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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 practices.
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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 with in 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,
we are working on forming a Massachusetts Work-Family
Council. The goal is to institutionalize a holistic
approach to the integration of work and family by bringing
together the broad range of stakeholders involved in
the problem. We are following a three-stage operational
plan: (1) The Workplace Center convenes a consortium
of academic centers dealing with work-family and related
issues to develop a proposal for a Council; (2) Consortium
members use the proposal to engage significant stakeholders
in further planning and recruitment of interested parties;
(3) A committee formed by the Consortium and stakeholders
takes steps to found a Council. As long as necessary,
the Workplace Center will serve as convener and organizer
of the process.
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Workforce Issues in
the Greater Boston Health Care Industry: Implications
for Work and Family,
Mona Harrington, Ann Bookman,
Lotte Bailyn, and Thomas A. Kochan
DOWNLOAD
THE PDF (WPC0001)  |
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Enhancing Patient Care
Through Enhancing Employee Voice: Reflections on
the Scanlon Plan at Boston's Beth Israel Medical
Center,
Mitchell T. Rabkin, MD, and Laura
Avakian
DOWNLOAD
THE PDF (WPC0002) |
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Supporting Caring Caregivers:
Policy and Practice Initiatives in Long Term Care,
Susan C. Eaton and Barbara Frank
DOWNLOAD
THE PDF (WPC0005) |
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Reinventing the Health Care System from Within: The Case of a Regional Physician Network in Germany,
Katrin Kaeufer, Claus Otto Scharmer and Ursula Versteegen
DOWNLOAD
THE PDF (WPC0006) |
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Beyond
Work-Family Balance: Advancing Gender Equity and Workplace
Performance. Rhona Rapoport, Lotte Bailyn,
Joyce K. Fletcher, and Bettye H. Pruitt, Jossey Bass,
2002.
 Everyone
who struggles to meet the demands of work and personal-life
responsibilities knows how tough it is. This book shows
that it is the deeply engrained cultural separation
of work and personal life that has limited our ability
to deal effectively with this conflict. Based on work
with a dozen organiztions, the authors detail workplace
interventions that meet the goals of work-personal life
integration, equity, and effectiveness.
 GO
TO PUBLISHER'S SITE FOR THIS BOOK
Working
in America: A Blueprint for the New Labor Market.
Paul Osterman, Thomas A. Kochan, Richard M. Locke, and
Michael J. Piore, MIT Press, 2001.
 The
American labor market faces many deep-rooted problems,
including persistence of a large low-wage sector, worsening
inequality in earnings, employees' lack of voice in
the workplace, and the need of employers to maximize
flexibility if they are to survive in an increasingly
competitive market. The impetus for this book is the
absence of a serious national debate about these issues.
GO
TO PUBLISHER'S SITE FOR THIS BOOK
Care
and Equality: Inventing a New Family Politics.
Mona Harrington (Routledge, 2000)
 Who
is now caring for America's children, for the elderly,
the sick, the disabled? According to Mona Harrington,
the traditional system of caregiving - until now almost
entirely dependent on the unpaid labor of women in the
home - is in a chaotic state of disrepair, as women,
in large numbers, move into the workplace. Harrington
issues an urgent call for new political conversations
about assigning responsibility for this important part
of the "general welfare" that the Constitution charges
us to promote. Care must now, Harrington argues, become
the joint responsibility of the family, the private
employer, and the various levels of government.
GO
TO PUBLISHER'S SITE FOR THIS BOOK
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