"Too often, doctors and nurses are blind to the fact that housekeepers are an essential part of [the care] team," Duke University professors Neil Prose and Ray Barfield write in a STAT News opinion piece.

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Prose is a professor of dermatology, pediatrics, and global health at Duke University School of Medicine and co-director of Duke's Health Humanities Lab. Barfield 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.

Meet the 'keeper of the house'

One day after finishing rounds, Prose and Barfield noticed that one of the housekeepers, Malcolm, was in "deep conversation with the parents of one of our very sick patients." Later that day, Malcolm told Prose and Barfield about some concerns the patient's family had discussed with him. Malcolm explained that, although he's mostly responsible for cleaning patient rooms, he often supports the families and children in the ward. 

"I don't call myself a housekeeper," Malcolm told them. "I am the keeper of the house."

Prose and Barfield write that Malcolm's description of his job "knocked [them] back on [their] 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," they write.

The project

The revelation led Prose and Barfield to organize a focus group to learn more about the support housekeepers provide patients.

"Where we work, housekeepers clean 36 rooms a day," they write. "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."

The physicians soon decided to grow the focus group into a film project that highlighted how the housekeepers contribute to 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," Prose and Barfield write.

One housekeeper named Lorna told Prose and Barfield she likes singing Bob Marley's "Three Little Birds" with patients. According to Prose and Barfield, the "catchphrase 'don't worry about a thing' [is] her favorite.'" they write.

Another housekeeper named Rosetta, who'd worked at the medical center for more than two decades, gave meal tickets to a family so they could buy food, and another woman named Gladys often used Spanish to comfort and encourage Spanish-speaking, first-time mothers.

But some of the stories "were less encouraging," Prose and Barfield write. One housekeeper said that when a patient she'd become close with died, no one told her he had passed. Another housekeeper mentioned one doctor would refuse to move out of her way when she was moving her large cleaning cart down the hallway, "reinforcing to her that housekeepers are invisible to doctors and nurses," Prose and Barfield write.

The importance of cooperation

Prose and Barfield write that while physicians are "consistently" told that "clear, respectful communication with their teams is essential for patient safety and quality of care," physicians "often" overlook housekeepers.  

For instance, after interviewing 29 housekeepers, Jane Dutton, a professor of psychology at University of Michigan, found that clinicians undermine housekeepers by ignoring them or getting in the way of their work.

But that's not to say progress isn't being made, Prose and Barfield note.

At the premiere of their film, one physician "mentioned that the director of the burn unit in her hospital routinely included the housekeeper in morning rounds," Prose and Barfield write. This allowed the housekeeper to give doctors "useful information about the patients with whom she interacted, which contributed to her sense of feeling respected and valued for her work."

Lorna, the singing housekeeper at Prose and Barfield's medical center, described her job as emotionally draining but said "the support she receives from the nurses and other members of the team" help her carry on each day, they write. 

But in order to truly support the housekeepers, Prose and Barfield write, "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" (Prose/Barfield, STAT News, 2/5).

To watch the authors' documentary, click here.