I have a Ph.D. from Harvard and a 20-month-old child.
Without child care, life revolves around the toddler.
I am a political science professor and researcher, but lacking child care, I count myself lucky to work a few hours each day.
I am increasingly aware there is no such thing as the so-called work/family conflict. This is not only a personal observation. Scholars have found that good jobs – full-time, with benefits – and family, without help, are simply incompatible.
Work and family are both full-time pursuits. If the problem is framed as a choice between them, the battle is lost, since family will usually win. Telecommuting and “workplace flexibility” are important but do not make up for a lack of time and space to think and work.
Those who need care, especially little children, are needy and adorable, and mothers are evolutionarily disposed to focus on them.
(Whoops, excuse me, the toddler is trying to kill herself again … OK, child saved, with minimal screaming on both of our parts. Now what was I thinking? Did I reorder all our prescriptions? Hold on, I’ll be back.)
The national shift to home-based work and schooling has had challenging consequences for parents, especially mothers. Sometimes these effects are lovely, like giving us more time with family, but if your goal is getting work done, good luck to you.
She’s worse than a cat; she climbs on me, presses things on the computer, sucks its edges and screams for attention, in addition to the normal baby bodily functions that comprise a disproportionate section of my thinking – when did she last poop? Is that a rash?
It’s not just me.
Submissions from women to academic journals have plummeted since COVID-19 hit.
One geography professor tweeted, “It’s hard enough to keep my head barely above the water with the kids at home and interruptions every 2 min … I can’t imagine writing a paper now.”
Another scholar said the data on diminished submissions from women made her cry because it wasn’t just her.
It turns out that someone has to supervise – and sometimes force – children’s learning, even if online, and this takes actual work. With parks, museums, sports, pools and movie theaters closed, and with kids mostly unable to hang out with friends, someone also has to do the physical and emotional labor of keeping children busy, engaged and upbeat. This too is work.
Then there is the simple fact that family members are eating, working and playing in houses most of the time, which means more cooking, more cleaning, more grocery shopping and, yes, more toilet paper.
(OMG the baby took a two-hour nap. I got to exercise and even shower. No time for leg-shaving but I’m still a new woman. Now what was I thinking…)
Because it is not just time, you see. Sometimes the child is playing quietly, and theoretically I could sit down and bang out a research article, but my brain is fuzzy as hell.
Before the baby, and before COVID-19, I had great plans for composing scholarly articles in my head during all that nursing downtime. But I forgot that hormones can change your brain and behavior.
Feminist theory and research finds that much of what people think of as “biological sex” – female or male – is socially constructed, as in, strongly based on culturally contingent assumptions about women and men as groups. I firmly believe, and teach, this as evidence-based truth.
Hormones, though, have undeniable physical and mental effects. If they are turning your body into a milk-production and child-protection facility, there can be some side effects on brain function. Many of these changes (increased empathy and vigilance) are useful evolutionarily, and the physical alterations appear to be short-lived. But there can also be negative effects on memory and focus. If your brain is your job, as mine is, this can cause some serious work disruption.
Pat Schroeder had two young children when first elected to Congress as a Democrat from Colorado in the 1970s. When asked how she could do both jobs, she famously replied, “I have a brain and a uterus, and I use them both.”
I try to live up to Schroeder’s standard, but lately I’ve found I have to qualify it; I tell myself she meant sequentially, not simultaneously.
Sequential is fine, as long as I have time and space to switch gears – I’m a first-time mom at 40 and the gears sometimes stick or stall out – and the peace of mind to focus beyond the child and the never-ending housework. We don’t call this “women’s work” anymore, and men do more than they used to, but it’s essential work and still mostly done by women.
With luck and science, COVID-19 will recede soon, and we can trickle back to offices, for which I have a newfound respect.
Will the U.S. take something positive from this crisis by learning an enduring lesson about the power of child care?
Americans tend to think of having children as an expensive, private choice. The alternative is to think of it as a public good.
Other countries offer far more generous parental leave and low-cost, high-quality daycare, knowing that “work versus family” is a false formulation. The U.S. is losing serious talent and promoting gender inequality by continuing to misunderstand the problem.
There are many potential options when child care is made a priority in a society.
Government subsidies for child care centers would help low-income workers have access to good care. The U.S. almost managed this in 1971, when Congress passed, on a bipartisan vote, a bill to establish child care centers across the country, funded in part by the federal government. President Richard Nixon vetoed the bill.
Universal pre-K starting at age 3, as in New York City, is another option to advance the interests of working parents and children.
And because working parents are drowning in high child-care costs, the government could offer subsidies and tax relief for curriculum-based care – which encourages child development and learning as well as safety – for those early years. I make a pretty good salary, but still, an extra US$1,000 a month or more to ensure my child is safe and well cared for while I work is painful.
It’s not a work-family conflict; it is a lack of high-quality, low-cost child care. Framing the problem otherwise damages the ability to enact good solutions.
It also makes a lot of good, hardworking parents feel enduring guilt over a problem that isn’t theirs alone to solve.
Stephen Forney, MBA, CPA, FACHE, excels in fixing “broken” organizations and he has built a track record of achieving financial turnarounds at seven healthcare facilities, he tells HealthLeaders in a recent interview.
Forney has over three decades of experience as a healthcare executive, with a primary focus on problem-solving. He began his career fixing problems in areas such as information technology and supply chain, an approach and skill he has carried over into financial operations in the C-suite.
“In finance, it wound up being the same thing. Pretty much every organization I’ve gone to has been broken in some way, shape, or form,” Forney says. “I’ve developed a specialty doing turnarounds and this will be my eighth.”
Forney speaks about his new CFO role at the Tewksbury, Massachusetts–based Catholic nonprofit health system Covenant Health, which he joined in mid-September, and how driving revenue and reducing expenses must go hand-in-hand to achieve financial balance.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: Covenant is coming off its fifth straight year of operating losses. What is contributing to those losses and how do you plan to address those financial challenges?
Forney: The thing is, most turnarounds—to a greater or lesser extent—look a lot alike. With organizations that have [financial] issues, there are obviously always unique aspects to every situation, but virtually every healthcare organization that’s not doing well is because of the same relatively small handful of issues.
[For example,] revenue cycle is probably No. 1. Productivity has not been well attended to; expenses haven’t had a lot of discipline around them in a broad sense. That’s not to say that all decisions are bad, but in a systematic fashion, things haven’t been looked at. Frequently, driving volume and growing the business needs a better focus.
In the case of Covenant … there has been a plan developed to address all those areas and we are addressing them already, even though we will be posting another operating loss in fiscal [year] 2019. But the trajectory is good and some of the things that we’re now looking at are what I would consider to be phase two–type initiatives. How do we accelerate and move them to the next level?
On October 1, we outsourced our revenue cycle. I’m pleased that we were able to get that accomplished. Obviously, it’s early but, at least anecdotally, initial trends look good.
HL: Where do you fall on the dynamic between focusing on expense control measures or revenue generation?
Forney: I always feel like you need to do both. Expense management and working towards expense strategies is easier, quicker, and more straightforward.
[Revenue growth strategies] take time, take effort, and tend to [have] a much higher degree of uncertainty around the volume projection. Those are necessary and they’re things that we need to invest in because, at some point, you can’t cut any more from your organization, you’ve got to grow the top line. To me, it’s sort of like step one is stabilize your revenue cycle and stabilize your expenses. Then while you’re doing that, work on growth that’s going to take place 12 to 18 months down the road.
HL: Are you optimistic about the federal government’s efforts to move the industry toward value-based care?
Forney: Going back about a decade, I thought the ACE program, which was [the federal government’s] bundled payment program, was a solid step in the right direction. It gave organizations a chance to collaborate in compliant fashion with physicians to bend the cost curve and have beneficiaries participate in the bending of the cost curve as well. I was with one of the pilot health systems that [participated], and it was a remarkable success.
Everybody got to win; CMS, patients, physicians, and systems won by creating value. Yes, I think that the government has a good role to play in [value-based care] because they have such a large group of patients that they’re willing to experiment like that. [The federal government] can come up with potentially novel ways to get people to buy into this.
HL: What is it like to be at the helm of a Catholic nonprofit system and how does it affect your leadership style?
Forney: From a philosophical standpoint, the principle of creating shareholder wealth and good stewardship are not significantly different. You’ve got an end goal in mind, which is, you’re taking care of the patients and a community. In one case, whatever excess is left goes to a private equity fund or shareholders. In the other case, [the excess] stays in your balance sheet and gets reinvested in the community.
HL: Given your three decades of healthcare experience, do you have advice for your fellow provider CFOs, especially some of the younger ones?
Forney: Focus on being that strategic right-hand person to the CEO. In my experience, that has been one of the things that marks a successful CFO from one that isn’t as successful.
CEOs are going to get ideas from everywhere. They’re outward and inward facing. They deal with the doctors and the community, and they’re going to get all sorts of great ideas.
The CFO needs to be that person [who is] grounded and says, ‘Well, what about this?’ That doesn’t mean saying no. The whole idea is how do you make it [sound] like a yes. To me, the CFO role just grounds all the discussions, from working with physicians to working with the community.
CFOs over the last couple of decades have been operationally oriented. Now they need to start becoming clinically oriented.
There’s a real benefit in being able to sit down and talk with a physician and understand [what] they’re doing. … It winds up becoming a way to help ground the clinicians in the hospital operations because now you’re having a dialogue with them instead of them just saying, ‘You don’t understand. You’re not a clinician.’ That would be something that I would have a young CFO try to stay focused on, even though it’s dramatically outside the comfort zone for people that typically go into accounting.