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

7. From Skills to Meaning

7 From Skills to Meaning Those with a stake in New York’s health care workforce training industry mobilize several arguments in support of their programs. Most prominent is the ubiquitous argument that training and education programs are necessary to compensate for the gap between the skills of the workforce and the requirements of jobs. Common as well is the argument that the industry helps people gain access to working-class jobs and can even be the means of meaningful upward mobility. These rationales warrant further examination to come to a more nuanced, and accurate, explanation of this industry’s endurance and ability to command substantial financial, even psychic and emotional, support. There is little to examine, however, when it comes to the claim that the kinds of training that have been funded in New York City might improve the conditions of health care work or patient care. A glimpse into what multiskilling and soft skills training initiatives actually entailed is enough to show that they were far more likely to accommodate, rationalize , and even exacerbate the difficult working conditions frontline health 160 Never Good Enough care workers face. The sources of problems in health care work and patient care are located much further upstream than the attitudes of individual workers, beyond the reach of short-term, narrow in-services and skills programs. Furthermore, no one in the city’s health care sector, including 1199, has pressed for or developed systematic or ongoing evaluations of training programs that would assess their content and their impact on working conditions or the quality of care in health care facilities, even using measures as basic (and limited) as staff or patient satisfaction. A representative at the Consortium for Worker Education said they had trained 37,000 people in the public hospital system in communication skills, resulting in “tremendous changes in hospital environments.” This was anecdotal evidence and especially difficult to believe given what I had observed at one public hospital’s customer service retreat and, as important, given that more than a quarter of the workforce in the public hospital system was being laid off at the same time. A nationwide study of the growing number of labor-management training partnerships in health care confirmed that they remain unevaluated elsewhere too. “There are few initiatives to assess the impact of joint efforts on quality and performance,” the report concluded.1 I interpret the fact that those with a stake in the industry have not sought evaluations that might show the impact of their programs on working conditions and patient care as evidence they were never really the primary objects of such training. Nonetheless, the training industry’s self-justification must still rest on more than its supposed ability to provide skills, as we will see. The seeds of a more versatile and open-ended justification were evident when the training sessions I observed became an environment of mutual support, in striking contrast to the workplace. Trainers talked to me not only about skills, but about health care workers’ need for meaning and respect, acknowledging a pervasive and deeply rooted problem. By tapping into this profound need, and attempting to meet it, training programs that fail to improve conditions in the workplace and rest on the tenuous notions of “skills” and a “skills gap” not only persist, but thrive. Trainers and educators in many industries have always promised their courses will bridge the gap between the skills of workers and the demands of jobs. Recall the words of the administrator at the Consortium for Worker Education: “there’s always going to be a need for training and From Skills to Meaning 161 upgrading and there will be other [training] monies available as time goes on because we understand that the economic development of the workforce depends on constantly being upgraded in order to have any kind of job security.” In the 1990s in particular, both critics and advocates of restructuring and reengineering believed that the nature of work in health care facilities was soon to be radically transformed and the health care workforce was vastly underprepared for the demands of a market-driven health care sector. Trainers and educators who justify skills training (whether for communication or performing EKGs) in this way use the same logic that has been ubiquitously used for decades to explain away the declining living standards and prospects of working Americans: It is...