August 22, 2022

HOMERuN Collaborative: Parental Leave Policies in Hospital Medicine

The Hospital Medicine Reengineering Network (HOMERuN) is a rapidly growing collaborative made up of more than 50 Hospital Medicine groups from academic and non-academic hospitals across the United States.

Moderators: Areeba Kara, Anne Linker, Gopi Astik, Marisha Burden, Angela Keniston, Matt Sakumoto Focus Groups: We held 6 moderated breakout rooms with 4-5 participants each. Moderators used a semi-structured guide and held group discussions for 45 minutes.

Current State of Parental Leave

For Clinicians: Evolving to become more inclusive: Many described their experiences as the first men in their groups to take parental leave, others noted how policies were recently updated to allow time off for non-birth parents Parental leave is confusing and unclear: Many described the pressure to "self advocate," lean on the experience of colleagues, and "work in the shadows" to understand the leave process Few centers have clear planning leading up to parental leave Even fewer have strategies to support return Experience described as "disappointing" and "overwhelming" Clinical shifts taken off may need to be paid back, with expected negative impact on wellness

For Groups and Institutions: Used frequently Wide variation in support provided Generally well-tolerated by groups as long as it is a planned event Complex calculations involving FTE, duration of employment, employers, and roles

Challenges for Hospital Medicine

Traditional childcare options do not fill the needs; especially problematic for families with two professional parents with new challenges posed by the pandemic Hospitalist block scheduling may make planning difficult Finding locum coverage for academic hospitalists may be especially difficult The weight of self imposed expectations ("We need to find ways to save ourselves from ourselves") Hospitalists may have multiple employers with differing policies Human resources less familiar with nuances of hospital work Harder for smaller groups to provide flexibility Verbal affirmation and support but covert disincentives (e.g., pay reduction, covering "off" shifts in compressed time. Options and strategies for the temporary transition of non-clinical, grant, research and scholarship responsibilities are limited

"Resiliency has gone down."

Consequences

Decrease in total work effort or shifting to night work for women Experience of taking leave provides a different perspective Child-bearing decisions become contingent on availability of leave ("The first person you tell is your clinical director of operations, not your parents") Conflict between academic productivity and parenting ("I was losing my mind trying to figure out how to schedule meetings when my son was napping") Increases pay inequity between genders Sense of isolation for returning parents who feel they are alone in feeling overwhelmed

"Almost every returning birth mother has had to decrease overall FTE."

Strategies Currently in Use

Planning: Budget for parental leave ("If you don't budget for it, it becomes quite a burden"), "buffer" hires Creation of tip sheet by those with recent experiences Handoff and clear expectations around authorship and credit for scholarship and projects Public-facing page that transparently helps you understand eligibility and benefits Efforts to decrease exposure risk for pregnant women Dedicated administrative specialist who meets prospective parents to discuss options Fostering celebratory culture around births/family additions

Return: No "first call" responsibility or night call for 3 months following return Provision of lactation space equipped with workstations, hospital grade pumps and refrigerators close to wards Increasing access to wearable pumps Decrease census by one patient for duration of nursing Lactation credits

"There's a lot more we can do."

Future Directions

Collaborate and borrow from discipline of nursing and ambulatory medicine Collaborate and review data with Obstetrics on risks of pre-term labor and other adverse pregnancy outcomes and design work accordingly Role of state and federal laws Work on changing the culture of medicine Consider specific approaches to those undergoing fertility treatments Include learners in all strategies crafted Work on building trust and ensuring privacy to encourage earlier planning and comfort with disclosing plans for birth, adoption or surrogacy Shift and share responsibility of coverage from Divisions to institutions Intentional focus on decreasing pay inequities between genders that result from parental leave Standardization across Divisions Invite more input from the hospitalists to understand challenges Working to improve the workday (hospitalist RNs, discharge coordinator, etc.) will indirectly improve experience

Key Takeaways: Parental leave benefits vary widely between sites Parental leave is stressful for hospitalists to navigate There are few strategies in place to prepare for leave and fewer strategies to ease reentry following parental leave Current policies may increase gender inequities in salaries and negatively impact wellness Sites that staff for parental leave with buffers may handle absences better

The HOMERuN Patient and Family Advisory Council

Do you need the patient and family perspective on your quality improvement, research, or clinical operations project? Do you want to brainstorm ideas with patients and families about a project you are planning?   Anyone who is part of HOMERuN has access to the HOMERuN PFAC. The HOMERuN PFAC includes 11 members from across the country who can work in partnership with you to maximize the patient-centeredness of your work.    For more information about the PFAC, including scheduling time to bring your project to the PFAC, please contact James.Harrison@ucsf.edu or Tiffany.Lee@ucsf.edu

HOMERuN Antiracism, Health Equity, and Justice Work Group

Our Antiracism, Health Equity, and Justice Working Group will have new leadership under Areeba Kara. We welcome back everyone who was involved and invite others to join! Please reach out to Tiffany.Lee@ucsf.edu if you would like to join.

Become a Site for the RELIANCE Study: Roflumilast or Azithromycin to Prevent COPD Exacerbations

Purpose of RELIANCE: Both roflumilast and azithromycin have been shown to reduce the risk of COPD exacerbations compared to placebo. However, there has not been a head-to-head comparison of these two FDA-approved medications. RELIANCE is intended to support hospital efforts to reduce the risk of all-cause hospitalization and premature deaths in individuals with COPD.  RELIANCE is Seeking Community-Based Hospitalists: Hospitalists are critical in the development of post-discharge care plans and medications used by people with COPD. We found from preliminary work that identification of people with COPD while they are hospitalized is an efficient recruitment method for RELIANCE. Benefits and Compensation: $500/year honorarium for being a community partner (paid after registration) plus $200 per patient enrolled. Option to participate in clinical roundtables with COPD thought leaders. Contribute topic ideas for future grant proposals or publications related to hospitalist care. Community Partners will not be investigators / authors, but will be acknowledged in the RELIANCE publication.  Please reach out to Tiffany.Lee@ucsf.edu if you are interested in participating and would like more information about RELIANCE.

Foundations in Healthcare Leadership Fall Program

Created and led by the Institute for Healthcare Quality Safety and Efficiency (IHQSE), Foundations in Healthcare Leadership (FHL) is a rigorous development program for individuals looking to build a leadership career in healthcare. FHL blends practical in-person training, application to real world challenges, and longitudinal executive coaching with a tailored development and feedback program in the workplace to accelerate success. October 18-21, 2022, in-person, Denver, CO + 1-year virtual monthly coaching Learn more and register here

Our next meeting will be on September 9, 2022.

Parental Leave Image Attributions: Cartoon Vectors by Vecteezy @ Vecteezy.com

Check out the HOMERuN website for more information. If you would like to join the HOMERuN Collaborative calls, please reach out to Tiffany.Lee@ucsf.edu.