysomnographic findings: A study of nuclear power plant shift workers

The literature widely recognizes that shift workers have more health complaints than the general population. The objective of this study was to describe the prevalence of sleep complaints and verify the polysomnographic (PSG) variables of shift workers in two Brazilian nuclear power plants. We carried out a subjective evaluation with a sleep questionnaire. Based on these results, the interviewees that reported sleep-related complaints were referred for polysomnographic evaluation. of the 327 volunteers initially evaluated by the sleep questionnaire, 113 (35%) reported sleep complaints; they were significantly older, had higher body mass index (BMI), and worked more years on shifts than those without sleep complaints. of these 113, 90 met criteria for various sleep disorders: 30 (9%) showed obstructive sleep apnea (OSA), 18 (5.5%) showed limb movement, and 42 (13%) evidenced both sleep problems and had a significantly higher proportion of sleep stage 1 and arousals compared with the 23 shift workers that had no indices of sleep problems. The present study found that 90 (27.5%) of the evaluated participants met the PSG criteria of some type of clinical sleep disorder. This high proportion should be investigated for associations with other aspects of work, such as working hours, working schedule, years performing shift work, and access to health services. Due to the strong association between sleep disorders and the incidence of fatigue and sleepiness, the evaluation of the sleep patterns and complaints of shift workers is essential and should be considered to be one of the basic strategies of industry to prevent accidents.

Ultramorphology and histology of the venom gland of workers of Apis mellifera (Hymenoptera, Apidae) before and after an electrical shock treatment

This paper describes the ultramorphology and histology of the venom reservoir in 14-day old workers of Apis mellifera, immediately before and after the application of electrical shocks with the object of causing venom elimination and reservoir collapse. The external epithelial surface of the reservoir was differentiated according to its morphological aspects into posterior, median, and proximal or duct regions at the ventral surface and into anterior and posterior regions at the dorsal surface. While the epithelium of the proximal region forms a ventral infolding, a dorsal salience is formed at this region. These structures and the epithelial regions persist both in full and empty reservoirs. The reservoir appeared full and distended before the electrical shocks were applied and became empty and withered afterwards due to the elimination of the secretion, without any reductions in length. Nevertheless, some secretion was kept inside the lumen, thus suggesting a possible role for the reservoir in the modification of the secretion.

Recurrent neural network for induction motor speed estimation in industry applications

Many electronic drivers for the induction motor control are based on sensorless technologies. The proposal of this work Is to present an alternative approach of speed estimation, from transient to steady state, using artificial neural networks. The inputs of the network are the RMS voltage, current and speed estimated of the induction motor feedback to the input with a delay of n samples. Simulation results are also presented to validate the proposed approach. © 2006 IEEE.