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Leveraging technological change to address racial injustice and worker shortages in frontline care delivery

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. As the seemingly neverending battle against COVID19 soldiers on, women and POC (people of colour) constitute the overwhelming majority of troops drawn into battle. They disproportionately staff many of the frontline healthcare delivery jobs most vulnerable to SARSCoV2, and now its most virulent mutation, the Delta variant. These jobs include ‘enrolled’ (in the UK) or ‘licensed’ (in the USA) practical nurses (LPNs), certified nursing assistants (CNAs) and inhome carers, all of whom put themselves and their families at great personal risk for the benefit of their patients. Pandemic conditions may be a relatively new development for these workers, but the abhorrent quality of frontline healthcare jobs is not. While ‘job quality’ remains a subjective and elusive construct, we can all imagine a ‘highquality’ bundle of economic, sociological and psychological attributes—generous or at least sufficient pay and benefits, job security and opportunities for advancement, a modicum of discretion over and interest in one’s work, and perhaps some control over one’s working time. 2 We might even hope that over time, technological advances including smartphones and robots could somehow encourage an upward drift in the incidence of all of these soughtafter ascriptions. But for decades, technologycentred automation has eroded job quality, making it easier for managers to squeeze wages and ignore poor employment conditions. Ironically, COVID19 provides a rare opportunity. With its lead foot on the gas pedal, it accelerates workplace technological change—all while managers and policymakers sit squarely in the driver’s seat. If these sectoral leaders seize the wheel, they can steer the coach and the economy away from technologycentred automation and toward the path of workcentred technification. In fact, a recent report undertaken in the USA suggests that for all of the misery wrought by COVID19, it could actually induce leaders—even in that fragmented system—to implement emerging technologies in a way that shores up employment conditions for essential frontline care deliverers. Conversely, if the sector remains on its present path, COVID19 will instead hasten the forms of technological adoption that abrade job quality in frontline care delivery. As if that were not enough to sound the alarm, this unguided, indiscriminate adoption of information and communications technologies (ICTs) and robotics could imperil patient safety by exacerbating the structural shortages in workers willing to undertake this work or the cognitive overload and burnout among those remaining. 5