Abstract
Over the course of several decades Jeffrey Pfeffer has produced a series of books centered around a common theme: that it is both possible and desirable to reorganize work in ways that are beneficial to employees and to produce positive outcomes for firms. The previous books have emphasized the components—broad jobs, worker training, job security, employee engagement—of what are termed high performance or high commitment work systems. In Dying for a Paycheck the author extends his argument by making the case that the lack of these systems deeply damages people’s health.
Pfeffer argues that far too often the organization of work, the Human Resource Management (HRM) decisions of firms, leads to significantly negative health outcomes for employees. He makes his case by offering an estimate of the health consequences of “bad” practices: job insecurity, lack of health insurance, long hours, stress, work–family conflict, and several others. There is a deep literature on each of these topics, and the argument that unemployment hurts people’s health, for instance, would not be new to any specialist. But an important contribution of the book is that it pulls together all of these practices into a coherent story about how organizations mis-value people. Additionally, Pfeffer provides an estimate of what these bad practices add up to in terms of a total scorecard of needless deaths. This latter estimate is shocking and powerful. It is also likely to be controversial, but if it opens a debate on the overall question, that in itself would be a big step forward. Along these lines it is surprising that Pfeffer does not discuss accidents and physical injuries at work. This omission had to be a conscious decision, but in industries as diverse as residential construction and home health care the rate of injuries is high and is directly related to the kind of HRM practices (as opposed to technology) that interest Pfeffer. But the inclusion of physical injuries would only make his case stronger.
Having made the case in broad strokes, Pfeffer looks at a number of the practices in detail and concludes by offering ideas about how to improve jobs and achieve healthier outcomes. The chapters on each practice are valuable reading, particularly for those not steeped in the more technical scholarly literatures. The net effect is sobering and certainly supports the core argument that much about how work is organized is bad for our health, often tragically so. The dangling question is how to explain the prevalence of bad practices and, with this explanation in mind, how to make things better.
Pfeffer never steps back and offers a general theory of bad behavior but two threads run through the book, one more insistent than the other. The first thread is that employers just do not get it. If they paused and reconsidered their assumptions they would reform themselves. This line of thought is consistent with much of Pfeffer’s prior scholarship that highlights best-practice companies such as SAS, Southwest Airlines, Costco, and so on, and indeed these companies reappear in this book. But happily so too do new (to me) firms. And repeatedly the story is that the CEO had an epiphany that treating people better is not just the right thing to do but will improve firm performance. “We became aware that all twelve thousand people who work for us are somebody’s precious child (p. 18)” is a typical comment from these newly enlightened leaders, and Pfeffer goes on to say that the performance of the company in question is outstanding. The implicit lesson is that if only this realization could be broadly diffused the problem would be much alleviated. This, then, becomes a story about information and learning; it is not a story that some, and perhaps many, of these bad practices are in fact profit maximizing and need to be blocked.
This latter story does appear in Pfeffer’s policy discussion of health insurance in which he praises a San Francisco tax on employers that forces them to face up to the social costs of inadequate insurance. But this is really the only time the “epiphany” perspective is challenged, and Pfeffer does not acknowledge or attempt to resolve the conflicting underlying theories. A persuasive defense of the epiphany viewpoint would require a full accounting of the costs and benefits, from a profit-maximizing employer’s viewpoint, of “good” versus “bad” policies but Pfeffer does not offer this. At best what is provided is a discussion of some benefits, for example reduced turnover or more alert workers, but not the costs of achieving these benefits.
It is certainly the case that some of the issues Pfeffer addresses in Dying for a Paycheck should be win–win to fix and the book’s missionary approach, accompanied by information sharing and perhaps some incentives, is the right way to go. A clear example is improving scheduling practices so that people have reasonable notice of their working hours. Another example is improving work–life balance policies. But is job security normally in a profit-maximizing employer’s interest? Are there not many cases when it is in an employer’s interest to push for long hours? And is devolving job control to employees typically profit maximizing? Pfeffer might want to answer yes to these questions, and he uses the phrase “doing well by doing good.” But if “doing well” means maximizing profits then he does not make the case. Many employers may disagree with his claim, and their disagreement would be based in the reality that their private costs would outweigh their private benefits. It seems likely that for many firms unhealthy policies are not simply due to a failure to see the light.
To the extent that bad practices are reality based from the viewpoint of employers, then the policy menu offered by Pfeffer is incomplete. His focus is on better measurement and selling the win–win case and not on regulation (with the exception of health care) nor on countervailing power. Indeed worker voice and unions are not discussed in the book, nor, in any depth, is political mobilization around these concerns. It seems to me that regulation, worker voice, and political action are more important than the book lets on.
The foregoing describes my concerns. But it would be a mistake to end the review on this note. Pfeffer has provided a great service by forcing us to understand workplace health issues in a holistic way. Instead of thinking of each topic—stress, health care, unemployment, and so on—as a separate question, Pfeffer encourages us to consider them as a group, one might say a syndrome, that is linked to a firm’s overall HRM philosophy, values, and policies. Furthermore, on each of these topics Pfeffer provides a wealth of data and real-world cases and has done so in a very readable and engaging way. Dying for a Paycheck is a deeply humane book that addresses a vitally important topic. It should be widely read.