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The Keckley Report

It’s Always Labor Day in a Hospital

By September 8, 2015March 1st, 2023No Comments

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

I remember it like it was yesterday. I was 16 and it was my first day as a scrub technician at the Baroness Erlanger Hospital in Chattanooga in June, 1966. I arrived clueless about the role but full of youthful energy as I embarked on what has become a career in healthcare.

I learned a lot about hospitals and doctors that summer. I learned that everyone in the hospital was expected to do whatever it took to make the doctors happy. I learned scrubbing protoscopes isn’t fun and setting up Stryker frames tedious. I learned to eat fast in the employee cafeteria where I paid for my meals while the doctors ate free in their dining room. I learned patients can be testy and nurses can be tough. I learned to avoid the parking crunch for the 7 am morning shift by getting to the remote parking lot at 6:40 am sharp. And I learned about people…

‘Willis’ ran central sterile supply in the basement of the hospital where I worked—a strong, bigger-than-life black lady known to everyone in the hospital. She made sure clean “stuff” got to the floors on time. Willis’ sidekick was Annie—a slender black lady with an infectious smile who wore tennis shoes because the role was about “being fast.”  And John– he dropped out of high school and had been a runner for Willis for 10 years at the time. He’d often slip away to smoke a cigarette and had big dreams. Erlanger paid well, he said, but he had his sights set on bigger things. One day, he said he needed a loan to pay his rent; I gave him $100 and never saw him again. And Dr. Cunningham—Erlanger’s version of Marcus Welby…always measured, professional, with warm eyes that affirmed a person’s personhood, and those bowties!

Over the course of the next 5 years, my summers and Christmas breaks in high school and college would be filled at Erlanger. I worked in the operating room as a surgical assistant to make sure prep trays were in order pre-surgery and in the emergency room where event after event sensitized me to the frailty of life suddenly taken. It was Erlanger that taught me about the unique role hospitals play in a community, and the incredible mix of people who make hospitals their work home.

Today’s it’s called Erlanger Medical Center. Gone are the color tiles used to direct patients to the lab or pharmacy. Gone is the old patient tower, replaced and upgraded by new bricks and sticks. And central sterile supply is still downstairs but bigger now and called Central Sterile simply.

This week, the Bureau of Labor released its August jobs report showing unemployment at a seven-year low of 5.1% based on 173,000 jobs added last month. Healthcare jobs were responsible for one third of the growth, but declines in mining and manufacturing continued. Hospitals alone added 15,900 bringing year-to-date net employment gains to 100,000. So the news was mixed: “Never before has the nation’s unemployment rate plunged so low — a point when companies should be competing aggressively for workers — while wages have stayed so flat,” the Washington Post columnists wrote. In response, the stock market closed down 1.7% noting the job growth was below the 212,000 considered necessary and the average hourly wage rose 8 cents/hour to $25.09, well behind inflation and corporate earnings were the lowest since the 2007 financial crisis.

The people side of hospitals is unique in our society: the 4.9 million who work in our 5,723 hospitals are skilled and semi-skilled and come from all religious and ethnic backgrounds. With demand for hospital services increasing as a result of older and sicker patients, and insurance coverage expansion via the Affordable Care Act, the hospital workforce is being stretched to keep pace. Caregiver shortages are well documented: most studies estimate we need 125,000 additional physicians and 500,000 nurses by 2025. Hospital closures continue as margins disappear, and with them jobs. But that’s only a start.

Hospitals need digital health specialists who understand social media and assist in building connectivity between care teams, individual patients and their closest confidants. We need informaticians to help structure and apply vast amounts of clinical, operational and financial data into elegant dashboards that send real-time alerts and reminders to coordinated care teams – aka ‘synchronous flow of information.’ We need physicians equipped to lead complex organizations that extend beyond bricks and sticks and health coaches to activate patients as shared decision-makers with their care teams. We need young and able to work in Central Sterile and volunteers to help visitors navigate our hallways and websites. And we need leaders who are undaunted by the challenge of transforming hospitals into systems of health.

The hospital workforce—caregivers and those that support them– is accustomed to working odd hours, holidays and weekends. Some treat patients directly; most do the work so they can. And granted, we’re paid well. At $29.30 plus generous benefits that add 34% to their costs, our hourly workers fare better than most. And nurse and physician median household income are well above average U.S. household wages. But it’s hard work and getting harder.

Chances are most hospital workers missed the news last week that CMS is experimenting with a new “Value Based Insurance Design” program in its Medicare Advantage program in 7 states and the American Association for Physician Leadership survey results showing 90% of physician leaders want a better understanding of healthcare finance. They missed the news because they were working.

Willis, Annie and Dr. C taught me hospitals are special places. The people who work there aren’t headcount or overhead. They’re doing work that’s meaningful and purposeful together. They are emotionally attached to “their” hospital where their family and friends celebrate the beginning of life and often mourn its end.

I go back to Erlanger about once a year. It’s changed a lot. But in one respect, it hasn’t. It’s still about people. That’s what makes hospitals special places and why it’s always Labor Day in a hospital.


SourcesChico Harlan and Ylan Q. Mui “Unemployment rate falls to 5.1 percent, but Americans are not finding pay increases,” Washington Post, September 4, 2015; U.S. Department of Labor Bureau of Labor StatisticsAmerican Hospital AssociationCMS Value-based Insurance Design ProgramAmerican Association for Physician LeadershipPeter I. Buerhaus, PhD, et al. The Future of the Nursing Workforce in the United States: Data, Trends and Implications, 2009; Michael J. Dill and Edward S. Salsberg, “The Complexities of Physician Supply and Demand: Projections Through 2025,” Association of American Medical Colleges, November 28, 2008

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

©2015 Navigant Consulting, Inc.