Universal Worker Reorganization of Work

Universal Worker

Reorganization of Work Strategies

Medical work places are often among the most hidebound when it comes to organizing their workplace strategies and habits along new lines. But such a reorganization is often vital to provide the best possible care to patients. While improvement in medical care is often conceived of in terms of advances in medication or medical techniques, there can also be significant improvements brought about in terms of medical care that arise not via medicine itself but as a result of a better organization of the culture of the institution that is providing the care.

In the scenario that we are presented with here, there is a proposal to institute a "universal worker." This is a relatively new concept within the arena of healthcare but not entirely without precedent. It is also a relatively radical rethinking of the way in which medicine is practiced and delivered. More than most workplaces, medical workplaces are highly departmentalized, with workers in each job category often highly dedicated to defending their turf. The following accurately describes the ways in which most healthcare work places function:

Traditionally, the tasks carried out in the nursing home and indeed in every other health care setting - have been highly compartmentalized: nurses do the nursing, food service workers prepare the meals, laundry personnel do the laundry, and so on. Staff tends to be task-oriented and the focus is on getting the job done.(Widdes, 1996)

One of the most important points made above is that the justification for the clear-cut complex division of labor is that each job is defined by its function.

This might seem to be obvious: How else should a job be defined? Especially within the field of medicine, where it is the result that matters, function would seem to be paramount. This is certainly one legitimate way of defining a job. But Senge, among others, provides a framework that suggests an entirely different way of defining a job, one that supports the concept of a universal healthcare worker.

In a learning organization, leaders are designers, stewards and teachers. They are responsible for building organizations where people continually expand their capabilities to understand complexity, clarify vision, and improve shared mental models -- that is they are responsible for learning & #8230;.Taking this stand in the first leadership act, the start of inspiring (literally 'to breathe life into') the vision of the learning organization (p. 12)

In a healthcare setting with leadership determined to allow all workers to expand their responsibilities so that their jobs are commensurate with their skills and training, the universal worker can be a major contributor to a more efficient workplace.

Ripple effects of the introduction of a universal worker model

It is important to note that in adding universal workers to the hypothetical medical workplace in which we find ourselves, all of the other positions will shift slightly too. This is an essential truth of any system in which humans with different self-interests interact with each other on a regular basis. Not all medical professionals (of course) will increase their functions greatly. Surgeons, for example, are likely to continue performing surgery and only performing surgery. Given their value in purely economic terms, it does not make much sense for them to do anything but what they are trained for. It is also true that surgeons are generally relatively already fulfilled by their jobs.

However, other medical professionals are likely to have their job duties shift. Registered nurses, for example, are likely to be able to focus their time on providing healthcare that requires a high level of education and discretion rather than on more routine tests. The same is probably true of physicians' assistants and other classes of nurses. They may also change their orientation may also change to a more holistic one as the culture of this healthcare institution shifts away from a purely functional orientation to an orientation that focuses on the whole care of a patient.

Individuals performed low-level jobs (that is, jobs with low prestige, low salaries, and a narrow range of required skills and duties), on the other hand, are generally not satisfied with their jobs and would welcome an increased range of responsibilities. Thus the concept of an universal healthcare worker is especially relevant in a medical context in which a very high degree of the care is provided by personnel who are neither doctors or nurses. Such a locale that is ideal for the insertion of a universal healthcare worker is a long-term care facility.

Increasing the job satisfaction of workers in long-term care facilities is especially important because such facilities experience very high turnover rates. This is expensive for the institution, stressful on the workers, and traumatic for the patients.

While some assisted living facilities still operate within this model the industry as a whole is moving toward a more "holistic" approach to care in which the "universal worker" attends to all the daily living needs of their residents: assistance with ADLs, meal service, light housekeeping, laundry, programming, etc. Rather than dealing with four or five different people to have their needs met, residents are able to relate to one or two staff members who actually know them and are familiar with their needs, their routines, their likes and dislikes. The result is care that is more personal, customized and consistent.

The "universal worker" approach also seems to enhance job satisfaction. In Manor HealthCare's Arden Courts: Alzheimer's Assisted Living facilities, we've had feedback from staff who tell us that they enjoy the feeling of being responsible for the resident "as a whole" rather than for only one aspect of their care. It is a feeling that undoubtedly enhances the caregiver's sense of "job importance." Whether this greater job satisfaction leads to reduced turnover remains to be seen. (Widdes, 1996)

The above paints a very rosy set of consequences for the introduction of the universal worker into healthcare settings. However, there are also serious criticisms of this movement, which tends to question the motivation of healthcare organizations toward this shift.