Time Banking System

WHAT?                                                                                                                                                               

The goals of this intervention are to:󠄀

•  identify tasks that are typically not compensated or poorly recognized and assign them “credits”󠄀
•  identify services that mitigate work-life conflicts or work-work conflicts 󠄀
•  coordinate a system in which credits are tracked and redeemed for services

WHY?                                                                                                                                                                 

Work-life conflict and work-work conflict are identified as barriers to success in medicine and contribute to burnout and job dissatisfaction. Research has found that interventions that focus on “buying time” for individuals tends to promote greater happiness [1]. The current protocol describes a time banking intervention, initially designed for faculty in the Stanford School of Medicine, to acknowledge the time spent on tasks that are typically underrecognized (e.g., teaching, service, and extra clinical activities). Credit values are assigned that can be redeemed for services that mitigate work-life conflicts (e.g., laundry services, meal delivery) or work-work conflicts (e.g., grant-writing assistance, help with conference presentations).This time-banking system has shown to be feasible and has been found to increase perceptions of a culture of flexibility, wellness, understanding of professional development opportunities, institutional satisfaction, and research productivity [2].

Organizational Culture and Values	This intervention concretely demonstrates departmental acknowledgement of the “extracurricular” service work that residents perform (i.e., activities promoting the success of one’s colleagues and the program/team overall). The act of logging these hours/behaviors helps individuals to understand the proportion of their own time and their co-residents’ time are devoted to these activities, and to feel recognized for supporting their program.
Control & Flexibility	There is no “one-size-fits-all” solution for acknowledging the different work-life and work-work conflicts that people face in medical training. By allowing residents to choose when and how to spend credits, this system creates an efficient way for programs to provide the tailored support needed to help each individual meet her or his specific work and life challenges.
Work-Life Balance	Credits may be redeemed for services that “buy time” for residents in their home lives and therefore mitigate work-life conflicts.

How?                                                                                                                                                                  

Step 1: Designate a coordinator and team. 

1. Designate a staff member (e.g., program coordinator) or a resident to coordinate this intervention. Ideally, the coordinator should be an administrator, as this demonstrates the departmental investment in the project, and as residents have very limited time. However, a research resident could potentially coordinate this intervention, if their efforts are appropriately recognized (e.g., with a baseline number of credits, with a title, with financial compensation).
2. Convene a panel of residents for Steps 2 and 3. Recruit a diverse cohort of residents (e.g., PGY, gender, residents who are not part of the same “friend” group) because homogeneity in thought may result in inequitable credit assignments.

Step 2: Determine the credit-earning activities and tasks.

1. Conduct a survey or a focus group with residents to identify activities and tasks that are unrecognized and should earn credit in the time-banking system. Consider:
   1. Trading shifts to accommodate another resident’s request.
   2. Providing coverage on short notice.
   3. Working on a holiday.
   4. Mentoring residents or students.
   5. Serving on a resident-led committee.
   6. Interviewing applicants for the residency.
   7. Leading didactic sessions.
   8. Helping to design curricular material.
   9. Organizing resident social events.
   10. Advocating for other residents (e.g., being an ally when a co-resident is experiencing a microaggression).
2. A list of sample activities from Stanford’s program may be found in this Appendix.
3. Convene the panel of residents to assign credit values to each activity. At Stanford, activities are generally assigned credits proportional to the time invested(i.e., 1 credit/hour), but some are valued more subjectively (e.g., coverage on short notice).
4. Consider granting everyone a baseline number of credits., In Stanford Emergency Medicine, starting values are assigned with the most credits awarded to those who are more junior, as these faculty tend to have less control over their schedules: Assistant Professor 20, Associate Professor 15, Professor 10.
5. Consider allowing participants to donate some of their credits to others, as Stanford now does.
6. Consider implementing a cap of total accruable credits. In Stanford’s Emergency Medicine program, caps are: Assistant 25, Associate 20, Professor 15.

Step 3: Determine the rewards.

1. Conduct a survey or focus group with residents to identify services of interest. A list of examples from Stanford is available. Consider:
   1. Rewards for work-life support:
      1. Housecleaning
      2. Laundry and/or dry-cleaning
      3. Childcare
      4. Meal or grocery delivery
      5. Dog-walking
      6. Task outsourcing
      7. Amazon Prime
   2. Rewards for work-work support:
      1. Preferences for call or vacation scheduling
      2. Lunch with a faculty member of their choice
      3. Financial support for conference attendance
      4. Leadership training(e.g., financial support for conference attendance)
      5. Assistance with grant writing, statistics, manuscript editing
      6. Speech or public speaking coach
      7. Interview simulation
      8. PowerPoint design
      9. Life coaching
2. Have the coordinator research local businesses and costs for the identified services of interest. The cost of the faculty program at Stanford (including a career coaching component) was $2500-$3000/participant per year; however, this cost can be greatly reduced based on the choice of rewards/incentives.
3. Convene the panel of residents to assign credit prices to all available services. At Stanford, 1 credit is roughly equivalent to $40-50, but this can be adjusted depending on your residents’ accrual rate and the cost of the services being purchased/used. 

Step 4: Develop a system for time tracking and redeeming rewards.

1. Publish a list of activities with their credit values and services with their credit prices such that it is easily accessible to all residents (e.g., shared drive, signage throughout resident workspaces, mass email).
2. Develop a system for logging the hours/activities for time banking. This may be accomplished via:
   1. Residents log their own hours/activities using a a free, online time-tracking tool or an online spreadsheet (e.g., Google Spreadsheets).
   2. Residents email their hours/activities to the coordinator who keeps an electronic or a physical log.
3. Time banking logs should be accessible to all residents for accountability and recognition. The coordinator is responsible for the credit redemption process (e.g. collecting information from participants, scheduling and/or paying different services) and tracking the credit accrual and usage.

Step 5: Reevaluate periodically. Repeat your survey or focus group annually to:

1. update your list of activities
2. refine the point assignments to increase equity
3. get feedback on existing services
4. add new services                                                                                                                                                                                                                                                                        

Helpful Resources                                                                                                                                             

                                                                                                                                                                                    Coaches/Successful Implementations

•  Stanford University
  •  Coach: Magali Fassiotto, PhD, Assistant Dean for Faculty Development and Diversity
  •  Contact: magali.fassiotto@stanford.edu

References                                                                                                                                                         

1. Whillans AV, Dunn EW, Smeets P, Bekkers R, Norton MI. Buying time promotes happiness. Proceedings of the National Academy of Sciences. 2017 Aug 8;114(32):8523-7.
2. Fassiotto M, Simard C, Sandborg C, Valantine H, Raymond J. An Integrated Career Coaching and Time-Banking System Promoting Flexibility, Wellness, and Success: A Pilot Program at Stanford University School of Medicine. Academic medicine: journal of the Association of American Medical Colleges. 2018 Jun;93(6):881-7.