Never Good Enough: Health Care Workers and the False Promise of Job Training

5. “It All Comes Down to You”: Self-Help and Soft Skills

5 “It All Comes Down to You” Self-Help and Soft Skills When millions of dollars for training the health care workforce became available in the late 1990s, tens of thousands of New York City hospital workers were sent to training classes in such areas as customer service, communication skills, team building and teamwork, cultural diversity, conflict resolution, and leadership training. These “soft skills” courses were among the most heavily funded areas of training and, like multiskilling courses, presented as necessary preparation for the world of market-driven, competitive health care. In the courses I observed, health care workers were askedtocomparetheirhospitalstoMicrosoft,McDonald’s,Disneyland,and Singapore Airlines, and themselves to Donald Trump and Bill Gates. Patients became “customers” or “clients” and clinical services “product lines.” Private consultants, some new to the world of training altogether and others possessing proprietary training packages they had long offered to private businesses, created presentations tailored for health care. As one said, health care was an “untapped market.” 112 Never Good Enough Muchofthistrainingwasbuiltontwoquestionablepremises:thathealth care is like other businesses and that soft skills training for frontline health care workers is an effective response to changes and difficulties health care organizations face. The weaknesses of these premises were vividly exposed in the training courses themselves, which I observed in 2001–2002 in three settings: a communication skills program at a midsize private hospital, a “retreat” on teamwork and customer service for employees of a public hospital , and in-services at one of the city’s largest (and recently unionized) home health care agencies. I also interviewed trainers and officials at these organizations, as well as independent training consultants working in the area of soft skills. In the courses, instructors encouraged the participants to think of their employers as businesses and themselves as salespeople. They sought to teach soft skills for the hard realities of a market-driven health care sector. They consistently posited that individual workers were responsible for producing the cooperation necessary for improving care. As the communication skills instructor succinctly put it, “the most fertile area for greater control lies within the self.” The participants’ reactions to such advice, though, pointed to the complex and social nature of the problems they faced, of which instructors themselves were sometimes aware or participants forced them to confront. Just as the instructors’ messages were similar, so were the dilemmas they faced. They carried out their training seminars in the absence of a larger plan to improve the conditions of health care work. In fact, training programs arguably became the only, and therefore inevitably inadequate, response to the pressures and stresses frontline workers faced. The conversations, interactions, and exchanges that took place in the courses themselves were not scripted, and it was in these moments that the problems health care workers face and the limits of training were evident. There were tensions between what instructors wanted to teach and what participants needed and between the expectations of those who implemented training programs and their effects. From the perspective of almost any stakeholder in the process, one might argue soft skills training programs were a dismal failure. Yet they were and continue to be highly funded, and many participants enjoyed them. Indeed, the conversations that arose during the training itself not only show the limits of this kind of training but also indicate why so much was invested—emotionally and financially—in it. “It All Comes Down to You”: Self-Help and Soft Skills 113 The communication skills class1 began like a self-help or personal development seminar. At 8:00 a.m. sharp in a windowless room adjacent to the hospital’s training department, the instructor opened with a section on the “essentials for success.” She encouraged participants to assess their present situation and think concretely about their futures and aspirations. She handed out various self-assessment forms; some asked participants to “think about where you are now” and whether they were “satisfied with your personal life progress.” Some contained questions aimed at encouraging participants to make more concrete plans for their future, asking, “are your underlying values clear and sharp in your mind?” and “are you as successful as you can be?” The instructor stressed that participants should write their goals down, since what is written down is “more real.” And she warned, “failure to plan is a plan to fail.” As she discussed various pathways to success, the possibility of...