Worried about burnout of its top physicians and scientists, Stanford Medical School is trying a new weapon -- a kind of banking system that will let doctors "pay in" and "draw out" workload levels over the decades of their careers.
The new program, being tested this fall in five medical school departments, was the result of an "aha moment" about why earlier work-life balance programs for the medical school's 872 faculty members had failed to gain traction.
Professors were declining to take advantage of time-honored traditions like sabbaticals and newer policies like extension of the tenure clock, said Hannah Valantine, a professor of cardiovascular medicine and senior associate dean for diversity and leadership.
"People in some sense were afraid of being viewed as not serious about their careers," Valantine said.
They worried they would look less committed and also that they would place undue extra burdens on their colleagues if they took time away.
It dawned on planners that the medical school's policies to promote work-life balance -- however appealing and up-to-date -- conflicted with the deeply held values of faculty members.
"What we found is faculty members don't want flexibility if it comes at the price of success at the very highest levels," said Jennifer Raymond, an associate professor of neurobiology who got involved in the search for answers.
And yet, worries about losing top doctors and research scientists to burnout were only growing.
"We recognize that physician burnout is a huge problem, and it leads to poor patient care, turnover and poor quality in general," Valantine said.
"Our two, world-class hospitals right here aspire to be the best and want to deliver the highest possible quality of care, and the faculty are the engines by which this happens."
Raymond, who works with doctoral students, said: "We're hearing more and more of them say, 'I love science, but I don't want an academic career because it's not compatible with any outside interest.'
"We'd like to be able to compete for the best and the brightest, not just people who are willing to work 24/7," she said.
Studies have shown that young graduates are turning away from academic work because of perceptions that faculty careers are not conducive to work-life balance, Raymond said.
In 2010, a 35-member Stanford task force launched a renewed quest for solutions.
The group looked at part-time models used at Kaiser and Palo Alto Medical Foundation, but "We realized what our faculty was asking for was really not part-time, but something else," Valantine said.
"We couldn't figure out what that 'something else' ought to look like."
Valantine turned to Stanford colleague David Kelley, founder of the design firm IDEO, and author of "Design Thinking."
"We'd heard he'd come up with creative solutions based on human-centered design, and we wondered if he could help us," she said.
Kelley referred the medical professors to the San Mateo consulting firm Jump Associates, which delved into ethnographic research, probing the lives of faculty to draw out answers.
They held in-depth interviews and filmed eight professors -- from when they got up in the morning and transitioned from home to their homecomings at the end of the day -- and then analyzed the clips in search of themes.
"One of the things we saw the faculty doing were trying to bank favors with their colleagues," Raymond said. "A woman would do more hours of call than she'd ever done in her life right before her maternity leave."
The team's "aha moment" came after hearing a kidney specialist comment that after the birth of her first child she bought a minivan to ferry neighborhood children in hopes that their parents later would return the favor.
"We thought, 'If we could somehow formalize this' -- because the people who banked favors never seemed to feel comfortable calling those favors back in," Raymond said.
"A formalized trading system might help in a culture that makes you feel like you should never show any sign of needing help."
Hence this fall's pilot programs, in which faculty members can earn credits through extra work and later "buy back" time or services, such as housecleaning, meals or the use of a science writer to help write and edit grant proposals.
First, professors must participate in a long-term career planning session, laying out professional goals as well as opportunities for things like sabbaticals.
"It's more natural to leverage these policies if it's part of a planning process and not something that's done by special request on the side," said Caroline Simard, the medical school's senior associate dean for diversity and leadership.
Because of its work on the program, the medical school recently was named a winner in the Alfred P. Sloan Award for Excellence in Faculty Career Flexibility.
"Without innovative new work models, we risk losing generations of promising young physicians and scientists from academic medicine," medical school Dean Phillip Pizzo said.
Valantine argues that sabbaticals actually can be career enhancers, not career drags.
"We think if you take these things you actually will be more productive, in terms of the standard, classical academic metrics of success," she said.
The traditional academic career path was designed for a different era, when families had a single breadwinner with a spouse at home to take care of everything else, Valantine said.
"Now most families have both adults working, and people want to have better relationships with their children. The workplace needs to change in its expectations and the way work is designed and done," she said.
"At the core of that is integration of life and work as opposed to 'balance.'"