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Q&A With Neil Prose, MD, Maker of ‘Keepers of the House’

Housekeepers are often the unsung heroes of the hospital — they keep everything clean and sanitized, cleaning up the messes no one else wants to deal with. But they also play another role, helping to humanize each patient’s hospital stay.

Neil Prose, MD, professor of pediatrics, dermatology, and global medicine at Duke University in Durham, North Carolina, made a 15-minute documentary about these vital workers, “Keepers of the House,” with his wife, documentary filmmaker Rhonda Klevansky. It features housekeepers at Duke University Hospital and Duke Regional Hospital discussing their work.

Prose talked to MedPage Today Washington Editor Joyce Frieden about the film. This interview was edited for length and clarity.

Where did the idea for the documentary come from?

The idea came along about 5 years ago, just in a conversation over coffee with a colleague of mine, Ray Barfield, a pediatric oncologist and palliative care physician. We were talking just generally about the role that hostel housekeepers play in the emotional support of patients and their families. We kind of hit upon this idea that it was so unappreciated and unnoticed by our colleagues and by ourselves.

And that very day, Ray had a conversation with a housekeeper who was talking about his work with the families and how he supports them. And he told Ray, “I think of myself, not so much as a housekeeper, I think of myself as the keeper of the house.” And that became the title of everything we were going to do moving forward.

Our original decision was to do a study. We thought we would just publish something in the medical literature about this. And some folks would read it and maybe it would change some lives. So we organized — with the help of some sociologists, because we didn’t know how to do this kind of research — a group of housekeepers and the stories that emerged were so remarkable just in that focus group. It was also about the time of the 2016 election, so the country was in turmoil and we felt the need to do something more than just a journal article.

We arrived at the idea of a film, and I had the great fortune and wisdom many years ago to marry a documentary filmmaker, Rhonda Klevansky, who really did all the hard work. The idea behind the film has always been as a tool for medical education that we can somehow use these stories to help healthcare providers learn lessons about humility and teamwork and empathy.

How long did it take to put together?

The process of actually putting together the movie became more complicated than we anticipated because of all the issues related to HIPAA [Health Insurance Portability and Accountability Act] and compliance, and we discovered that filming in the hospital itself was going to be very difficult. So we ended up hiring an animator to do the animation and it took a long time to put all that together. I’m really glad it happened that way because it turned out much better, I think, with the animation. And then we found a musician who wanted to create music and then Rhonda and I kind of put that all together, edited the interviews, which took — it was a big process because she had hours of film. It was finished a year and a half ago, in September 2019.

How was the film funded?

I’m co-director of the Health Humanities Lab at Duke. Funding for the film came largely through the Health Humanities Lab, which is a group that tries to create links between medicine and humanities.

How has the role of housekeeper changed during the pandemic?

Basically, the role of the housekeeper is to sanitize surfaces and floors, and to clean patients’ rooms, and that’s of course really vital work and even more vital during the pandemic, because at some point it’s almost the only thing we have, is keeping things clean. And, so that has always been really critical and important and valued work.

Neil Prose, MD

The housekeepers in the film said that they were performing other services for patients. Can you give some examples?

They were doing so much more than just cleaning. And I think because they had the time and interest in spending time with the patients while they were doing their work, they were doing things that were really surprising to all of us. The stories in the film include a housekeeper who collected money for a family that was lacking in resources to pay for lunch, and another who made sure that a new mother didn’t drop the baby out of the bed when she was falling asleep. Others offered encouragement to patients that were struggling with medical decisions, offered advice on things like lactation, and in one case, sharing food for a potluck with the patient — with the nurse’s permission, of course. In another case, the hospital room was too small and they helped them get into a larger room.

Have you talked to the housekeepers since the pandemic started? How has the pandemic affected their work?

So there is the whole issue of patients not being allowed to see family. And so in that case, you can imagine the role of the housekeeper in providing emotional support became more important than ever with COVID patients, and also with patients who don’t have COVID but were alone and contending with a serious illness.

Also, sadly, because the housekeepers are so under-recognized and underappreciated, there were situations where they weren’t given adequate PPE [personal protective equipment] at the beginning, or weren’t given adequate education and training in how to deal with COVID. And so there were illnesses and fatalities among housekeepers and a lot of anger about the way they were being treated during the pandemic, because … nurses and doctors were being applauded as heroes and everybody else who does the other work, like housekeepers and transport workers and service workers, were being ignored and marginalized. So that was getting back to the educational goals with the film; we thought that one of the lessons would be what kind of compassionate work that these people embody. We are trying to help to humanize the housekeepers so that doctors and nurses and other members of the team appreciate what they’re doing, which often doesn’t happen.

Has any previous research been done on the role of housekeepers in healthcare facilities?

Yes, we came across the work of a professor at the University of Michigan named Jane Dutton. And she actually came up with some wonderful research about the notion of being valued and devalued at work. And the conclusion she came to is basically the meaning of our work and the way we feel depends on the daily interaction with others, which is to say that the way that housekeepers felt about their sense of well-being tended to depend as much on what the doctors and nurses were doing than as what their supervisors were saying.

What were the issues they identified?

Things like the doctors not recognizing the cleaner’s presence — not knowing their name or just walking by as if they don’t exist. You could have the same housekeeper on your ward for years and not know his or her name. And the other thing that came up over and over again, was making the cleaner’s job more difficult — for instance, the housekeeper is trying to move her cart down the hall and nobody will get out of the way. And then not being included in like potluck dinners and activities on the hospital ward, and walking over freshly waxed floors, ignoring the signs — all the things that make people feel like they just don’t exist.

In the film, we talked about what happens when a patient dies and the housekeeper isn’t informed, and then this person they came to know very well, just vanishes. And there’s no attempt to include the housekeeper in the process of dealing with that loss.

How do the housekeeping staff members get these extra things done and have these conversations when they have so many rooms to clean? Is the time to do that built into their jobs?

That’s a really good question. The best I can say is that the housekeepers managed to do it despite the time pressures that they’re under. I think it’s just more a testament to their dedication that they’re able to have these little conversations with folks in the course of doing the work they need to do every day. It’s just people doing things beyond their job description, and what fascinated us when we did these interviews is the extent to which they saw that as a calling. And it wasn’t just like this horrible job and I’m going to do it to make money — this is something that people just want to do because they cared about doing it and they considered their job to be a very important job, even if nobody else may recognize it at the moment.

I just want to add one more thing. The film is not meant to ever glamorize the work of housekeepers. And that’s a big part of my worries about the project. There are still enormous issues with respect to wages and working conditions that need to be addressed more than ever. So we’re not kind of saying that everything is fine — far from it. We’re just poking at one piece of the puzzle, in the hope that people will recognize the work as being vital, and that folks as a result will get more equitable treatment.

What do you hope to achieve with the film?

Our ultimate goal is to get this into medical schools to be used routinely as a teaching tool. I think it will matter. I think people will walk onto the ward the next day and think that it might be a good idea to greet the housekeeper, to learn, or whatever it takes to change the situation.

Our first step has been to create a curriculum and publish it in the medical literature. We thought that something that is sort of evidence-based will get much more traction at medical schools. We just submitted that to a journal and we’re waiting. We’re just hoping to have it published in the near future, at which point we’ll make extra new efforts to get it out into medical schools, nursing schools, physician assistant schools, and so forth. I have shown it at a number of different grand rounds, but it’s a process and our hope is to do the educational piece.

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    Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow