From the March-April 2016 issue of News & Letters
by Htun Lin
Under the Affordable Care Act, it’s standard HMO practice to offer patients the opportunity to fill out an advance directive as an exercise in considering one’s quality of life, not just its prolongation. Frontline healthcare providers have a concrete reason for quality-of-life care concerns. But in the HMO business campaigns promoting quality of life over quantity, things are not really what they appear.
Some questions are quite blunt: “While you’re under our care, if your heart stops working, do you want us to resuscitate you? Do you want us to take any extraordinary measures?” At times the patient gives a puzzled look and responds with, “I sure hope so” or “Isn’t that what I’m here for?”
QUOTA ON LIVES
It all depends on whose definition of “extraordinary measures.” This debate goes on among healthcare workers during a medical emergency. What to a worker is ordinary concrete care might be deemed “extraordinary” by management. When frontline care providers take the time necessary to provide quality care, often they run counter to management’s quota of labor time allotted for those tasks. No wiggle room is given to accommodate variations in patient care needs.
Contrary to corporate slogans in their marketing campaigns about quality care, today’s HMO is about controlling quantity of care, by means of big data, to maintain the bottom line.
In the first chapter of Capital, Marx described capital as a phenomenon with appearance vs. essence, by beginning with the commodity form. This has meaning for me as a worker, because our daily experience on the shop floor is full of this contradiction between the professed goal of quality vs. the real game of measuring its quantity, especially labor time.
That is essentially the conflict exemplified recently by a brave nurse in Oregon. Linda Boly was fired after she complained to management that cost-cutting measures were jeopardizing patient care. Hospital management accused this conscientious nurse, a 30-year veteran, of violating work rules by working off the clock, not meeting her daily quota of patients and not being able to care for several patients at the same time while feeding the computer.
COURT VICTORY FOR ONE WORKER
The whole controversy revolves around how much time a nurse like Boly is spending on each patient. Boly was written up three times for failing to meet productivity quotas and for working off the clock to complete chart work at the end of the day. During a disciplinary hearing Boly had been told, “We all slow down as we age,” as though her spending “too much time with patients” were her issue and not the hospital’s design.
Boly testified before the Oregon Legislature twice —using real-life examples from her job to speak the truth publicly about how Legacy Good Samaritan Medical Center endangered patients by rushing nurses —and that riled management. Boly fought for passage of Oregon’s Nurse Staffing Law, which would give nurses more power to actually provide patient care.
Veteran nurses will tell you the subtext of not meeting quotas is, “You’re spending too much time with each patient and we want to replace you with a new crop of workers.” We workers know that management design of the work flow sets us up for failure. When something goes wrong, they scapegoat the worker.
WORKING AGAINST RULES
A lot of dedicated providers continue caring and/or charting after they’ve already clocked out. This is common practice for all care providers pressed for time. But we have seen even doctors at Kaiser suspended for having a backlog of “incomplete charts.”
Administrators can, if they don’t like you, do a “gotcha” and exclaim, “You’ve violated state labor laws.” It’s an offense to work off the clock. You take the blame, even though they set up the game.
The jury saw through the transparent hypocrisy of management at Legacy Medical Center, and Nurse Boly won her case with back pay. But it’s not about winning in court. The battle over labor time is not just an individual battle. The labor laws which were put on the books by the collective effort of workers were not violated by workers but by management.
Only by acting as a collectivity can we workers overcome this separation between appearance and essence under capitalism, where there is a contradiction between quality vs. quantity of life and health.