Malcolm cleans patient rooms and offices in the large medical center where we both work as pediatric doctors.
After finishing our respective rounds one afternoon, we noticed that Malcolm was deep in conversation with the parents of one of our very sick patients. We met him later in the hall, and the three of us began to talk. After Malcolm told us a bit about the concerns of our patient’s family, he mentioned the ways he often supports and cares for the children being treated on our ward.
“I don’t call myself a housekeeper,” said Malcolm, who has been with the hospital for 10 years. “I am the keeper of the house.”
Malcolm’s description of what he does knocked us back on our heels. It made us realize that we pass dozens of housekeepers in the corridors and elevators every day and — like most other physicians — pay little attention to what they really do and had little appreciation of their contributions to patient care.
Our blindness to the important work they do every day led us to organize a focus group to learn more about it. From that grew a film project that documented the ways hospital housekeepers participate in patient care. Throughout this process, we quickly realized that they often interact with patients more than physicians do, and they do so with great compassion.
Lorna, originally from Jamaica, told us she enjoys singing with patients — Bob Marley’s “Three Little Birds” with the catchphrase “don’t worry about a thing” being her favorite.
Rosetta, who had worked at our hospital for more than 20 years, found a way to provide meal tickets for a visiting family who couldn’t afford food.
Barbara, with the OK from a nurse, shared with a patient the collard greens and fried cornbread she had brought to work for a hospital potluck.
La Shara encouraged a frightened young woman to have much-needed heart surgery.
Maybelline maintained a friendship with a patient long after her hospital discharge.
Gladys used her native Spanish to communicate with first-time mothers, and often gave them encouragement and informal advice about breastfeeding.
We also heard stories that were less encouraging. One housekeeper told us that a patient she had come to know well during his hospital stay had taken a turn for the worse and died, and no one bothered to inform her of his passing.
Another housekeeper talked about a doctor who repeatedly refused to move out of the way when she was maneuvering her heavy cleaning cart down the crowded corridor, reinforcing to her that housekeepers are invisible to doctors and nurses.
Where we work, housekeepers clean 36 rooms a day. Their work is vital to the prevention of serious infections and to the efficient running of the hospital. It’s clear they also play an important role in the care of patients.
“Interprofessional cooperation” and “teamwork” are among the newest buzzwords in modern hospital medicine. Doctors are consistently reminded that clear, respectful communication with their teams is essential for patient safety and quality of care. But we’ve often been blind to the fact that housekeepers are an essential part of that team.
Jane Dutton, a professor of psychology at University of Michigan, worked with colleagues to research the ways in which hospital housekeepers feel valued or devalued by the actions of doctors and nurses. Through 29 interviews with workers, she and her team found that doctors and nurses frequently undermined housekeepers’ sense of value and well-being by ignoring them or by acting in ways that made their work more difficult.
When we premiered our film at an international conference, a Swiss physician mentioned that the director of the burn unit in her hospital routinely included the housekeeper in morning rounds. The housekeeper provided useful information about the patients with whom she interacted, which contributed to her sense of feeling respected and valued for her work.
In one interview for our film, Lorna says that the emotional toll of working with sick and dying patients is very high, and she is able to continue only because of the support she receives from the nurses and other members of the team. But how often do clinicians provide that much-needed support?
No matter where you work, you are a member of one or more teams that are larger than you imagine. Doctors like us — and our health care institutions — need to give keepers of the house, along with food service workers, patient transporters, and other “invisible” workers the respect they have long deserved.
Neil Prose, M.D., is a professor of dermatology, pediatrics, and global health at Duke University School of Medicine and co-director of Duke’s Health Humanities Lab. Ray Barfield, M.D., is a professor of pediatrics and Christian philosophy and director of medical humanities at Duke’s Trent Center for Bioethics, Humanities, and History of Medicine. The 15-minute documentary “Keepers of the House” was designed to be incorporated into an interprofessional curriculum for doctors, nurses, and other health care providers.