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The MIT Workplace Center has chosen
three industries that are critical to the functioning of the Massachusetts
regional economy as a focus for our work: health care, high tech,
and legal services. For specific projects, we collect baseline
data on the scope of products and/or services, the size and demographic
composition of the workforce, and recent trends that have an impact
on the overall structure and organization of companies in these
industries, as well as information on work-family policies and
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Health
care is the leading employer in the region, with over 450,000
workers in a wide variety of professional, paraprofessional,
and low skilled occupations. Employers include acute care hospitals,
sub-acute facilities such as rehabilitation centers and nursing
homes, home-based health agencies, outpatient clinics, and hospital-based
and community-based medical group practices.
Our initial research in health care involved interviewing over forty leaders
in the industry to learn about pressing workforce issues. Our findings are
summarized in a working paper, "Workforce Issues
in the Greater Boston Health Care Industry: Implications for Work and Family." We
found that many of the most pressing problems – such as staffing shortages
and long/inflexible work hours – have a direct impact on both patient
care and work-family issues, but that work-family issues are not named as such.
We see the invisibility of these problems as an issue in itself that bears
further investigation.
Our continued work follows a two-pronged approach - research and intervention.
Research: In several selected sites – covering
acute care, sub-acute care and primary care – we
are documenting the connections between workforce
problems and problems facing workers at home. We
hope to show how unresolved issues in the workplace
affect the families of health care workers and vice
versa. These multidimensional impacts will be gathered
by observing the work process, through written surveys,
and by interviews with health care workers, their
families and members of community-based services,
and institutions that have a stake in the well being
of the health care workforce.
Intervention: The second prong of our approach
will be to work collaboratively with workers, managers,
and other stakeholders in specific health care workplaces
to identify work-family problems and create alternative
structures and supports through work redesign or
other appropriate initiatives.
Teams Project
Ann Bookman and Mona
Harrington are conducting research on the operation
of two teams of health care professionals at a large
multi-specialty medical practice organization in
Boston. They have conducted individual interviews
with members of the Extended Care and Supportive
(formerly the Palliative Care Team) teams, as well
as with some family members of those teams. They
are doing work observations of team members - some
at nursing home sites and some in patients' homes.
Additional interviews are being conducted with nursing
home staff and patients' families. Research so far
indicates possible work-family interventions in three
areas:
- The interface between the teams and nursing home staff members
- addressing work hours, flexible arrangements, and stress.
- Work organization and integration or services, connecting the
work of the teams and staff based in outpatient centers - addressing
flexible work arrangements, work load, and stress.
- Work-family conflicts of patients' family members engaged in
decision-making and direct care - addressing flexible arrangements,
public policy supports, and integration of the needs of patients,
institutional caregiving staffs, patients' family caregivers,
and employers of family caregivers.
Medical Residents Work Hours Project
In June 2002, the Accreditation Council for Graduate Medical Education announced
the first national limits on the work hours of all medical residents, establishing
an average 80-hour work week for residents who now may work more than 120 hours
a week. The new rules do not take effect until July 2003, but anticipating the
Board's action, surgery departments at two Boston hospitals have adopted several
changes to begin to comply with the impending regulations. Kate
Kellogg is gathering qualitative data through observation of work processes,
and through interviews with residents, the people with whom they work, and partners/spouses
of residents. The project is tracking the way these changes in work practice
for surgical residents affect their ability to do their jobs and their ability
to integrate their work and personal lives. The aim of the study is to identify
both areas that work well and areas that are dysfunctional, and to analyze key
elements of each.
Lotte Bailyn is conducting
research on two surgical units at a Boston hospital -
a general surgery floor and the thoracic floor. She is
following nurses to understand their lives, particularly
how their work schedules intersect with their personal
lives and how the nurses interact with the surgical residents.
Physician Careers Project
The changes occurring in the health care system and in the composition of the
physician workforce are having a significant impact on the career paths and professional
fulfillment of Massachusetts doctors. Forrest Briscoe examined
these impacts by conducting a longitudinal survey and interviews within a large
medical practice organization. He finds that despite their traditional bias against
such large organizations that constrain autonomy, many doctors appear to value
working in larger organizational settings because of the better hours and more
predictable schedules available there. Briscoe is also completing a representative
survey of doctors across the state, co-sponsored by the Massachusetts Medical
Society. Data from this survey will allow him to generalize the findings of his
thesis research by systematically comparing career and work options across different
organizational settings (large medical groups, small private practices, hospitals,
etc). A possible intervention in this project is helping one large medical organization
in evaluating and improving the implementation of part-time and job sharing arrangements
for physicians.
Accountability in Health Care
John Carroll, in partnership
with the Massachusetts Coalition for the Prevention of
Medical Errors, is preparing a report on accountability
in health care and how the "shame and blame" culture
of personal accountability can be combined with a focus
on system improvement to enhance quality of care and
reduce errors. This report will be used in preparation
for a workshop bringing together major stakeholders in
Massachusetts to discuss new approaches to accountability.
The Role of Nurses in Change Programs
John Carroll is investigating
the role of nurses in initiating and implementing change
programs intended to enhance patient safety and quality
of health care, including how they are responding to
the reduction in hours of surgical residents.
Non-Pecuniary Rewards for Nurses
Economists tend to view money as the motivating factor and the basis of how all
decisions are made. Although limited, the research on non-pecuniary aspects of
jobs suggests otherwise: money is clearly not the only dimension that people
value in jobs. When making employment decisions, people do not always choose
the highest paying job, but instead trade-off wages against other important dimensions
(e.g., flexibility, work conditions, autonomy). Roberto
Fernandez and Brian Rubineau developed a
longitudinal survey design to study the tradeoffs nurses make when choosing among
multiple job offers. The survey has 3 important elements:
- Subjects are presented with several hypothetical
job offers, constructed in terms relative to their
current job (e.g., longer commute, more flexible
hours, etc.)
- Subjects are asked to make rank these offers along
several dimensions
- Subjects are asked about their current job-seeking
status, and willingness for more detailed follow-up.
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Having been invited to join the Boston
Bar Association’s Standing Committee on Work-Life Balance,
we are supporting on-going projects of this group. Its predecessor,
the BBA Task Force on Work-Life Balance, conducted a three year
study of Boston area law firm practices with respect to work-life
issues and published a report with broadly conceived recommendations
for change. (See "Facing the Grail: An Implementation Plan
for Addressing Work-Life Issues in the Legal Profession" at www.bostonbar.org,
under Document Directory.) One result has been the successful promotion
of work-life initiatives undertaken by the managing partners of
13 major Boston firms. The role of the Workplace Center is to contribute
to data collection, literature review, and general assessment of
projects. We are also working with Standing Committee attorneys
to prepare materials for business school students on work-life
issues in the professions.
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The MIT Workplace Center plans to study "New
Economy Firms" and to enhance MIT Sloan School’s research
on the organizational evolution of new enterprises in the greater
Boston area. In particular, we are interested in analyzing the
relationship between a company’s employment practices (i.e.,
policies concerning internal organization of work, hiring, training,
promotion, compensation, etc.) and their business strategy to see
whether and how these policies affect the performance and evolution
of new firms over time. Professor Diane Burton is interested in
the overlap between entrepreneurship and employment relations.
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Pursuing the "Call to Action" in the Sloan Work-Family Policy Advisory Board Report (2001), we have worked with a consortium of other research centers in the state on a new approach to work-family problems—the creation of a Massachusetts Work-Family Council. We are proceeding legislatively, having developed a bill based on an innovative key component. It creates a Council that puts together stakeholders from all sides of the problem—business, labor, government, community organizations, women’s associations—to identify new common ground on matters of private sector policy and practice as well as public policy. We think their resulting proposals can become a catalyst for economic growth in the Commonwealth at the same time that they enhance the quality of life for working families in the state.
An important focus of the Council’s mission will be public education and outreach. To that end, the Council will conduct hearings to identify major work-family issues in the Commonwealth, promote successful policies and practices in the public and private sectors and create a repository of best practices, as well as provide public education on work-family issues and on the need for public policies and private workplace practices that support the well-being of both employers and families.
But prior to the Council coming into existence, we have been engaged in public education through the process of discussing and developing the Council idea with a wide range of stakeholder groups, with legislators interested in work and family issues, with legislative leaders whose backing is essential to the success of any proposal, and with leaders in the various stakeholding communities whose involvement will be important to a Council once it is established.
VIEW A SHORT HISTORY OF THE MASSACHUSETTS WORK-FAMILY COUNCIL INITIATIVE
(In 2006, the bill (House 4216) passed the House and Senate in one legislative session only to be pocket vetoed by Governor Romney at the end of his term in January 2007. While this was disappointing, we are pleased to report that the Massachusetts Work-Family Council bill was re-filed by Rep. Lida Harkins at the start of the 2007 legislative session and, as of early February 2007, it is awaiting referral to a House committee.)
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