Here is a brief extract from a valuable book that described how outsourcing was losing the sort of crucial healthcare information that can come from the supposedly "unskilled workers."
Appelbaum, Eileen, Peter Berg, Ann Frost, and Gil Preuss. 2003. "The Effects of Work Restructuring on Low- Wage, Low-Skilled Workers in U.S. Hospitals." In Eileen Appelbaum, Annette Bernhardt, Richard J. Murnane, eds. Low-Wage America: How Employers Are Reshaping Opportunity in the Workplace (Russell Sage Foundation): pp. 77-117.
85: "because food service and housekeeping are not typically seen as distinct sources of hospital success or expertise, some hospital administrators have outsourced these functions or their management to external firms that specialize in these areas. On the other hand, food service workers, housekeepers, and nursing assistants all have direct contact with patients, and contacts can affect patients' experiences in the hospital and satisfaction with care. In response, other hospital administrators have sought to improve employee skills within these jobs and ensure a more stable workforce through more careful selection, cross-training, and work reorganization."