by Tamara Moellenberg and Millie P. Arora

Following the largest healthcare worker strike in U.S. history which saw some 75,000 Kaiser Permanente employees across half a dozen states walk off the job, many people are asking: how did we get here? Chronic staffing shortages, stagnant compensation eroded by inflation, and increasingly unsafe work environments are all major contributing factors. Yet, as applied ethnographers who have led research teams in clinics and hospitals around the world, observing procedures, interviewing clinicians, and shadowing them throughout their day, we’ve seen that the issues run deeper: healthcare workers are losing a sense of meaning in their work, even in highly respected and skilled specialties such as surgery. Theorists of work have identified three critical ways in which most people find meaning in work, through 1) satisfaction with the outcome or ‘product’, 2) reward from the activity itself, and 3) a sense of connection with, or feelings of belonging among their colleagues. All three wellsprings of meaning are increasingly being eroded in hospital settings.  

To begin with, very few hospital practitioners now get to see the full arc of the patient journey. The Taylorisation or factory-isation of the hospital now means that many healthcare providers (HCPs) play a highly specialised role that allows them only compartmentalised insight into a patient’s treatment and recovery. One nurse at a trauma centre in the southwestern US for instance told us how, given initiatives to streamline surgical processes, she now rarely has time to speak to patients: “They don’t remember us. They don’t interact with us. Even in the pre-op area, we speak to them for five minutes before we must take them back to surgery.” She primarily encounters the patient as a body on the table, her role and interaction restricted. Whereas earlier in her career, she might have been more involved in post-op care, that time is now squeezed by menial tasks formerly outsourced to vendors, such as cleaning – a necessity given tighter budgets and staffing shortages. Her efforts spent elsewhere, the nurse no longer has insight into the outcome – the ‘product’ of her labor – which is the patient restored to health and function, putting at risk her sense of purpose in her career.  

Relatedly, clinicians have become increasingly alienated from the activity of providing care itself – another loss of meaning in their profession. Numerous nurses we’ve met talk about how administrative procedures meant to speed up the efficiency of the hospital, such as checklists, are increasingly both part of how they spend their time and how they are evaluated. (Some even felt such time pressure that they didn’t take breaks during or between procedures, unable to provide basic care for themselves, much less their patients.)   

This frustration with ‘menial’ work extends beyond nurses: one northeastern-based transplant surgeon even described his work to us as akin to a car mechanic. “It’s like an assembly at a car factory…every car is the same,” he said. Today, many clinicians are expected to perform procedures in the same way, with the same steps, instruments, and techniques each time to improve the efficiency, safety, but also profitability of the hospital. (With a more streamlined process, operating rooms can treat more patients and hospitals can make more money.) This standardisation has expanded beyond the OR, with growing ranks of central administrators defining protocols for everything from supply storage to meal planning. Again, there are good reasons for this. Yet without some scope for creativity and problem-solving – a feeling that they are applying their expertise in ways that advance the medical profession – many clinicians struggle to feel connected to and engaged in their work.  

“This frustration with ‘menial’ work extends beyond nurses: one northeastern-based transplant surgeon even described his work to us as akin to a car mechanic.”

Finally, many healthcare workers are losing a sense of connection to their colleagues, a third source of meaning at work. It isn’t always this way. One nurse from a northeastern trauma centre described to us the satisfaction she sometimes finds in being able to anticipate the next instrument a doctor needs before they even ask, “the faster you can get them what they need, the better”. Clinicians now must do “more with less”, in the words of one manager at a mid-Atlantic hospital, with technicians serving multiple procedures at one time and nurses rotating across not only across surgical teams but even specialties – to take the OR as one example.  

Numerous studies have found that time pressure, lack of autonomy, and poor work relationships are key causes of burnout. When clinicians must perform faster, with less freedom and fewer opportunities to collaborate effectively, more of them will face physical and mental collapse. This is a problem for societies where demand for skilled healthcare workers is increasing in line with rising rates of chronic disease and aging populations. We see an opportunity for hospital systems, policymakers, as well as medical technology and pharmaceutical companies, to work together to counteract healthcare burnout – and in turn, major strikes – by doing more to restore a sense of meaning in their work, namely by 1) giving clinicians greater insight into the outcome of their work as measured by long-term patient health and well-being, not just by efficiency metrics such as procedure times and turnover; 2) finding ways for clinicians to innovate new best practices and problem-solve within the protocols that protect patient safety; and 3) providing more ways for clinicians to build and leverage effective colleague relationships, perhaps in part by recognising that efficiency is not only achieved through agile processes and staff rotations, but by a group of people who work well together finding their ideal flow.   

Helping healthcare professionals restore meaning in their work is a way toward not only advancing the availability and quality of care but also restoring dignity to it. As the strikes threaten to continue, understanding what both drives and erodes a sense of meaning at work for healthcare professionals is a vital step in solving some of the biggest, most urgent issues in our care system.