Let COVID show us how health care can best harness new technologies

For weeks, Jonathan Vargas Andres has seen patients dying.

He and his fellow intensive care nurses in a North Carolina hospital have seen scores of patients die in the last few months. There have been more than 41,000 COVID-19 cases in the state, with more than 1,000 deaths. Some 800 people are currently hospitalized, and the infection rate is climbing, with more new cases every day. 

Once diagnosed, people are completely quarantined from family and friends. Cut off from any other person for fear of exposure, those infected are increasingly reliant on technology for outside contact, even at the moment of death. 

“They usually say their last goodbyes through iPads,” Vargas Andres said of the patients he’s seen die from coronavirus. “Just thinking that that could be your family member in that bed and you’re not going to be able to be there…it’s just sad.”

This scene has played out thousands of times across the country. Technology in health care, already ascendant before the pandemic, has seen rapid experimentation in hospital rooms, doctor’s offices, and waiting areas, for example, tapped as a way to deal with the social distancing requirements of this novel pandemic.

But, frontline caregivers like Vargas Andres are rarely asked for their input regarding the implementation of new technology. The research I’ve conducted over the past year, released today by the UC Berkeley Labor Center, shows that this experimentation, without any interventions, could easily transform the industry by hurting workers and alienating patients 

I spoke to dozens of health care experts about how technological change would impact the health care industry. The results were, for workers and patients, a warning: without a purposeful push from worker groups and others, technologies like telehealth, autonomous robots, and artificial intelligence will likely erode job quality and, by extension, patient care.

These three technologies, in particular, are undergoing rapid experimentation as health care providers seek to cut costs while increasing access and quality — experimentation likely accelerated by the demands of the COVID-19 pandemic. 

The quantity of health care jobs in the United States is likely not at risk, given the expected growth in demand for health care and health care workers over the coming decades. But how these technologies are implemented will dictate the quality of these jobs. Should we really let job quality erode for this group of workers, in particular? The entire system rests on them.

For instance, home health care workers may experience micro-management and increased surveillance at work if electronic visit verification — a means by which workers are monitored through a smartphone — is widely deployed. Orderlies may see their work tasks reduced as hospitals use semi-autonomous robots for laundry delivery and meal transport. Humanoid “therapeutic robots” may start giving faux empathy via screens — leaving patients unsatisfied and workers alienated.

The result could be a less personalized, more structured form of health care that is organized around the technology rather than the work itself. As pressures to cut costs mount for health care providers, the allure of technological adoption as a response becomes irresistible. Without a concerted effort to include workers in such a response, this change will leave the same workers now hailed nationally as heroes with fewer skills, more stress, and less freedom at work.

Health care workers are the fastest-growing segment of the workforce, expected to grow to 13.8 percent of all jobs — or 3.4 million more jobs than today — by 2028. The millions who fill those jobs will largely be women and people of color, meaning any impacts on job quality will inevitably hit those communities hardest.

There are myriad steps that policymakers can take to ensure thoughtful adoption of technology, so that nurses, orderlies, janitorial staff, personal care assistants, and other health care workers do not become increasingly stressed, surveilled, and micromanaged at work. 

If technology is introduced with ample time for workers to be trained in its use, health care providers can increase job quality, support skill development, and ultimately reduce costs.

Tele-medicine, for instance, can be used to increase access for patients who cannot go into the doctor’s office and to reduce stress for health care workers who, my research shows, ironically often felt closer to patients when they used telehealth than when they provided rushed, in-person care. They saw patients day-to-day, meeting their families and pets, seeing their homes, and engendering deeper connections, rather than seeing patients once every three months. 

This requires that workers — likely through unions — be involved in the rollout of the technology. If technological change makes jobs or their inherent tasks obsolete, workers continue being paid while being taught how to work alongside the emerging technology. Such models are essential. 

The industry upheaval introduced by COVID-19 brings this work-centered approach within reach. The political interests that would have otherwise pushed technological change down the default path do not currently have the same standing they did just a few months ago. Unions, supported by policymakers and health care providers, have the opportunity to demand that workers be brought into the decision-making fold. They should seize it. 

Adam Seth Litwin is an associate professor of industrial and labor relations at Cornell University. His report, “Technological Change in Health Care Delivery: Its Drivers and Consequences for Work and Workers,” was commissioned by the UC Berkeley Labor Center and Working Partnerships USA and released today. Follow him on Twitter @ProfASLitwin.