UC Berkeley/Working Partnerships USA Report Looks at Technology and Job Quality in Healthcare

June 23, 2020
How will the implementation of newer technologies, including digital communications/telepresence, semi-autonomous service robots, and AI, impact the quality of work life in healthcare? A new report examines the issues

A new report from the University of California at Berkeley Labor Center and Working Partnerships USA released on June 23 examines issues around how likely technology is to impact job quality in healthcare, and suggests that technological adoption may accelerate as a result of the COVID-19 pandemic.

The report, titled “Technological Change in Health Care Delivery: Its Drivers and Consequences for Work and Workers,” also finds that the pandemic could provide a wind of opportunity to shift the dominant strategy for technological adoption in health care toward a “work centered” approach. The current approach is likely to lead to increased surveillance, micro-managing, and worker deskilling, as technologies are used to cut costs. A work-centered approach would instead allow workers to have a say in how new technologies are introduced, to receive training to develop new skills, and ensure their job quality isn’t diminished.

"Technological change in health care is accelerating, putting more strain on workers as providers seek to cut costs and increase efficiency," said Adam Seth Litwin, the report’s author and an associate professor of industrial and labor relations at Cornell University, in a press release announcing the publication of the report. "If business continues as normal, we could see workers stripped of rewarding tasks, alienating them from their work and suppressing job quality. But that path isn't inevitable. If workers are brought into the fold, technological changes can increase the quality of care workers are able to provide, while driving improvements in their pay and job quality."

Healthcare is one of the largest sectors in the country, with annual health care spending equal to $3.5 trillion in 2017, or 17.9 percent of GDP. It’s also the fastest growing sector for jobs, with 13 percent of all private sector workers and 16 percent of the union workforce. Women and people of color are over-represented in many healthcare occupations.

“We know that our need for health care workers is growing in the U.S., and the COVID-19 pandemic has underscored just how essential these workers are,” said Annette Bernhardt, director of the Low-Wage Work Program at the U.C. Berkeley Labor Center. “This report shows that the biggest threat that technology poses to health care workers in the near future is not job loss due to automation, but instead job quality loss in the form of reduced wages, and increased micromanaging through surveillance.”

The report identifies three technologies that are likely to see wider-scale adoption in the near future: digital communication, autonomous service robots, and machine learning. Technologies like telehealth, increasingly popular before the pandemic, are facing increased experimentation and will likely be rolled out widely in the coming years. Electronic visit verification threatens micro-surveillance for home healthcare aides. Laundry robots may leave orderlies with fewer, more mundane tasks.

The report suggests, however, that the specific technologies that are adopted and the ways in which they are implemented are not predetermined.

“This report makes clear that policymakers and health care leaders have a choice: they can start by asking ‘what can technology do?’ and relegate humans to filling in the gaps, or they can start by asking ‘what are people good at?’ and use technology to support those people,” said Derecka Mehrens, executive director of Working Partnerships USA. “COVID-19 is showing how brave and dedicated healthcare workers are — we want them providing the care and human connection you’ll never get from a robot.”

In the report, Litwin wrote that “Our research identified three types of emerging technologies most aligned to the health care sector’s guiding objectives:

Digital communications and telepresence. In simplest terms, this category includes any smartphone or internet-connected computer. However, digital communications technologies have a broad range of applications, including in the home care setting and in the virtual provision of patient care, e.g., telehealth, telemedicine, and telehospitals. Digital technologies have aided the transition from paper-based to electronic health records and allowed for richer, more data-dependent ways of leveraging interconnected health records.

Semi-autonomous service robots. While humanoid, caregiving machines largely remain the province of fiction, a simpler form of service robot already traverses hospital hallways. These robots accept external commands from users and can maneuver and operate on their own by taking in, processing, and reacting to information absorbed through sensors. They can pick up soiled sheets and dirty dishes, and they can deliver meals and medications, among many other tasks.

Artificial intelligence. The use of artificial intelligence (AI) in health care has only just begun. AI differs from other technologies in its ability to “teach” itself: rather than following predetermined, detailed directions provided by programmers, one particular form of AI—machine learning—allows technology to develop its own rules and responses once “trained” by existing data. AI can essentially supercharge existing digital technologies, including those allowing for virtual care delivery.

The consequences of these technologies for work and workers depend on how they are put to use towards addressing the objectives guiding the health care industry. For example, regulation has promoted the use of electronic visit verification (EVV), which monitors direct care workers through a smartphone. This technology has facilitated documentation but it has also increased micro-management of workers. However, similar technology could be used by the same workers in a very different manner, potentially empowering them to serve as a patient’s point person for the entire team of providers contributing to their care plan. For example, service robots and other AI applications could be used simply to trim the workforce and justify more limited activities and pay for workers. Or, they could be used in such a way that they free up time for these workers to focus on other activities, in particular those that depend on skills at which humans excel compared to robots, such as empathy and communication. The ways in which new technologies are deployed hinges on the choices that we make about the future direction of the industry.”

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