Workplace Rules in the House of Medicine: A Difficult Choice When Health Is at StakeFebruary 02, 2010
More on the Shriver Report: A Woman’s Nation (www.awomansnation.com)
The focus of the chapter “Family Friendly for All Families” dispels an important myth: that having the same rules that men have is enough to successfully bring women into the workplace. Women have different needs, different schedules, and different priorities than men do, so “what is good for the goose” is not necessarily “good for the gander” when it comes to family-friendly workplace policies. The problem then lies in how we can change workplace policies to better support women and men without creating untenable situations for employers and the various other stakeholders.
While I believe in most instances that workplace policies can be changed to better support women and their families, similar changes in the rigid American health care system workplace are inherently more difficult. Why? Because it is the nature of the health care business: Illness cannot be postponed or cancelled, so building flexibility into this system is an enormous challenge.
Delivery of health care services depends on precise timing, as well as on the presence of highly skilled workers at all levels of the system. When a health care provider — a physician, nurse, anesthesiologist, nurse practitioner, lab technician, physical therapist, paramedic, etc. — is absent from her or his work, it may not be as easy as in other professions to find a comparable substitute in a timely fashion. When a specific physician or nurse is absent, the burden left to the other workers may create a dangerous situation in which errors are more likely and patients’ welfare is compromised — perhaps even jeopardizing a patient’s life. Float pools of health care providers are expensive and do not necessarily provide adequate continuity of care or the level of skills necessary for acceptable results. And the absence of a specific surgeon, anesthesiologist, or nurse may mean that a scheduled surgery or other procedure must be cancelled or postponed. In such cases, who loses? The patients, of course.
The demand for health care is predictably unpredictable. And it is cost prohibitive for an employer to maintain a workforce large enough to satisfy all absentee possibilities. So when faced with adjusting day-to-day staffing, the employer — often a hospital, surgery center, clinic, or physician’s office — may be crippled when even one employee has an unplanned personal need. Again, who suffers? Employers and co-workers, of course, but most of all, the patients.
My personal experience may help to elucidate this conundrum: Sometimes I can’t predict the time it will take me to do an operation, and the day may run late. As a shift ends, not every child who is scheduled has had surgery. The pediatric hospital to which I bring many of my young patients has eliminated mandatory overtime for the nursing staff, and sometimes no one will agree to stay. The result may be that we have to delay surgery on a child who has not eaten all day and who is cranky and scared. As the hours pass and the parents of our young patients get anxious and angry, the hospital staff needs to decide whether to cancel the surgery altogether or wait until someone from the evening shift becomes available. Is this good business? Clearly not. And more importantly, it is certainly not good medicine.
Is it possible to improve health care workplaces so that they are more family friendly for their workers? Of course. But health care delivery to patients — along with too-high health care costs, safety and efficacy, efficiency, and patient satisfaction — should be a top priority when addressing the workplace needs of health care providers who are also caregivers at home. And whom do we ask providers to abandon — their families or their patients?
In the health care workplace, where women make up 75 percent of the skilled workforce that includes physicians, nurses, pharmacists, therapists, among others, there is potential for both flexibility and fairness for workers that can lead to the ideal of “family friendly for all families” without breaking the already beleaguered health care system. Stay tuned.
This post was written by Linda Brodsky, pediatric otolaryngologist and advocate for gender and pay equity. Her blogs can also be read at The Brodsky Blog.