When I wrote my doctoral dissertation, I set out to understand why nurses at a hospital in Boston, famous for the quality of its nursing care, were literally crying about the deteriorating quality of the care they could deliver. For these nurses, the everyday experience of trying to do their best and somehow falling short of the mark was a deeply personal one, affecting their feelings about themselves and their work. At the same time, these individual experiences, the little battles, the everyday successes and failures, were also part of a much larger social context.
Nurses worked on unit within hospitals within healthcare systems within insurance coverage areas within a changing industry within a country struggling to contain rising healthcare costs. The way their work was organized, managed, taught, valued, licensed, and funded—social, organizational, and system issues—all shaped what happened in the intimate moments between nurses and patients. In these cases, as in so many others, the personal is also the social.
After receiving my doctorate from Harvard University, I worked a short stint as a Survey Scientist a the Picker Institute in Boston, an organization famous for its patient-centered care surveys, until the company’s untimely closure. I then became a Senior Research Associate at Brandeis University’s Schneider Institute for Health Policy, where I had the opportunity to collaborate on a number of projects exploring issues related to the way health plans try to manage physicians’ prescribing, organization and coordination of post-discharge surgical care and consequences for patients, advantages to particular types of physician job design, and the effects of management and job quality on workers and care in nursing homes. In the meantime, I reworked and transformed my NSF-funded dissertation into the book Code Green: Money-Driven Hospitals and the Dismantling of Nursing. The book spoke to broad changes in the hospital industry, which I argued had contributed to the current nursing shortage by changing the nature of nurses’ work and making the job less desirable.
In 2004, I moved to New York to take a tenure-track job at Queens College—a near miracle given my own initial trajectory out of academia and into industry, the competing needs of a two-career marriage and motherhood, and the changes in higher education that have made such jobs sparse (a personal story that is also very sociological). At Queens, I continued my research on healthcare, examining issues of teams, high performance work environments, and nurses’ education. With the passage of the Affordable Care Act, I have turned my attention to issues related to the healthcare workforce and health reform. My interests in the way that healthcare work is structured, designed, and supported and the consequences for patients and providers have been a neglected part of the conversation on health reform, but one that likely will determine much of the success of our efforts.
I also became involved in various aspects of university administration, serving as Associate Chair of Sociology, Associate Dean of Social Sciences, and even Acting Dean of Social Sciences. These administrative assignments fed my growing interest in the role of middle managers. As intermediaries between larger structures and frontline workers, what kind of difference, if any, did we actually make in everyday experiences?
While I continue an active research agenda in healthcare, in my newest project, Publishing in the Digital Age, I explore the way digitization is changing the business of publishers, the careers of writers, and the experiences of readers. This project was inspired by my own personal aspiration to be a novelist and the very personal highs and lows I experienced in trying to bring my writing to market. While my alter ego, D. B. Shuster, writes tales of crime and intrigue, I bring the same rigor that characterizes my healthcare research to this new study of the publishing industry.