This post was originally posted on NSC’s Medium.
Everybody wants to talk about the Future of Work (FOW), but they don’t necessarily want to have the same discussion — nor should they. It’s time to recognize that there is a diversity of futures ahead for U.S. workers in different industries, even when they’re dealing with the same structural shifts in the labor market. Our policy responses will need to be just as nuanced and industry-focused.
When confronting a topic as large as the future economy, researchers tend to focus on the big picture — the structural mega-trends that could potentially touch all workers and companies. But even at that conceptual level, there are disagreements between FOW analysts (and their foundation sponsors) about which mega-trend is the dominant threat. For some, it’s the rise of alternative work arrangements that are replacing traditional employer-employee relationships with low-wage gigs and independent contracting. For others, the FOW is about automation’s perceived threat to replace human labor with machines and computer algorithms.
These dueling FOW discussions attract not only different think-tanks and foundations, but also different groups of worker advocates, industry leaders, and policymakers. They likewise generate different policy recommendations, from portable benefit packages to offset the gigs, to universal basic income or lifelong learning to help humans keep pace with the robots.
So there is already more than one future being discussed under the Future of Work banner. But for those of us in the workforce development field — training providers and intermediaries preparing under-employed workers for skilled jobs, or helping employees advance into higher-skilled positions within companies — the FOW is even more complicated than that. Grappling with these mega-trends with firms of various sizes across different industries — manufacturing, healthcare, information technology, construction, energy, retail, agriculture — we see a multiplicity of futures that standard FOW policy proposals can only partially confront. As leaders of a coalition that has long called for U.S. labor policies that build out a national infrastructure of industry partnerships that can fine-tune policies to focus on a sector’s specific workforce challenges, we see a need for such a perspective within current FOW discussions as well.
Take, for example, the differing trajectories that technology and workforce issues have taken between the manufacturing and healthcare sectors.
Manufacturing has been the default lens through which most people currently view the future of automation and A.I. Download any “Future of Work” publication, and it likely sports a graphic of colorful robotic arms on a factory floor with nary a human being in sight. That image taps into a popular narrative of U.S. manufacturing: Tech = machines in workplaces where humans once stood = shrinking workforce = bad for workers.
Of course that narrative glosses over other factors that contributed to manufacturing job losses over the past half-century, including trade and international competition. It also misses how technology in many cases improved the job quality and wages of factory work over the same period. As early as the 1950s, union leaders like the United Auto Workers’ Walter Reuther testified to Congress about the labor movement’s cautious embrace of automation as a way to improve the working conditions (decreased repetitive tasks, improved safety) and productivity of U.S. manufacturing workers, so long as that increased productivity led to higher wages for those newly skilled to harness that technology. That same belief is still resonant today, as was apparent at a recent meeting of the AFL-CIO’s newly created Future of Work Commission. Industrial union leaders cited Reuther’s legacy when talking about the labor movement’s interest in managing, rather than fighting, the introduction of A.I. onto the factory floor. Labor/management partnerships would also ensure that current as well as new workers were trained to be the pilots versus the victims of new robots and other tools.
Over the years, the federal government has likewise stepped in to support the introduction of new technologies into American manufacturing. This included the creation the Manufacturing Extension Partnership (MEP), based out of the Commerce Department’s National Institute for Science and Technology (NIST), to help smaller manufacturers adopt the latest technologies used by larger firms to stay internationally competitive. More recently, President Obama (and to a lesser extent, President Bush before him) called for new federal investments in training to prepare millions of workers for jobs that manufacturers claimed were going unfilled because of a shortage of skilled workers. The Trump administration has even more loudly staked its political claim on the future of the U.S. manufacturing workforce — though it has been less clear, beyond its effort on trade, if the administration has any plans to tangibly invest in training the manufacturing workers of tomorrow.
The future of work in U.S. manufacturing will thus follow a pretty distinctive history. Automation’s impact on factory employment has been over a half-century in the making, such that both workers and employers in the sector have become accustomed to the trend. While images of factory robots may prompt anxiety from FOW observers outside the industry, many people inside manufacturing — both those who own the robots and those who work with them — see technology as a hedge against future job losses in an increasingly competitive international market. Worker advocates acknowledge that the number of factory workers may continue to decline, but that most of that job loss will be concentrated in lower-skilled manufacturing occupations that require a high school degree or less. This is a tragedy for the workers who were in those less-skilled positions; their displacement raises a set of equity issues that to date have received relatively little attention from policymakers. Otherwise, most of today’s manufacturing workforce discussion has been about how to attract workers — particularly young workers — with higher levels of education into the sector. Rather than being a harbinger of potential future displacement, robots and associated tech are actually a selling point to these prospective young recruits whose parents’ generation otherwise still sees manufacturing as low-skilled, dirty and dying.
How might the same technology trends play out for our nation’s healthcare workforce — a sector that has received relatively little attention in FOW discussions?
Specifically, what impact might AI and digital technologies have on caregiving occupations — the nurse aides, home health aides and personal care assistants who comprise the majority of healthcare workers?
For one, unlike the long-term trend toward fewer, higher-skilled manufacturing workers, caregivers are only poised to grow in number, pushing the healthcare sector to become the largest single major industry for employment by 2026. Industry efforts to control costs and increase the productivity of that growing healthcare workforce have likewise been different. While manufacturers increased worker productivity through the infusion of modern technology, today’s healthcare providers had more often relied on an old school method that factory owners had instituted a century ago to get more output per each worker — that is, the “speed-up.” Caregivers who were physically lifting, cleaning, feeding, medicating and toileting patients were just asked to work faster to cover more patients during each shift. Such strenuous demands took its toll, generating among the highest workplace injury rates of any employment sector.
All of this contributed to average annual caregiving workforce turnover rates of anywhere from 60 to 100%. Such a labor strategy could only be sustained by a ready supply of workers, often women of color and immigrants, who lacked many other job options. But with growing demand for aging and disability services and a tightening labor market in which even lower-skilled workers have less demanding job options for the same low pay, caregiving’s high-turnover, high-stress workforce strategy has finally met its limit. There is also a small but growing number of healthcare providers who have become concerned about the quality of care that could be provided by an unsupported workforce, and thus have begun collaborating with unions and other sector intermediaries to assess new approaches to their employees’ training, retention and overall job quality.
It’s in that context that the healthcare industry must re-examine technology as a means to both improve patient care and to stabilize its over-stretched workforce. The issue in healthcare is not necessarily whether the workforce is going to be down-sized by tech, but rather how the jobs of millions of healthcare workers — more than the entire manufacturing workforce in the U.S. — are going to be changed in a sector that to date has not seen many new labor-enhancing investments in technology. As more baby boomers demand to “age in place” at home versus in an institutional setting, new technologies to support that shift — ”smart” refrigerators that can assess when food is running low, blood pressure and medication regulators monitored off-site, telemedicine that allows doctors to communicate with patients at any hour — could soon become part of the frontline caregiver’s workplace, while at the same time even further increasing the number of home care jobs. Growing reliance on digital medical records and care plans that can be transmitted in real-time to caregivers will ensure more fine-tuned care for home-based patients, but it will also require caregivers with the necessary literacy and digital fluency to make use of that information.
Herein lies the fundamental challenge for a tech-infused future for caregiving work. While new factory technologies are being introduced into a sector staffed by higher skilled, tech-ready workers, home and community-based patient care is being delivered by a workforce that, statistically, has among the lowest literacy, math and digital skill levels of any industry cluster, including a large proportion of workers for whom English is not their first language. While the low-skilled, low-wage manufacturing worker is an anachronism of the past, the less and quickly trained, low-wage healthcare worker is the default for this growing industry.
Efforts to improve the wages, benefits, training opportunities and working conditions for this workforce have been a longstanding priority for advocates in the sector, including those in the unionized sectors led by SEIU and others. These efforts, coupled with the increases in safety and reduced injuries — to caregivers as well as their patients — that could come from new technologies, provide a welcome boost to current workers and should become more common in the industry. But healthcare also needs to make the sector more attractive to an entirely new generation of recruits. While manufacturers are using the glitz and sex appeal of shiny robots to enlist more educated young applicants, that option is not available for the majority of jobs in the healthcare sector. Healthcare has to figure out how to provide real opportunities to the millions of low-wage workers it already has — and will likely continue to attract — to raise their skills and increase job quality while keeping pace with the sector’s new technologies.
The Healthcare Career Advancement Program (H-CAP), a national organization of SEIU union locals and healthcare employers partnering to develop forward thinking solutions to emerging workforce issues in healthcare, has begun to bring this FOW discussion to the communities where such caregiving is taking place, involving employers, workers, and education and training providers in the conversation. With an extended network of workforce intermediaries that covers almost 1,000 employers and 650,000 workers from every occupational level in the healthcare industry — from home care, to skilled nursing facilities, to clinics and hospitals — across 15 states plus the District of Columbia, these labor/management industry partnerships are on the front lines of developing an FOW agenda that directly engages industry to develop workforce solutions. This agenda prepares new and incumbent workers with the skills needed to support a transitioning delivery system — now and in the future — and harnesses technological innovation in order to provide higher quality care to patients.
It may not seem particularly insightful to conclude that manufacturing and healthcare are two different industries. We would agree. But as participants in various “future of work” events over the years, we’ve noted that obvious point is often lost in FOW forums (with some notable exceptions). In-depth discussions about the breadth or tempo of AI’s future applications, while fascinating, often miss the basic point that workplace technology’s impact will ultimately be determined not by the acumen of its design engineers, but by the operating constraints and capital budgets of different companies, and by the skills of the workers tasked to apply it. Firm and workforce constraints, in turn, are going to be quite different from industry to industry.
As we saw with automation in manufacturing, the availability of the technology did not guarantee its adoption by smaller firms without government assistance. Worker adoption of technology in a manner that benefited both firms and the workforce required both public and private investments in the skills of those workers, as well as efforts by unions and other industry intermediaries to jointly manage the technology’s introduction in a manner that took full advantage of the new abilities of a changing workforce. Some of those same challenges will face tech’s introduction into the healthcare sector, requiring both public and private interventions that enable that transition effectively and equitably. Yet healthcare’s specific industry context will likely mean that the specific interventions required — new training regimens, new occupational titles and career pathways, new means for ensuring that new tech improves both job quality for workers and care quality for clients — are likely going to be quite different from those developed for the FOW in manufacturing.
Industry context should be incorporated not only by FOW theorists. It needs to be embraced by policymakers as well. While there are some universal policies that could be improved across the board for all workers impacted by automation — such as a more robust and predictable public means for supporting and retraining workers whose displacement is a result of irreversible structural changes in an industry vs. the cyclical result of a momentary downturn in the economy. But other FOW policies, particularly those trying to support the advancement of workers and firms in a new technological age, are going to have to be industry-specific. Such sector-specific policies could be initiated at the national level, as was done for U.S. manufacturing in the past. They could also be developed or implemented at the regional level by sector-specific partnerships of employers, unions, workers, labor/management partnerships, training providers and other intermediaries. Either way, we will need a more diverse set of joint public and private collaborations in managing the FOW than has been discussed up until now.
Our coalition members — employers, unions, community colleges, community organizations, workforce boards, industry intermediaries — look forward to working with FOW experts and policymakers to see if we can bring more of their on-the-ground, industry-specific expertise into future FOW discussions. There is more than one future in the FOW. Let’s involve workforce experts from across all sectors to help figure out how to make that future accessible and beneficial to all U.S. workers and businesses.
