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.”

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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.

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  • Tim Keller s book Every Good Endeavor speaks quite clearly to this. We are all part of a large team and if even one team member does not show up or does not do their work the entire team suffers. There is no part of the team doing work that is more honorable than the others.

  • 25 years ago, I had a partial miscarriage and went to a well known health system in Oakland for a D&C. I was crushed emotionally and in severe pain. I was not prepared for the lack of compassion by the doctors and nurses I met. They treated me like a drug seeking inconvenience. The only person who showed compassion was the housekeeper. I will always be grateful for her kindness, humanity, and compassion. That taught me that every hospital employee can make a difference. Thank you housekeepers!

  • I am so, so glad that finally some real intelligent Visionist persons out there looking out for us!! I am a keeper of the House in the Emergency Department. Am very, very, very polite Housekeeper!! For 13 years am working I tell you I have faith. Endurance. Persevearance to hold my Tongue ! Yes! Not all…but some of them are. Even the body language can tell you to stay out of this one way!!!! But I learn in life that a person can be like any other if they Study, and everyone cannot be Doctors and nurses… their must be someone to do the cleaning and am very proud of the great job have done. When we come across ignorant people like those !! It makes me want to slop and go!!!! But with a clean heart I cannot do it. I will end by saying this no matter what you have been through in life hold your head up be strong push forward and do not let anyone think they’re better than a Housekeeper, i am the most important person in this world and am from Jamaica and it’s so funny am Lorna and i sing and say those same Frazer at work. I hope all that being said will taken seriously. (Blessings)

  • if people could only be arsed to care for the bodies the goddess generously gifted them with, they wouldn’t need to squander so bloody much money on health care. A couple hours of exercise three days a week, moderation in diet, frequent hand-washing, not spending one’s day glued to some screen or tv ~~ everyone’s capable of improving

  • I have been working in health care for the past 40+ years and totally agree that “keepers” of the house, food service workers, nursing assistants, etc. are truly valuable employees that get little to no recognition. I am so glad to see some positive action fir those who serve on the health care team . I work with our environmental director and his team close. I speak and talk to them on a daily basis in my position as Director of Employee Health and Infection Surveillance. Again I think they deserve 100% recognition for there part in health care.

  • I have always acknowledged, spoken with and thanked the housekeeping staff, as well as other staff at the hospital where I worked. Many of my peers do too. What’s the point to this article?

    • Eileen, I’m glad to hear that you and many of your peers are kind to housekeeping staff. It seems to me that the point of this article is to encourage those who are not so kind to be more like you.

    • Great article which reminds me of a story that I heard about a hospital administrator cutting housekeeping and bedside nurses’ staffing numbers and cutting free staff members’ Thanksgiving pumpkin pies, all to save money. The facility morale appeared to go down but the infection rate and errors appeared to climb. Profit targets were met and top level staff got bonuses. My family has gotten healthcare in other western countries and lived overseas. We prefer systems which don’t have such discrepancies in how top level staff and those in the patients’ rooms get treated and paid. This video reminds me of the importance of all team members. Thank you!

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