Article title: Superbugs versus outsourced cleaners: Employment Arrangements and the Spread of Health Care–Associated Infections
From ILR Review
On any given day, one in every 25 patients in U.S. hospitals has a health care–associated or hospital-acquired infection (HAI)—one of a handful of so-called superbugs that contribute to the deaths of 75,000 of these patients. Not surprisingly, health care practitioners and scholars have turned their attention to clinical and delivery-of-care factors that might account for HAIs. This article provides novel, quantitative, empirical evidence linking a specific type of employment arrangement—outsourcing—to patient safety. It shows that in addition to the more widely examined clinical culprits, the HAI challenges plaguing the U.S. health care system are also a function of the strategic employment choices that organizations make in relating to their nonclinical staff. The findings have important implications for health care scholars, practitioners, and policymakers.
On any given day, about one in 25 hospital patients in the United States has a health care–associated infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately, the spread of most HAIs can be halted through proper disinfection of surfaces and equipment. Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the important task of defending hospital patients (as well as staff and the broader community) from the spread of HAIs. Despite the importance of this task, hospitals frequently outsource this function, increasing the likelihood that these workers are under-rewarded, undertrained, and detached from the organization and the rest of the care team. As a result, the outsourcing of EVS workers could have the unintended consequence of increasing the incidence of HAIs. The authors demonstrate this relationship empirically, finding support for their theory by using a self-constructed data set that marries infection data to structural, organizational, and workforce features of California’s general acute care hospitals. The study thus advances the literature on nonstandard work arrangements—outsourcing in particular—while sounding a cautionary note to hospital administrators and health care policymakers.
Superbugs versus outsourced cleaners: Employment Arrangements and the Spread of Health Care–Associated Infections
Adam Seth Litwin, Ariel c. avgar, and Edmund E. Becker