Janet T. Civian

The relationship of perceived flexibility, supportive work–life policies, and use of formal flexible arrangements and occasional flexibility to employee engagement and expected retention

This study examines the relationship of perceived workplace flexibility and supportive work–life policies to employee engagement and expectations to remain with the organization (expected retention). It also explores the association of formal and occasional (informal) use of flexibility with these outcomes. Data are from a multi-organization database created by WFD Consulting of studies conducted between 1996 and 2006. Results revealed that perceived flexibility and supportive work–life policies were related to greater employee engagement and longer than expected retention. Employee engagement fully mediated the relationship between perceived flexibility and expected retention and partially mediated the relationship between supportive work–life policies and expected retention. Both formal and occasional use of flexibility were positively associated with perceived flexibility, employee engagement, and expected retention. These analyses provide evidence that workplace flexibility may enhance employee engagement, which may in turn lead to longer job tenure.

Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools.

Purpose Vital, productive faculty are critical to academic medicine, yet studies indicate high dissatisfaction and attrition. The authors sought to identify key personal and cultural factors associated with intentions to leave one’s institution and/or academic medicine. Method From 2007 through early 2009, the authors surveyed a stratified random sample of 4,578 full-time faculty from 26 representative U.S. medical schools. The survey asked about advancement, engagement, relationships, diversity and equity, leadership, institutional values and practices, and work–life integration. A two-level, multinomial logit model was used to predict leaving intentions. Results A total of 2,381 faculty responded (52%); 1,994 provided complete data for analysis. Of these, 1,062 (53%) were female and 475 (24%) were underrepresented minorities in medicine. Faculty valued their work, but 273 (14%) had seriously considered leaving their own institution during the prior year and 421 (21%) had considered leaving academic medicine altogether because of dissatisfaction; an additional 109 (5%) cited personal/family issues and 49 (2%) retirement as reasons to leave. Negative perceptions of the culture—unrelatedness, feeling moral distress at work, and lack of engagement—were associated with leaving for dissatisfaction. Other significant predictors were perceptions of values incongruence, low institutional support, and low self-efficacy. Institutional characteristics and personal variables (e.g., gender) were not predictive. Conclusions Findings suggest that academic medicine does not support relatedness and a moral culture for many faculty. If these issues are not addressed, academic health centers may find themselves with dissatisfied faculty looking to go elsewhere.

The Experience of Minority Faculty Who Are Underrepresented in Medicine, at 26 Representative U.S. Medical Schools

Purpose A diverse medical school faculty is critical to preparing physicians to provide quality care to an increasingly diverse nation. The authors sought to compare experiences of underrepresented in medicine minority (URMM) faculty with those of non-URMM faculty in a nationally representative sample of medical schools. Method In 2007–2009, the authors surveyed a stratified random sample of 4,578 MD and PhD full-time faculty from 26 U.S. medical schools. Multiple regression models were used to test for differences between URMM and other faculty on 12 dimensions of academic culture. Weights were used to adjust for oversampling of URMM and female faculty. Results The response rate was 52%, or 2,381 faculty. The analytic sample was 2,218 faculty: 512 (23%) were URMM, and 1,172 (53%) were female, mean age 49 years. Compared with non-URMM faculty, URMM faculty endorsed higher leadership aspirations but reported lower perceptions of relationships/inclusion, gave their institutions lower scores on URMM equity and institutional efforts to improve diversity, and more frequently engaged in disparities research. Twenty-two percent (115) had experienced racial/ethnic discrimination. For both values alignment and institutional change for diversity, URMM faculty at two institutions with high proportions (over 50%) of URMM faculty rated these characteristics significantly higher than their counterparts at traditional institutions. Conclusions Encouragingly, for most aspects of academic medicine, the experiences of URMM and non-URMM faculty are similar, but the differences raise important concerns. The combination of higher leadership aspirations with lower feelings of inclusion and relationships might lead to discouragement with academic medicine.

Faculty Vitality-Surviving the Challenges Facing Academic Health Centers: A National Survey of Medical Faculty.

Purpose Faculty with high vitality are essential to the missions of academic health centers (AHCs). Because little is known about how to measure or enhance faculty vitality, the authors assessed current faculty vitality and identified its predictors. Method In a stratified random sample of 26 nationally representative U.S. AHCs, the authors surveyed 4,578 full-time faculty during 2007–2009. The validated survey measured detailed faculty perceptions of their professional experiences and organizational culture. Vitality was measured with a previously evaluated five-item scale. Results Of the faculty invited, 2,381 (52%) responded, with 2,218 eligible for analysis. Respondents included 512 (23%) underrepresented in medicine minority (URMM) faculty and 1,172 (53%) women. In a multivariable model including individual- and AHC-level factors, the strongest predictors of vitality were faculty members’ perceptions of four dimensions of AHC culture: Relationships/inclusion, Values alignment, Work–life integration, and Institutional support (all P < .001). Weaker predictors were faculty age, institution type (public/private), and the AHC’s National Institutes of Health funding rank (all P ⩽ .03). Half of the respondents scored high on vitality, whereas 25% had low, or suboptimal, scores. Holding perceptions of culture constant, neither female nor URMM faculty had vitality scores that were different on average from male or nonminority faculty. Conclusions A large percentage of faculty lack the vitality essential to meeting the AHC missions of discovery, education, and patient care. Enhancing faculty vitality, and AHC resilience, requires more attention to strengthening relationships, improving the misalignment between faculty and institutional values, and improving work–life integration.

Mentoring Faculty: A US National Survey of Its Adequacy and Linkage to Culture in Academic Health Centers.

Introduction: The aims of this study were to (1) describe the quantity and quality of mentoring faculty in US academic health centers (AHCs), (2) measure associations between mentoring and 12 dimensions that reflect the culture of AHCs, and (3) assess whether mentoring predicts seriously contemplating leaving ones institution. Methods: During 2007‐2009, our National Initiative on Gender, Culture and Leadership in Medicine (C ‐ Change) conducted a cross‐sectional study of faculty from 26 representative AHCs in the United States using the 74‐item C ‐ Change Faculty Survey to assess relationships of faculty characteristics and various aspects of the institutional culture (52% response rate). Among the 2178 eligible respondents (assistant, associate, and full professors), we classified their mentoring experience as either inadequate, neutral, or positive. Results: In this national sample, 43% of the 2178 respondents had inadequate mentoring; only 30% had a positive assessment of mentoring. There was no statistical difference by sex, minority status, or rank. Inadequate mentoring was most strongly associated with less institutional support, lower self‐efficacy in career advancement, and lower scores on the trust/relationship/inclusion scale. The percent of faculty who had seriously considered leaving their institution was highest among those who had inadequate mentoring (58%), compared to those who were neutral (28%) or had positive mentoring (14%) (all paired comparisons, p < .001). Discussion: In a national survey of faculty of US AHCs, mentoring was frequently inadequate and this was associated with faculty contemplating leaving their institutions. Positive mentoring, although less prevalent, was associated with many other positive dimensions of AHCs.

Assessing the Culture of Residency Using the C - Change Resident Survey: Validity Evidence in 34 U.S. Residency Programs

BackgroundA practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents.ObjectiveTo develop and present evidence of validity of an instrument to assess the culture of residency programs and the clinical learning environment.DesignDuring 2014–2015, we surveyed residents using the C - Change Resident Survey to assess residents’ perceptions of the culture in their programs.ParticipantsResidents in all years of training in 34 programs in internal medicine, pediatrics, and general surgery in 14 geographically diverse public and private academic health systems.Main MeasuresThe C - Change Resident Survey assessed residents’ perceptions of 13 dimensions of the culture: Vitality, Self-Efficacy, Institutional Support, Relationships/Inclusion, Values Alignment, Ethical/Moral Distress, Respect, Mentoring, Work–Life Integration, Gender Equity, Racial/Ethnic Minority Equity, and self-assessed Competencies. We measured the internal reliability of each of the 13 dimensions and evaluated response process, content validity, and construct-related evidence validity by assessing relationships predicted by our conceptual model and prior research. We also assessed whether the measurements were sensitive to differences in specialty and across institutions.Key ResultsA total of 1708 residents completed the survey [internal medicine: n = 956, pediatrics: n = 411, general surgery: n = 311 (51% women; 16% underrepresented in medicine minority)], with a response rate of 70% (range across programs, 51–87%). Internal consistency of each dimension was high (Cronbach α: 0.73–0.90). The instrument was able to detect significant differences in the learning environment across programs and sites. Evidence of validity was supported by a good response process and the demonstration of several relationships predicted by our conceptual model.ConclusionsThe C - Change Resident Survey assesses the clinical learning environment for residents, and we encourage further study of validity in different contexts. Results could be used to facilitate and monitor improvements in the clinical learning environment and resident well-being.

Using a multi-organization database: Research methods, strengths, and limitations

This paper describes the WFD Consulting multi-organization database and the methodology used by the five quantitative studies in this special issue to examine workplace flexibility (Hill & Civian, 2008). The database includes 72,161 responses representing 312,459 employees from 25 US organizations in five industries gathered from 1996 to 2006. These studies have an average response rate of 45%. First, an overview of the research questions is presented. Next, definitions and psychometric properties of several commonly used measures and indexes are explained. After this, analytic strategies for hierarchical linear modeling including handling of missing data, protocols for model building, and accommodating clustered data structures are described. Finally, the strengths and limitations of using this kind of dataset for academic research are discussed.

A Novel Measure of “Good” Mentoring: Testing Its Reliability and Validity in Four Academic Health Centers

Introduction: Despite the well-recognized benefits of mentoring in academic medicine, there is a lack of clarity regarding what constitutes effective mentoring. We developed a tool to assess mentoring activities experienced by faculty and evaluated evidence for its validity. Methods: The National Initiative on Gender, Culture, and Leadership in Medicine—“C-Change”—previously developed the C-Change Faculty Survey to assess the culture of academic medicine. After intensive review, we added six items representing six components of mentoring to the survey—receiving help with career and personal goals, learning skills, sponsorship, and resources. We tested the items in four academic health centers during 2013 to 2014. We estimated reliability of the new items and tested the correlation of the new items with a mentoring composite variable representing faculty mentoring experiences as positive, neutral, or inadequate and with other C-Change dimensions of culture. Results: Among the 1520 responding faculty (response rate 61–63%), there was a positive association between each of the six mentoring activities and satisfaction with both the amount and quality of mentoring received. There was no difference by sex. Cronbach &agr; coefficients ranged from 0.89 to 0.95 across subgroups of faculty (by sex, race, and principal roles). The mentoring responses were associated most closely with dimensions of Institutional Support (r = 0.58, P < .001), Institutional Change Efforts for Faculty Support (r = 0.52, P < .001), Values Alignment (r = 0.58, P < .001), Self-efficacy (r = 0.43; P < .001), and Relationships/Inclusion/Trust (r = 0.41; P < .001). Discussion: Data demonstrated that the Mentoring scale is a valid instrument to assess mentoring. Survey results could facilitate mentoring program development and evaluation.