Supporting Family Caregivers in STEMM: A Call to Action (2024)
Chapter: 7 Innovative Approaches to Career Flexibility
7
Innovative Approaches to Career Flexibility
This report thus far has presented established approaches that have been tested and improved over time for best practices that support caregivers through better and more accessible information about resources, more control over weekly work schedules, and stopping the tenure clock and modifying duties. But, as noted in Chapter 6, cultural barriers remain and inadequate support for caregivers still exists, with repercussions for retention and advancement for women and other family caregivers. Action cannot only look to what has already proved to be beneficial but also should push beyond current barriers and strive for even greater support for family caregivers. This chapter details innovative practices as a call to action for new and inventive solutions that encourage creative thinking.
A common theme that has emerged is the importance of flexibility and experimentation to successfully maneuver competing responsibilities. Rigidly organized traditional science, technology, engineering, mathematics, and medicine (STEMM) workplaces do not serve our workforce and do diminish its ability to perform in the creative and scholarly ways for which they have trained. Data from Future Forum find that flexibility is just behind compensation in terms of factors affecting employee satisfaction, and the vast majority of workers want flexibility in both where and when they work (Future Forum, 2022). Moreover, many newer entrants to the workforce expect flexibility and support for personal and family life as a critical job support (Friedman, 2022).
In response to these challenges, the committee sought out workplace examples of innovative ideas, ones that go beyond currently established policies to tackle cultural change and provide greater support to caregivers particularly in the realm of flexibility. There is also the need for innovative solutions to support students, and thinking creatively, the examples presented here could be adapted to their needs.
The following innovative approaches do not have the same degree of research backing and evaluation as the best practices outlined in Chapter 6, but they encourage us to look beyond current practices to consider what the future may hold for supporting family caregivers. The committee also draws on the words of family caregivers themselves (see Boxes 7-1 and 7-2) to detail the kinds of actions they see as beneficial to reimagining the academy to be more supportive of family caregivers.
As with the best practices detailed in Chapter 6, the potential for negative and unintended consequences always remains, even more so when policies are new and innovative. Engaging innovation remains important to advance support for caregivers, but care must also be taken to ensure attention to how policies are implemented and ensure adequate evaluation of both success and challenges to adapt and build further.
From the sample programs and practices covered in this chapter, the committee suggests five drivers of good culture that stand out and could
BOX 7-1
Reimagined Academy: Alternative Visions of Academic Success
Caregivers put revised standards and process for tenure and post-tenure advancement at the center of their alternative visions for the academic STEMM workplace.
Building on the idea of a “COVID statement” (implemented on some campuses for faculty who came up for advancement during the early pandemic), interviewees suggested institutionalizing a process for taking ongoing caregiving responsibilities into account in academic advancement decisions. Several interviewees proposed that all tenure and promotion packages should include a written statement on responsibilities outside of the university.
serve as effective antidotes to a toxic culture: trust, transparency, asking and listening, collaboration, and accountability. Thinking creatively about each of these drivers can spur action toward new and unique ideas.
Trust: Current forms of management typically do not engender trust in employees. Focusing on how many hours a person sits at their desk is not a measure of their productivity. Trust is evident when employees are empowered to set a schedule for themselves that meets their needs, as well as the needs of their employer.
Transparency: Transparency involves the quality of being open to public scrutiny. In so many workplaces, private deals abound—when you work, where you work, or how you work, as well as your compensation. Transparency about these arrangements and requirements for advancement and tenure increases the possibility of equity plus the recognition of individual needs and responsibilities.
Asking and listening: Many workplace innovations in both scheduling and work processes do not come from top-down fiats. They come from asking employees what works, what does not work, and what they need, and then listening to their answers. Employees are closest to the work and often know better than others what needs to change to support their needs and promote their productivity.
A packet for promotion, for tenure, for evaluation would contain a section that describes your outside responsibilities, your home responsibilities…. ‘Tell us about who you are outside of work and what other responsibilities you have.’
Interviewees envisioned a caregiving statement detailing current (and relevant recent past) caregiving responsibilities, and perhaps other outside activities that conferred a sense of the candidate as a person with compelling investments and accomplishments beyond the academic workplace.
“The timeline maybe wouldn’t need to be so rigid, or even the expectation of actual amounts of productivity, if you could take the opportunity to explain: “This is what I did with my time. Despite the fact that I have X, Y, Z other responsibilities to take care of at home … I was still able to manage to do this thing in this amount of time with what I have.”
BOX 7-2
Reimagined Academy: Care-Centered Academic Workplace Norms
Many interviewees spoke to the need for radical change in the culture of academic STEMM workplaces in the United States, rejecting what they saw as the primacy of competition and individualism over care and collaboration.
Caregivers of color and those from immigrant backgrounds in particular made a compelling case that academic STEMM workplaces would do well to adapt some of the assets reflected in non-dominant cultures, particularly around valuing care and collaboration.
“When you become a caregiver, you acquire so many skills that are very helpful in teamwork. So, I think if academia starts valuing more than achievement, how good you are as a collaborator, I think a lot of caregivers coming from … a minority background will be very successful because by definition … it’s not by definition, by history, I mean the people who come from minority backgrounds, they have to struggle. So, there are a lot of valuable skills in that journey that can be very helpful in teamwork.”
Interviewees advocated incorporating “the values of caregiving” into the broader culture of STEMM workplaces. Rather than making special accommodations for caregivers, some suggested universal changes that made academic STEMM workplaces more consistent with a balanced life and substantial priorities outside of work.
Collaboration: Today’s work environments often center on teams. We see this in the private sector as well as in academia in shared jobs and shared laboratories, as described below.
Accountability: Any workplace change demands accountability. Is it reaching the goals it set? Are the individuals being held accountable? Accountability is built into several of the examples provided below.
Each of these drivers plays an important role in exploring novel approaches for university supports for family caregivers and allows individuals to be their most authentic selves. The committee presents them next to ignite imagination about how organizations can rethink work within a framework that is compatible with workers who are caregivers.
“We have a rule here that … everything has to be done by 5:00 because daycare pickup is 5:30. So, as a department, we don’t do anything that starts after 4:00. It’s a very simple policy, but it’s very impactful.”
Universalizing a culture of work-life balance, they suggested, could place caregivers on more level footing with their peers (“nobody’s not showing up, nobody’s not doing their job”). But it also promoted work-life balance for everyone in the department. Many caregivers made the point that an academic STEMM culture that valued caregiving would be healthier for non-caregivers as well.
“If caregiving values were incorporated, I think standards would just be a little bit more realistic, and I think there would potentially be more room for people to be a little, a little more sane. Just because there would be room for that, like, life balance. Because, like, I said, I don’t think just because if your kids are older, or if you don’t have kids, I don’t think there’s any harm in taking breaks. I don’t think caregivers exclusively need that. I think people need that.”
Interviewees suggested that valuing care and recognizing caregiving responsibilities was central to cultivating a more holistic, less mechanistic regard for oneself and others in the STEMM workplace. As one interviewee who had supervisory responsibilities explained, “It’s [about] preparing for contingencies … having awareness that we’re working with people, we’re not working with machines, and that people have needs.”
INNOVATIVE APPROACHES TO PROMOTE WORKPLACE FLEXIBILITY
Temporary Decreased Effort
Disruption of on-site work patterns in academic institutions caused by the COVID-19 pandemic led many to look for ways to incorporate the potential for temporarily decreased effort and to explore alternative work options. Several universities have previously led and currently lead the way in addressing the need for transparent and accountable guidelines for negotiating part-time faculty positions.
Ten years ago, UMass Chan Medical School established criteria and a process for requesting part-time status.1 “These guidelines provided a clear and transparent framework to be used by both faculty and chairs in the discussion and subsequent decision about proposed reduction from full-time to part-time effort. The guidelines also clarify the process for decision-making and monitoring” (Thorndyke et al., 2017). The guidelines were implemented to ensure greater consistency in part-time work across the UMass health care system. A survey of department chairs and chiefs after implementation found that one-third had made use of them to discuss part-time options with faculty and found the guidelines to help in determining whether part-time work was an option and what approach made sense (Thorndyke et al., 2017). One important guideline allowed faculty initially hired into full-time positions to temporarily negotiate part-time and then return to full-time work. Similarly, in the University of California system, academic appointees may be eligible to reduce their percentage of time of an appointment from full-time to part-time for a specified period or permanently to accommodate family needs.2
Another version of flexibility is the Massachusetts Institute of Technology initiative, Work Succeeding, which provides rigorous guidelines as well as toolkits for managers and employees primarily focused currently on a variety of work sites: in-person, remote, and hybrid work rather than on decreased effort.3
University and medical school guidelines that emphasize transparency and accountability provide structure for both leadership and faculty in navigating the process to allow for part-time or off-site positions.
Teams
The significance of teams to higher education is increasingly apparent. Teams with scientific, educational, or administrative missions provide benefits that include creative solutions from differing perspectives. Collaborative
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1 To learn more about the UMass Chan Medical School part-time guidelines, see https://www.umassmed.edu/ofa/development/flexibility/part-time-guidelines/. As noted earlier in this report, when discussing part-time status, the committee is referring to work that is not contingent or marginalized in academia, but instead allows for a shift in intensity of work that is valued within the academy and can provide a path back to full-time work if desired.
2 To learn more about the University of California system part-time program, see https://academicaffairs.ucdavis.edu/work-life.
3 To learn more about the MIT Work Succeeding initiative, see https://hr.mit.edu/ws.
problem-solving leads to better outcomes, including validity of scientific findings. We have moved from the idealized image of the solo investigator generating brilliant new ideas to evidence that today’s most effective science is in multiauthored reports (Maddi et al., 2023). Of great importance to the mission of this committee is recognizing that teams can absorb the variation in effort that may be required to juggle work and family.
The smallest team is a duo. Examples of two principal investigators sharing a laboratory include Nobel laureates Michael Brown and Joseph Goldstein and, more recently, Katalin Karikó and Drew Weissman. A joint laboratory structure can lead to a better distribution of workload and play to each person’s strengths for a more fruitful creative process. It also provides trainees with different role models and perspective and, finally, helps even out the “ebb and flow of institutional knowledge” (Farese & Walther, 2021; Oldach, 2022).
Merging two existing laboratories or initiating a shared laboratory co-directed by two junior people avoids complications that could arise from a power differential. It is critical to get institutional acceptance of and willingness to support the scientific partnership model early in the process.
Job sharing is another alternative that allows meaningful engagement with decreased solo work responsibility. As a “creative approach to pursuing and achieving career goals for those with substantial obligations outside of their profession,” two employees share the responsibilities of one full-time job (Sacks et al., 2015). For example, two clinicians each work 60 percent and cover each other on the 2 days the other is off. They share an office, so they are both in the office together 1 day a week and can reconnect and discuss patient issues, but they essentially have a private office on the other 2 of their 3 days in the office.
Administrative role sharing similarly provides flexibility. For example, two academic physician colleagues, a married couple who are colleagues, share the role of program director that allows one of them to decrease work hours and cover childcare (Sacks et al., 2015). In another example, two individuals with different areas of expertise each spend 60 percent time in sharing a vice chancellor’s role. That leaves each 40 percent time for their own research and freedom to decrease total percent effort for a limited period when caregiving requires their attention. In addition to the flexibility benefit to each individual, the overlap uses the power and creativity of two people to brainstorm and is a bonus to the institution (Inge, 2018).
Open communication is essential in establishing and maintaining collaboration in job sharing, as well as any “nontraditional” work arrangement.
This collaboration must exist between individuals and also up the chain of command, as will be seen in the Predictability, Teaming, and Open Communication (PTO) model discussed later in this chapter. The initial design typically needs refining and can allow for modification over time as responsibilities outside or inside work change.
Grants to Support Caregiving Faculty
The flexibility necessitated by new caregiving responsibilities may mean cutting back from one’s previous work-time commitment yet maintaining research productivity. Financial awards can help basic and clinical investigators maintain momentum as they integrate family caretaking responsibilities with job responsibilities. For example, funds may be used to offset the salaries of additional “hands” in the laboratory or clinic. Massachusetts General Hospital4 and the Icahn School of Medicine at Mount Sinai5 have instituted such programs to support their investigators who are adding caretaking to career commitments. These programs often are funded by individual philanthropy or institutional budgets and occasionally by foundations, such as the Alfred P. Sloan Foundation or Doris Duke Foundation (Jagsi et al., 2022; Jones et al., 2019, 2020; Szczygiel et al., 2021). (For information on the Doris Duke Fund to Retain Clinical Scientists see Box 6-4 in Chapter 6.)
Lehigh University used a Sloan Award for Faculty Career Flexibility to institute a program of faculty grants of $6,000 each “intended to help untenured tenure track faculty members sustain research productivity while caring for a newborn or adopted child, or other family member.” Unlike the other faculty grants specifically targeted solely to supporting research, faculty members can use their grants in ways that they determine to be most useful, including covering costs for research travel or conferences, research assistance, technology, research materials, and for childcare and housekeeping.6 While these grants no longer have Sloan funding, they have been institutionalized, showing one way that foundation support can ignite new workplace approaches for caregivers.
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4 To learn more about the Massachusetts General Hospital program, see https://ecor.mgh.harvard.edu/Default.aspx?node_id=226.
5 To learn more about the Icahn School of Medicine program, see https://icahn.mssm.edu/about/gender-equity/programs.
6 For more information about the Lehigh University grant program, see https://provost.lehigh.edu/sites/provost.lehigh.edu/files/Lehigh_Sloan_Research_Grant_Reimbursement_Guidelines.pdf.
Flexible Tenure Processes Through Areas of Excellence
SUNY Upstate Medical University takes a unique approach to tenure. Faculty are not limited to a single career track but instead are asked to identify an “area of excellence” after joining. They can choose among three options—research, clinical service, and education—and faculty are not restricted to a particular track based on the percentage effort spent in each. The aim of this approach is to allow flexibility to pursue opportunities in different areas as they arise, rather than being limited to only one domain.
Faculty members work with their department chair each year to establish their area of excellence through an “Annual Agreement of Academic Expectations.” When a faculty member is up for promotion, they can select the area of excellence for the promotion committee to consider. In order to be promoted, the faculty member must demonstrate accomplishments in three domains in their area of excellence: leadership, innovation, and emerging regional reputation (American Council on Education et al., 2015).
Flexibility Supported by Time Banking
Given combined responsibilities of teaching, research, and clinical work, research has found that doctors on average work 10 hours more each week than other professionals (Shanafelt et al., 2012). This can result in stress that can lead to burnout, dissatisfaction with work, and ultimately, doctors choosing to leave. Though family-friendly policies may be officially available to help manage such stress, many physicians feel they cannot use them.
As noted in Chapter 5, one innovative solution is the time-banking system established at Stanford University School of Medicine. This chapter examines Stanford’s program in more detail. The program was implemented under former Stanford University School of Medicine dean Phillip Pizzo based on the realization that many doctors were choosing to leave careers in academic medicine due to challenges balancing this with family needs. He established a task force composed of clinical and basic science faculty from all faculty tracks and ranks, ranging from instructor to full professor, to fully understand faculty needs and challenges regarding work-life fit, including a benchmarking survey across 10 leading academic medical centers, published research, and focus groups. However, this work did not yield creative or novel approaches, so the task force leaders sought help from the Stanford University Hasso Plattner Institute of Design, or d.school, and a human-centered design company in the San Francisco Bay Area, Jump Associates.
A key finding by the multidisciplinary Stanford-Jump team was that although Stanford had nearly every “family friendly” policy on the books, faculty were reluctant to use them to avoid “signaling low commitment” and the resulting adverse career consequences that have been reported in academic and other settings. The team concluded that cultural transformation was needed to gain acceptance of flexible work practices. They identified two major domains of conflict, work-life conflict and work-work conflict,7 and created solutions for each conflict domain, structured around a framework they called Academic Biomedical Career Customization (ABCC) (Fassiotto et al., 2018).8 Its guiding principles were that all participants have different needs, and that transparency is essential.
The Stanford-Jump team recommended the creation of a time-banking system to provide a means of recognizing faculty efforts to support the flexibility needed by their colleagues. This was incentivized through a system of credits accrued from efforts to support others’ flexibility that allowed participants to “buy back” their time through the use of various services. The time faculty spent on service work that is often unappreciated, such as mentoring, committee service, and stepping in for colleagues on short notice, could be “banked” to receive credits that could then be used for services such as assistance with grant and manuscript writing, pre-made meals, housecleaning, care for children or older adults, and support for other household tasks such as with repairs or errands.
An evaluation of the program found that participants not only benefited in flexibility, but also saw workplace benefits. Specifically, results found that program participations received 1.3 times more grants during the period of analysis, resulting in over $1 million more in awarded funding per person (Fassiotto et al., 2018). These results suggest that innovative programs can help to reduce the extreme time pressures faced by academic medical faculty, even as institutional structures can remain restrictive. Stanford’s ABCC program was part of a 2-year, $250,000 pilot funded largely by the Alfred P. Sloan Foundation.
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7 Work-work conflict was defined in the report as challenges caused by the competing demands academic medical faculty faced from different aspects of their jobs, including research, teaching, clinical obligations, service, and administrative tasks.
8 The Academic Biomedical Career Customization planning tool created by Stanford University School of Medicine is available at https://sm.stanford.edu/app/abcc/.
Reentry Programs
Family caregivers may need to take time away from paid employment to focus on the needs of those that they care for, but reentry into the workforce can be a challenge, especially after an extended period away. Reentry programs provide on-ramps back into the paid labor force for those who needed extended breaks for any variety of reasons, including caregiving. Returnship and return-to-work programs generally provide training and mentorship to ease the transition back to work over the course of a few months and can help to encourage hiring managers to look beyond career gaps when considering potential hires (Vasel, 2021). Recent evidence suggests that men, however, may face penalties for using reentry programs due to gendered stigma against men leaving the workforce for childcare. Therefore, attention may be needed to ensure these programs are equally beneficial to everyone (Melin, 2023).
One example is the Re-Ignite program at Johnson & Johnson, which is aimed at experienced professionals ready to return to work after a career break of 2 years or longer. The program was started based on the realization that allowing for an on-ramp back into the workforce provided access to people who “come back to the workforce stronger and more prepared to take on the world’s most critical health challenges” (Johnson & Johnson, 2018).
In 2015, the STEM Reentry Task Force microsite, a career reentry initiative, was started by the Society of Women Engineers and iRelaunch. The initiative aims to increase the representation of women in technical positions through supporting reentry through returnships and return-to-work programs. Their website features many companies that have job opportunities for reentry (STEM Reentry Task Force, 2015).
Directly relevant to restarting a career in academia are the National Institutes of Health (NIH) reentry supplement grants, which were established by the Office of Research on Women’s Health in 1992. These grants were created to provide mentorship and retraining either full- or part-time for individuals looking to reenter an active research career following an interruption for caregiving or other qualifying events. Grant money can be used to update and extend research skills and to help reestablish the work they had been doing prior to a career interruption. Today, more than 20 of the institutes within NIH offer these grants (National Institutes of Health, 2023).
Predictability, Teaming, and Open Communication
Many professionals work 80-hour weeks both in and outside of STEMM. The result is often employee burnout, prompting exit from the organization, to search for something less stressful. An internal study conducted by a leading consulting firm, Boston Consulting Group (BCG), found that consultants could live with long hours but not with the unpredictability of those hours. BCG (working with Professor Leslie Perlow at Harvard Business School) developed a program entitled PTO—Predictability, Teaming and Open Communication—that is designed to rethink work processes and make the work more meaningful and manageable and thus reduce burnout (Kupp, 2021). This was a bottom-up initiative that began from asking and listening to their employees.
The three components of PTO are as follows:
- Predictability: consistent, protected offline time over the course of each week.
- Teaming: team collaboration and clear team norms to ensure everyone can take time off.
- Open communication: regular conversations facilitated by an outside coach to raise and address key issues as soon as possible.
At BCG, PTO increased work-life satisfaction and led to a 74 percent increase in intention to stay with the firm for the long term. Moreover, consultants using PTO felt more able to manage a high-intensity, high-growth career. One ingredient to the success of PTO is that a “confidential coach” is assigned to each team to coach them through the process, serve as a mediator when disagreements arise, and assist in setting “team norms,” such as not working on weekends. These coaches are already BCG employees and are selected based on their high emotional intelligence.
The principles of PTO can be appropriate for academia. By defining certain boundaries around work hours, such as no meetings after 5:00 p.m. or on weekends, and enabling an open collaborative effort, employees can be helped to achieve a more sustainable work-life balance, and junior colleagues can be empowered to advocate for themselves. Also, by working in teams, people are encouraged to communicate their individual scheduling expectations and check in regularly with team members. To the extent possible, having coaches available would facilitate the process.
Four-Day Workweek
The 5-day workweek was popularized by Henry Ford in 1926, with the goal of increasing production, and it has defined the workplace ever since. The assumption that the 5-day workweek is the most productive and efficient way to work has, however, been recently challenged by the results of a series of 4-day workweek trials. These trials were conducted over the last 18 months in multiple industries and sectors in the United States, Canada, the United Kingdom, and Ireland. Employees who worked 12 months at 4 days/full pay reported less burnout, improved mental and physical health, and better work-life balance. Employers who adopted these 4-day workweeks reported decreased turnover, sustained productivity, and because communication stayed constant, clients often did not even notice that the firms worked a 4-day week. To achieve these results, the 4-day workweek was the standard schedule within an organization, and old ways of working had to be rethought. For example, in many of the participating organizations, the number of weekly meetings was reduced and uninterrupted time to focus was increased. “The longer people worked in new, more efficient ways, the shorter their workweek became” (Fuhrmans, 2023; Thomas, 2021).
Bring Your Baby to Work
Another innovation that came from asking and listening is the Babies at Work program at Badger, a New Hampshire business that produces organic skin care products. In 2008, an employee who wanted to bring her new baby to work prompted Badger to work with the Parenting in the Workplace Institute to study other programs regarding babies in the workplace. Badger’s resulting program, still in place, allows parents to bring their infants up to 6 months old to work.9
Prior to the baby’s arrival, Badger’s Human Resources department works with the parent-to-be to develop a Memo of Understanding that lays out business expectations, specifying the number of daily paid work hours and identifying the backup person to care for the baby when work necessitates that the parent step away. During the period that the baby comes to work, parents typically continue to work 8-hour days, but are paid for 6 or
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9 To learn more about Badger’s program, see https://www.badgerbalm.com/pages/babies-at-work.
fewer hours, since everyone realizes no one can work 8 hours straight and care for an infant. The company reports that they have no recruitment costs, that turnover is very low, and that employee engagement is, in their words, “through the roof” (W. S. Badger Company, 2016).
SUMMARY OF FINDINGS FROM CHAPTER 7
Though the programs presented in this chapter may not have the rigorous research backing of previously discussed best practices, they represent unique and innovative approaches to the challenges faced in academic STEMM and other similar workplaces where cultural norms present barriers to true flexibility. Additionally, for many of these programs, anecdotal outcomes as well as some early examinations have been positive. If this report is to advance thinking and support for caregivers, it is imperative to think beyond existing approaches. COVID-19 has shown that American workplaces can rethink their time and timing of work, as well as their work locations and processes, to create more flexibility for employees and enhanced outcomes for employers. There is growing recognition that the structure of when, where, and how we work is mismatched to the needs of an increasingly diverse workforce (Christensen & Schneider, 2010).
- Current innovations allow us to consider what the future may look like to better meet the needs of family caregivers.
- Innovative solutions exist across a variety of sectors, including academia, nonprofit organizations, and for-profit businesses that seek to challenge existing norms and practices that hinder family caregivers.
- Innovative solutions range from simple shifts and accommodations such as fostering shared laboratories and positions allowing individuals to bring their babies to work to a more fundamental rethinking of work in the form of a 4-day workweek.
- Innovative solutions should aim to build trust, transparency, asking and listening, collaboration, and/or accountability to help promote a more caregiver-friendly environment.
