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Cleaning Up
To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. InCleaning Up, the first book to examine this transformation in the healthcare industry, Dan Zuberi looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. Drawing on years of field research in Vancouver, Canada as well as data from hospitals in the U.S. and Europe, he argues that outsourcing has been disastrous for the cleanliness of hospitals-leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death-as well as for the effective delivery of other hospital services and the workers themselves.
Zuberi's interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. Zuberi also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. He makes the case that hospital outsourcing exemplifies the trend towards \"low-road\" service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.
eBook
Behind closed doors: unlocking hospital variations in the use of seclusion and mechanical restraint - a nationwide multilevel analysis in adult mental healthcare in France
Monitoring and reducing restrictive practices in mental healthcare, including seclusion and restraint, is a global policy priority due to ethical concerns. However, research on these practices remains limited. This study aims to estimate the use of seclusion and mechanical restraint (MR) in mental healthcare at the national level in France, the variation in the use of these practices across hospitals, and associated factors considering a wide range of variables. We used the French nationwide system for the routine collection of psychiatric hospital claims data, which includes a specific register on seclusion and MR, covering all hospitals providing involuntary psychiatric care for adults in France. Data from 204 hospitals were analyzed for the year 2022. Additional information on patient, hospital, and contextual characteristics was obtained by linking data from other national sources, including somatic hospital and community care claims, annual hospital surveys and census data. Using these combined datasets, we conducted multilevel logistic regressions to identify factors significantly associated with variations in the use of restrictive practices. In 2022, among 98,271 involuntary psychiatric inpatient admissions across 204 hospitals, seclusion was used in 31,679 admissions (32%) and MR in 8,551 admissions (9%). Large variations in the use of restrictive practices were observed across hospitals, with some reporting no use of MR. Multilevel models showed that patient characteristics, including primary diagnosis and prisoner status, were among the strongest predictors of seclusion and MR use. Admissions to public hospitals with teaching activities or multidisciplinary services were associated with lower odds of seclusion, while a higher nurse-to-patient ratio and proportion of involuntary admissions were associated with lower odds of MR use. No contextual factors related to hospitals' catchment areas were significantly associated with the use of restrictive practices. Significant variations were found in the use of seclusion and MR across hospitals in France, which cannot be explained solely by patient needs. While patient characteristics were strong predictors, several hospital-level factors were also associated with these practices. These findings highlight the need for closer monitoring and targeted interventions to reduce unwarranted variations and raise concerns about equity and ethics in mental healthcare.
Journal Article
Conflicted health care : professionalism and caring in an urban hospital
\"This book takes an intimate look at how health care practitioners struggle to live up to their professional and caring ideals on twelve-hour shifts on the hospital floor\"--Provided by publisher.
Book
Selling our souls
Health care costs make up nearly a fifth of U.S. gross domestic product, but health care is a peculiar thing to buy and sell. Both a scarce resource and a basic need, it involves physical and emotional vulnerability and at the same time it operates as big business. Patients have little choice but to trust those who provide them care, but even those providers confront a great deal of medical uncertainty about the services they offer.Selling Our Soulslooks at the contradictions inherent in one particular health care market-hospital care. Based on extensive interviews and observations across the three hospitals of one California city, the book explores the tensions embedded in the market for hospital care, how different hospitals manage these tensions, the historical trajectories driving disparities in contemporary hospital practice, and the perils and possibilities of various models of care.
As Adam Reich shows, the book's three featured hospitals could not be more different in background or contemporary practice. PubliCare was founded in the late nineteenth century as an almshouse in order to address the needs of the destitute. HolyCare was founded by an order of nuns in the mid-twentieth century, offering spiritual comfort to the paying patient. And GroupCare was founded in the late twentieth century to rationalize and economize care for middle-class patients and their employers. Reich explains how these legacies play out today in terms of the hospitals' different responses to similar market pressures, and the varieties of care that result.
Selling Our Soulsis an in-depth investigation into how hospital organizations and the people who work in them make sense of and respond to the modern health care market.
eBook