Karen Sacks offers the first detailed account of the hospital industry's nonprofessional support staff---their roles in day-to-day health care delivery, and why they fought so tenaciously throughout the 1970s to unionize. This case study of the relationships between work life and unionization in Duke medical Center highlights women's activism in general and black women's leadership in particular.
 
In addition to an analysis of the dynamics of women's activism, Caring by the Hour provides a comparative study of Duke Medical Center's treatment of both black and white female workers. Sacks links patterns of racial segregation in clerical jobs to the relationship between race, working conditions, and unequal opportunities for black and white women, and to their differing work cultures and patterns of public militance. She also discusses recent changes in service, clerical, and professional work and their effects on white and black women, placing them in the context of national changes in health funding and policies.

During his fifteen years as chancellor, Dr. Ralph Snyderman helped create new paradigms for academic medicine while guiding the Duke University Medical Center through periods of great challenge and transformation. Under his leadership, the medical center became internationally known for its innovations in medicine, including the creation of the Duke University Health System—which became a model for integrated health care delivery—and the development of personalized health care based on a rational and compassionate model of care. In A Chancellor's Tale Snyderman reflects on his role in developing and instituting these changes.
 

Beginning his faculty career at Duke in 1972, Snyderman made major contributions to inflammation research while leading the Division of Rheumatology and Immunology. When he became chancellor in 1989, he learned that Duke’s medical center required bold new capabilities to survive the advent of managed care and HMOs. The need to change spurred creativity, but it also generated strong resistance. 
 

Among his many achievements, Snyderman led ambitious institutional growth in research and clinical care, broadened clinical research and collaborations between academics and industry, and spurred the fields of integrative and personalized medicine. Snyderman describes how he immersed himself in all aspects of Duke’s medical enterprise as evidenced by his exercise in "following the sheet" from the patient's room to the laundry facilities and back, which allowed him to meet staff throughout the hospital. Upon discovering that temperatures in the laundry facilities were over 110 degrees he had air conditioning installed. He also implemented programs to help employees gain needed skills to advance. Snyderman discusses the necessity for strategic planning, fund-raising, and media relations and the relationship between the medical center and Duke University. He concludes with advice for current and future academic medical center administrators.
 

The fascinating story of Snyderman's career shines a bright light on the importance of leadership, organization, planning, and innovation in a medical and academic environment while highlighting the systemic changes in academic medicine and American health care over the last half century. A Chancellor's Tale will be required reading for those interested in academic medicine, health care, administrative and leadership positions, and the history of Duke University.