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October 9, 2008

One on One: Center for Health and Care Work director Carrie Leana

Carrie R. Leana was bartending in a Texas country and western bar after earning her BA in English when she realized she’d better get on with her life’s work.

It’s just that she didn’t know what that was. “My career path was not linear,” Leana said, in a recent conversation with University Times staff writer Peter Hart.

“I thought I should go to graduate school in something. I thought maybe law school. Then somebody told me about an MBA program that was shorter than law school. (laughs) I thought ‘I can do that,’ and they offered me a bunch of scholarships, so that’s how I got an MBA,” she said.

After graduation, she went to work for a bank. She found banking to be a bore, “but I found the whole organizational interaction really interesting, how people who come into these jobs are shaped by them, and how other people shape their work,” Leana said.

Following that insight, she went on to earn a PhD, joined the faculty at the University of Florida and began field research in organizational behavior and management.

She has published two books and more than 70 articles on authority structures at work, employment relations and the process and effects of organizational change and restructuring in such settings as steel mills, public schools, insurance claims offices, aerospace firms, police departments and labor unions.

She came to the Joseph M. Katz Graduate School of Business in 1988 as an assistant professor and later was named George H. Love Professor of Organizations and Management.

She holds secondary appointments in the School of Medicine and the Graduate School of Public and International Affairs, and is an associate at the Learning Research and Development Center.

At the Katz school, she developed the MBA essentials executive program and directs the UPMC-Katz physician leadership program. She has taught in academic and executive programs in North America, South America and Europe.

In 2003, Leana won a Chancellor’s Distinguished Public Service Award. Among many other honors, she was named the 2007-08 winner of the Aspen Institute’s Faculty Pioneer Award for Academic Leadership.

Most recently, Leana was named director of Pitt’s new Center for Health and Care Work, which seeks to inform the national discourse on how to better legitimize, compensate, develop and regulate direct care work in health care and other industries. Jules Rosen, Pitt professor of psychiatry, is co-director of the center.

The center aims to facilitate interdisciplinary research to address economic and workforce opportunities in the direct-care sectors; heighten the profile of the research on care work conducted at Pitt, and facilitate development of training programs and executive education.

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University Times: What prompted you to launch the Center for Health and Care Work?

Carrie Leana: I got started with this after doing some work with child care. Then I met Jules Rosen, and he thought the work I was doing shared a lot in common with the nursing home workers he had been studying. He came to the conclusion that nothing was going to really change in terms of sustained quality until there was an improvement in the workforce across the board.

With the growing demand of these care occupations, there are persistent difficulties in recruiting and turnover. There are negative consequences for consumers of these services, for the workers themselves and for the organizations that employ them. It’s really a societal issue.

What do you bring to the center?

One of the reasons I came to Pitt in the late 1980s was I was studying unemployment, which Pittsburgh had been plagued by. I did research on job loss and bank closings for many years. I came to realize that human capital arguments were not really compelling to practitioners. They’d say, “If we’re going through hard times, why shouldn’t we just get rid of the employees? We’ll hire new ones later.” The traditional argument against that was we would never be able to replace all that job-specific human capital. It takes time to learn a job, to master a system.

Even though I started off with the traditional perspective, I found it less and less compelling. I realized that a lot of what we were labeling human capital was really social capital. It was because of all the shortcuts — by that I mean efficiencies: Who knows what, and knowing the right people to go to, to learn how things really work outside of the organizational chart. Those are really social capital kinds of arguments.

I did a lot of work in industries, and I began to think that research might be relevant to public schools. My colleagues and I embarked on a four- to five-year study with the New York public schools and we’re just now publishing the findings. Essentially, what we found was that human capital is important and it’s also what gets all the policy action, it’s what politicians tend to fund. The traditional focus has been on things like curriculum, which is important, but I’m not sure moving to a different textbook is going to improve things that much.

What we found is that the relations among the teachers at a school can explain at least as much variance in how well their students do as does human capital. Social capital is a significant factor, but one that doesn’t get any attention in policy circles. So part of our research is how to make that operational: How could you think about social capital in a way that you could measure it and use it?

Do you have specific recommendations for improvements in a school setting?

Part of every teacher’s day ought to be spent working with other teachers on lesson plans, on discussing students and their unique needs, comparing notes on what works and doesn’t work in the classroom.

In most schools that’s just not part of the day. You can do that on your own if you want, but you’re not paid to do it. I think things would improve if that becomes more of a foundational part of the job — although that also means you might have to hire more teachers to build that time into the schedule.

Would that apply to all school levels?

Not precisely. I also became interested in preschool education. A lot of the states, including Pennsylvania, are moving toward universal access to preschool and incorporating that into the existing school system.

One of the things we were interested in is the same human and social capital relationship. But we also knew that working with very young children in preschools is a very different job than working with fifth graders.

If you talk to people who are advocates and even to foundations, their fondest hope is that if only preschool can become as good as K through 6. That’s setting the bar pretty low. I also don’t know of any data that would support doing pre-K just like we do K-6.

We learned something from our studies with teachers in these other elementary grades that collaboration really does help them. In preschool classrooms you almost always have more than one adult. So, collaboration is just something that’s part of the daily job. But you can do that in a variety of ways. You can say, “I’m going to do these things, and you do those things.” Or you can do things jointly.

We looked at something like 60 different preschools. Some of them were in public schools, some were Head Start programs, some were free-standing centers. We observed these classrooms and had interviews with the directors, etc.

The punch line is this: Organizing these types of classrooms the way we do K-6 is not great. We looked at essentially how to change the preschool teacher’s job description. What we found in these preschool classes was that people who customized their work on their own were generally in lower-quality classrooms. In part, that involved transparency. These teachers wanted to be in a system where they could close the door and do whatever they wanted.

People who customized things collaboratively were in much higher-quality classrooms. So this collaborative-crafting was really a key.

A lot of policy work is thinking about how we get systems in place so that we can scale it up. We’re always looking for answers like, “Hey, let’s do it here they way do it over there.” But our research suggests that we have to think about preschool in a different way.

A lot of what we see in most public school systems discourages collaborative-crafting. In elementary schools, teachers are on the job even at lunch time, monitoring behavior. So there really isn’t any time for collaboration.

We asked 6,000 teachers: If you have a question, whom do you go to? They don’t go to the “experts” that the district has anointed, sometimes called master teachers. They don’t go to their principal or to the library. By 3:1 they will go to their colleagues. So we’ve invested in a lot of expensive systems that have this experts model and the experts are not being used.

In what directions has your research expanded?

I started thinking about the similarities and differences between these public school teachers on the one hand, and child care workers and elder care workers. All of them do face-to-face work. But child care work is much more about care, much more about assisting people who can’t manage on their own. In preschool, you’re really helping kids to be able to master daily activity. That’s also true of the elderly. When you think about assisted living, the assisted part of that is literal.

Because child care and elder care are high-touch jobs, there’s a lot of emotional labor. By that I mean pretending to feel good when you’re not, smiling through the day, not showing your irritation.

The jobs also tend to be high-stress jobs. Care jobs can be physically demanding. The same with elder care. Laborers are the only job classification that has a higher incidence of on-the-job injury than nursing home caregivers.

This care work is generally very low paying and it’s also low status. Some people are willing to trade off money for status. Here you don’t have either. You have people doing very demanding work and not getting paid well for it, and nobody cares about what their opinion is.

It’s also a job with tremendous discretion. Usually, we pay for discretion, for judgment. Stock brokers get paid a lot of money because we’re counting on their judgment to make us all rich. In a day care center, other than keeping the kids fed and clean and quiet, what you do is up to you. And the worse the center, the more up to you it is.

It’s the same with elder care. When you think about what we regulate in elder care, it’s the medical aspect of the job: You must bathe your patients; you must feed them a certain amount. What we don’t do is legislate the dignity aspect, which is a very important part of elder care. It’s what we all want. We want personal care for our elderly mother, to not just give her a bath, but to do it in a way that maintains her dignity as an individual.

Do you think this is changing as baby boomers experience the greater need for high-quality elder care?

I don’t think it’s changing fast enough, but I think the pressures are there.

The question is: Are we going to let a social problem become a crisis? We have a situation where demand far outstrips supply for these workers, and it’s going to get worse.

What has your recent research shown in the care worker area?

One question with this study is: Why does anybody do it? And who stays with these jobs, not just who leaves them.

We’ve started a project, but we don’t have all the data in yet. But there are some things I can say. We did a focus group of about 50 of these folks. We found out that people who stay with their jobs are motivated by a different set of factors than the people who leave the jobs.

The people who leave tend to be motivated by factors in the work environment: whether their supervisor was disrespectful, whether they were understaffed, whether they had to work a lot of overtime. By the way, it’s not as though they leave and take better jobs; they leave and take the same type of job.

So, why do people stay? Is it because they’re treated with respect, because they don’t have as many demands on their time? That doesn’t seem to be the case. What we found instead is that people who had more stable work histories were people who by themselves imbued their jobs with more meaning.

There’s nothing in the environment that says this is important, meaningful work. The nurses and supervisors order you around. Nobody asks you about patient care. Patients often are not able to express appreciation for good work, and sometimes they’re even openly hostile. There’s nothing externally that’s reinforcing, so the reinforcing comes internally. I was surprised at how many of these workers described their jobs in terms of a calling. That calling in many cases was a religious calling: They do God’s work. That was one big factor that we didn’t expect.

The other big factor was feeling a sense of obligation to their patients. They wonder if they left what would happen. They’ll talk about the lack of respect and the challenges in the job, so they say the same kinds of things, but their sense is: “This is the work I’m called to do and I care about my patients.” Many of them would talk about how these patients were like family.

It some ways it’s very poignant. You see minimum wage workers going out and spending their own money to spruce up the room. Now, an economist would argue: “Well, that’s why they’re not getting paid much, because the job is so intrinsically rewarding we don’t need to pay them.”

That’s post hoc justification. The situation is more a choice: I am in this work and I can try to make lemonade out of these lemons, or I can just move from job to job looking for something I’m not going to find.

What we suspect is that taking these things into account — motivating a worker to stay and give quality care when they’re there, recognizing that calling and appreciating and cultivating that calling — would be a good thing.

A second study is focusing on retention. How can we develop these jobs so that there are meaningful career tracks?

A lot of policy efforts thus far have focused on how do we get people out of these jobs and into school to be LPNs (licensed practical nurses). That way they can dispense medication instead of just cleaning up after people. But somebody’s going to have to be cleaning up after people. We can’t off-shore it. And many of the caregivers want to do that job, they just want to have some sense of career ladder, more dignity, higher pay, higher stability and higher standards.

What are the data in this area showing?

We’ve just collected our baseline data with a random sample of about 1,400 of these workers in Pennsylvania. We want to follow the workers over two years. Most people in this line of work at the end of two years are not going to be in the same job. So we want to know who went to a better paying job, and why they quit.

We suspect a lot of issues with this workforce are the same as with the working poor, which most of them are. Nationally, about a third of single parents who are home health aides are on food stamps and about half live below the poverty line. Things that are a nuisance for us, like a car breaking down, are a calamity for them. If their car breaks down, or if their kid is sick or if they’re sick, they might lose a day of pay or even lose their jobs.

We think there’s a lot of opportunity to raise the standards for these jobs and for the workers in these jobs and for the overall quality of care. So much of this is publicly financed, so the states make regulations about the medical care. You could imagine them making regulations for nursing homes, for example, where your reimbursements are tied to your turnover, because if your turnover rates are high that’s an indication of bad quality.

Instead, we privatize this problem. Right now, basically, if your parents need help, it’s your problem. Let’s hope you have good insurance and a lot of disposable income. It’s the same with child care. It’s a privatized problem, instead of thinking this is society’s problem. We can’t keep going the way we are.

Is one of the goals of the center to get that message across?

Absolutely. One of the things we have in the center is an evidence-based approach to offering those solutions to influence policy. We’re not coming in with an ideology in terms of doing research that supports a particular position. Based on what we know so far, I still have some idealism left that the strength of the information, if it’s objective and not just somebody’s agenda, will drive policy.

If we’re in the front end of preschool design, let’s assume as a society we want to do it well, so let’s look at studies that we can learn from. What you see in education a lot and what we’ve seen in things like nursing home care is this rush to solutions. How do we get students to test better? How do we get the quality up?

I can see the urgency of it, but I also see discarded programs where we’ve spent millions of dollars and children’s lives and adult lives have sat on the wayside while we experiment without much foundational knowledge about what works. So at the center we hope we can provide that foundational knowledge.

Are there other ramifications to this approach?

Yes. When you think about regional economic development, a large part of any plan is to attract professionals to the region and that’s going to build a dynamic economy, etc. But part of that attraction is not only do you have opportunities for me, but also are the social supports in place here — good child care, good elder care?

If you don’t feel like your kids or your parents are in good hands, then you’re always on the phone, always distracted and that cuts into your work efficiency and is detrimental to your own well-being.

What’s it like being a woman professor in a business school?

I don’t think it’s as unusual as it was 20 years ago. But students are still coming into my office and asking if I can deliver this to Professor So-and-so (laughs). It happened just last week. There’s still this assumption that because you’re a woman, you must work for somebody else.

Things are changing. Now the MBA students are about 30 percent women. I teach executive MBA students and there it’s about 20 percent or less, maybe 15 percent. But that reflects the demographics in the workforce. Most of these people are in middle management, and by that time women are not as well represented as they are in entry-level jobs.

You’ve described your field as organizational behavior and management. What is that, exactly?

When I started as a professor, the approach I took, and I still take, is that our jobs were not just to reflect business practices and to teach our students what they are; the job is to reflect on business practices. What really interests me is looking at work and how people work. What makes one job different from another? What kind of person is the best fit for this job or that job? Work practice and work process is in a nutshell what I do.

How does that correlate with the fact that today people change jobs much more often than in previous generations?

There are huge repercussions. I always tell my executive MBA students that their jobs are more interesting than ever but also much more challenging than ever, because they are managing a much less stable workforce. The truth is the rules are not the ironclad rules we thought they were. Now at least we know that.

These days people come into jobs with different expectations. Did the change emanate from individuals? No, I think it emanated from organizational practice, but we learned the lesson pretty well and now people think of their jobs more in the short term, even in a university.

In job markets that aren’t dynamic, you stay, you stick. But in dynamic job markets — business, medicine, maybe engineering — it’s not that uncommon to change jobs several times.

So I think the relational aspects of work are probably more important now than ever, because you don’t have that toolbox system. You’re moving around, so why master any system? And the traditional systems have been shown to be too inflexible in many cases, so they’re not as useful. In some ways I think the kinds of work we do in my field are more relevant and more important for practice than ever before.

Can you point to other changes in business schools?

Business schools probably reflect trends in society more than lead trends in society.

As we all acquired 401(k)s, finance groups grew in business schools. Now with the demise of so many financial institutions, will finance groups shrink? Could be. I’m not an economist, but I’ve heard enough smart people who are, who think we’ll be moving into a period of re-regulation. The “Wild West” market days are fading.

I can’t explain the demise, but perhaps it’s another harbinger of changes we’ll see in business schools down the road.

But I don’t think these are ethical issues. It’s not that people were immoral. We set up a system that rewarded people for being more and more clever about coming up with imaginative schemes without anticipating the new risk that was created by the schemes. We set up a system that’s inherently going to be gamed by the haves at the expense of the have-nots.

If you think about finance, it’s the study of managing risk. It’s not an ethical so much as a regulatory issue. That makes me old-fashioned maybe, but I think that’s the case. The ground rules need to be questioned. If we change the rules of that system, maybe it becomes a more moral system.

The buzz phrase in the last few decades in business and other areas has been the global economy. Is there a way to encapsulate that? Is it good or bad?

It just is. It creates two things, one of which I guess you could consider as good: It creates opportunity. And the other I guess you could categorize as bad: There’s uncertainty. The more players operating from different playbooks, the more uncertain it becomes.

That also means a lot more opportunity than there ever was before. You can think on a different scale, and in different frames. So, whether you think globalization is good or bad in some ways depends on your stomach for risk and uncertainty.

Now, on the political scene, we’re not as embracing of risk as we were, say, 10 years ago. Ten years ago, globalization was an unmitigated good thing for everybody except maybe auto workers. You couldn’t find a Democrat or Republican to argue against it, and few economists or other experts would argue against it.

The question was framed that there would be some pain in the short term and gain in the long term. The only thing to argue about was how much pain and how long will it last. Nobody questioned the long-term gain.

Are those assumptions being challenged more now?

Alan Blinder, a well-known economist, talks about the distinctions in traditional labor economics between the educated and the uneducated, and between the skilled and unskilled. His contention is what we need to start thinking about is not so much education or skill set. The question to ask is: How “off-shorable” is your job? How much face-to-face interaction is really required versus not necessary?

It’s one of the things behind this center: If in fact that’s a division, that people who do work that you can’t easily off-shore, you can’t easily transmit via wire or even without a wire, that those jobs may become the backbone of the economy: the jobs that can’t leave.

How would you sum up your career so far?

I do interdisciplinary research, and I’ve worked with people all over the world, but also with a lot of different units at the University. I’ve learned so much by partnering with people whose background is in, say, education or medicine or child development. The way they look at things is so much different from own view. To me, one of the things that I really like about my work is being able to learn from so many smart people who are all over the place on campus.

When I say I’m an odd duck in a business school, that suits me, because I do like to hang around people who know things quite different from what I know. That’s more unusual than it should be. The longer my career, the more I want to reach outside just business.

Filed under: Feature,Volume 41 Issue 4

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