Contracting Out?
The Evidence on Hospital
Cleaning and Dietary Services
Susan Braedley MSW PhD , Associate Professor, Carleton University
April 29, 2017
Why it Matters:
Political, Practical,
Personal
 Canadians love and rely on their public health
care but worry about its financial sustainability
 Canadians work in health care, or for
companies that supply to health care
institutions or rely on customers that include
these workers. They worry about their jobs and
businesses.
 Canadians value hard work, efficient
spending and quality services
Three Main
Messages
 Contracting out management
hasn’t generated savings
 Contracting out management
hasn’t improve food or cleaning
 Contracting out management
reduces accountability and
eliminates democracy
 N. B. does not spend more on
hospital care than other provinces,
has a moderate rate of increase of
1.2% ( lower than inflation). Health
care makes up 38% of the
provincial budget(CIHI 2016).
 In international comparisons
among OECD member countries,
Canada’s health care
spending/GDP ranks 11th out of 35
countries at 10.1%, with the US
spending the most (16.9%) and
Turkey spending the least (5.3%).
(OECD 2017 with 2015 figures)
Affordability:
Health Care
Spending
Privatization Patterns: Setting the Climate
 Erosions of Public Services, which lead to
complaints
 Governments anxious to offload
responsibility, reduce costs
 Corporate marketing
 Contracts presented as promises
Why Not Privatize?
 No Public Accountability or Democracy
 Little Ability to Change Things once the Contract
is Signed
 A poor track record for quality, cost-savings and
local economic stimulation in Canada and
internationally
 Cost-recovery and savings strategies not passed
on to public
 Savings were short-term and very small
 Systems developed weren’t compatible
with the rest of the hospital services
Toronto
Hospital
Experience
 Significant added costs to administer
contracts, severance, re-training and
capital developments
 Significant decline in staff morale
 Serious decline in quality
(Carol Kushner 2005, quoted in Armstrong et al 2008)
Vancouver Hospital Experience
 Compass, Sedexo and Aramark got contracts for housekeeping,
dietary, laundry, maintenance and security
 9000 jobs cut but HEU maintained bargaining
 Downgraded new jobs created - half the pay and few benefits
( Stinson 2005, Chun, 2016)
2008
2013
2015
Measure
Use technologies that estimate and control how long each cleaning
task should take, without taking into account context-specific factors
Control
Have all requests for cleaning go through a central dispatch service,
so nurses have to “call-in” for a clean up, rather than ask a cleaner
who may be on the floor at that moment
Appearances
Focus cleaning on what shows, not what may be more problematic for
infection control or patient comfort.
How to Clean More Cheaply
Are these really “best” practices?
U.K. Evidence
 In Bach's (1989) case study of hospital cleaning, the outsourced
provider specified that they would use 45 cleaning staff compared
with the 58 included within the in-house bid, and other studies of
support services report similar reductions. A consistent pattern
emerges of substantial job losses accompanied by work
intensification and poorer terms and conditions in the UK and
internationally.

(Bach and Gavan 2010)
Latest Data on Improving Cleaning
 Surfaces are important – eg. some bedrail materials are easier to
disinfect than others
 Cleaning supplies are important – microfibre works best in some
instances, wipes in others
 Specialized training, enough time and adequate supervision are
essential
( Boyce, 2015)
Outsourcing
Food Services
in Public
Institutions
 In Saskatchewan, privatizing
food services in prisons in 2015
led to food strikes (Compass)
 In universities and schools,
complaints about food services
provided by Compass’s
educational branch (Chartwell)
and Aramark since 2010
Vancouver’s Coastal
Health contracted Food
Services to Sodexo :
Report 2016
 Food shortages in senior care
residences
 Almost no fresh food (“a 1/3 of
a banana maybe once every
three weeks”)
 Small portions, no second
helpings
 Watered down juice from
crystals, tea and coffee that
have little flavor
 “re-thermalized” food… !?
In Ontario:
 “If
I could change one thing it would be that we would not sign a 10
year contract for food and cleaning with Sodexo. We could do it
ourselves cheaper and better. They nitpick over everything we ask
them to do. If it isn’t exactly spelled out in the contract, it costs
extra. And it creates problems among our staff, too, with some
working for Sodexo and some working for us.”

(interview with CEO)
Taking Services “Back in House” is a Trend
among Municipalities internationally

 Contracting out management
has not shown cost savings
Three Main
Messages
 Contracting out management
has not improved quality
 Contracting out has reduced
accountability and eliminated
democratic control
Selected References

Armstrong, P., et al. (2008). Critical to Care: Women's Ancillary Work in Health care. Toronto, University of Toronto Press

Bach, S. and Givan, R. K. (2010), Regulating employment conditions in a hospital network: the case of the Private Finance
Initiative. Human Resource Management Journal, 20: 424–439. doi:10.1111/j.1748-8583.2010.00142.x

Boyce, J. M. (2016). "Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals."
Antimicrobial Resistance & Infection Control 5(1): 10.

Chun, J. J. (2016). "Organizing across divides: Union challenges to precarious work in Vancouver’s privatized health care
sector." Progress in Development Studies 16(2): 173-188.

Stinson, J., et al. (2005). The pains of privatization: How contracting out hurts health support workers, their families, and health
care, Canadian Centre for Policy Alternatives.

Whiteside, H. (2015). Purchase for Profit: Public-Private Partnerships and Canada's Public Health Care System, University of
Toronto Press.

Whiteside, H. (2015). Purchase for Profit: Public-Private Partnerships and Canada's Public Health Care System, University of
Toronto Press.

Zuberi, D. (2013). Cleaning up: how hospital outsourcing is hurting workers and endangering patients, Cornell University Press.