Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

This working paper synthesizes critical problems identified by interviews with more than 40 leaders in the Boston area health care industry and places them in the context of work and family issues. At present, the defining circumstance for the health care industry nationally as well as regionally is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce. Under such strains, relations between managers and workers providing care are uneasy. Five key issues affect a broad cross-section of occupational groups, albeit in different ways: staffing shortages; long work hours and inflexible schedules; degraded and unsupportive working conditions; lack of opportunities for training and advancement; professional and employee voices are insufficiently heard. The paper concludes with possible ways to address such issues

Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties

Unexpected Connections: Considering Employees\u27 Personal Lives Can Revitalize Your Business

Efforts to integrate work and personal life affect people at all organizational levels. Traditional approaches seem to exacerbate the problem by pitting employee and business goals against each other. The authors\u27 approach to integration is based on linking personal lives and work in an opportunity to innovate and change. In a research project, Bailyn et al. worked with a company known for leading-edge employee benefits to find out why employees were not fully using those benefits. At each site, they collaborated to help employees better integrate work with personal lives and help the site meet its business goals. They helped product development team members change work practices so they could get their own work done during the day and reduce emergencies. By looking at the work from the perspective of people\u27s personal lives, the authors found areas of stress that were hindering work efforts. In a highly controlled customer service center, a three-month experiment in flexible scheduling resulted in a reduction in absenteeism and improved customer service. Again, the authors used workers\u27 personal lives to identify how old cultural assumptions undermined progress. In another group, the authors helped members identify synergies between sales and service and respond to personal needs at the same time. In all cases, Bailyn et al. began by looking at the stresses in people\u27s lives and then considering how to alter the work situation to improve their lives. The authors\u27 three-step approach is: 1. View work from the perspective of personal life. 2. Identify ways to change work practices to improve effectiveness and enhance work and personal life. 3. Implement work-practice improvements. In the end, it is the link between personal lives and strategic issues -- an unexpected connection -- that becomes the lever for challenging work practices

Representational predicaments at three Hong Kong sites

Representational predicaments arise when a job incumbent believes that attributions and images assumed by dominant authorities unfavourably ignore, or disproportionately and unfavourably emphasize, aspects of the incumbent\u27s own work and social identity. This is likely to happen when the incumbent does not have a close relationship with a dominant authority, and when power asymmetries give the former relatively little control over which aspects of their work and social identity are made visible or invisible to the latter. We draw on critical incident interviews from three organizations to illustrate a typology of six types of representational predicament: invasive spotlighting, idiosyncratic spotlighting, embedded background work, paradoxical social visibility, standardization of work processes, and standardization of work outputs. We analyse responses to representational predicaments according to whether they entailed exit, voice, loyalty, or neglect. Incumbents tended to respond with loyalty if they felt able and willing to accommodate their work behaviour and/or social identity to the dominant representations, and if there were sufficient compensatory factors, such as intrinsic rewards from the work or solidarity with colleagues. Exit or neglect appeared to reflect the belief that it was impossible to accommodate. Power asymmetries appeared to deter voice. Individual employees with a close and cordial working relationship with a member of a dominant authority group, or who were relationally networked to one, appeared not to experience representational predicaments

Time in organizations : constraints on, and possibilities for gender equity in the workplace

Title from cover."December 2000.

Redesigning work for gender equity and work-personal life integration

This paper describes a series of intervention projects in the conditions and design of work geared to increasing gender equity in organizations and the ability of employees to integrate their working lives with their personal lives. It shows that approaching work with a work–family lens tends to lead to changes in the temporal conditions of work, in what has come to be known as flexibility in the workplace. With a gender lens, more nuanced aspects of the institutions governing the workplace come into sight allowing the possibility of greater actual change in the way that work is designed and accomplished, thus leading to a better fit between the current workforce and the workplace. Although such intervention projects are being done in multiple countries, the discussion is most relevant to the USA, with its limited – almost non-existent – national support for the reconciliation of work and family needs