To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. In Cleaning Up, the first book to examine this transformation in the healthcare industry, Dan Zuberi looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. Drawing on years of field research in Vancouver, Canada as well as data from hospitals in the U.S. and Europe, he argues that outsourcing has been disastrous for the cleanliness of hospitals?leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death?as well as for the effective delivery of other hospital services and the workers themselves.

Zuberi's interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. Zuberi also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. He makes the case that hospital outsourcing exemplifies the trend towards "low-road" service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.

Dan Zuberi is an associate professor and RBC Chair in the Factor-Inwentash Faculty of Social Work and the School of Public Policy and Governance at the University of Toronto.

Dan Zuberi's profile page

• Gold Award, 2014 ForeWord Magazine Book of the Yea

Cleaning Up affords its readers crucial insight into the healthcare industry, closely examining thesocial and economic costs of profit-driven healthcare. Healthcare policy affects so many people:workers, patients, and all of their families. Zuberi succeeds in proving his point: it is time to take actionto improve our healthcare system.

Monthly Labor Review

Researchers sensitive to the plight of low-wage workers in advancedindustrialized economies have long sought to convey the magnitude ofthe problem by retelling sorrowful tales of worker exploitation. Sadly,even their most sympathetic readers have numbed to these accounts.Author Dan Zuberi has found a clever way to transcend this apathy inhis new monograph based on about 100 interviews plus behind-the-scenes observations of the impact of hospital support staff outsourcingon patients and workers.

Work and Occupations

A book like this could easily read as a litany of woe and injustice, but the finalchapter, simply titled Cleaning Up, seeks to provide a roadmap forward thataddresses HAIs and worker justice....The book is written in an engaging and polemical style and the subject matterlends itself to catchy chapter titles and by-lines.

Journal of Industrial Relations

While this empirically informed book makes for a quick and easy read, it is both informative and thought-provoking. Zuberi's book provides a wealth of evidence that the outsourcing of hospital jobs has resulted in deteriorating working conditions and that, in turn, such conditions are the cause of an increase in hospital acquired infections....undoubtedly a valuable addition to the literature on the quality of care in hospitals and its links to the privatisation and out-sourcing of healthcare services.

Sociology of Health and Illness