Tiffany Starr, a local resident and breast cancer patient, spent over twenty hours sharing stories of her cancer experience with my research team at the Yale School of Medicine.  

For her efforts on this project through her role as a community partner, Tiffany was to receive $250 in compensation. As this was an externally funded project sponsored by Yale, her payment was going to be processed by the university. When it came time to compensate Tiffany, however, my team needed to advocate persistently to ensure she was paid on time. If we had not, she would have encountered the same delays experienced by our past community partners who had to wait months to receive their payments from the university. We were determined not to allow that to happen again. We could not compromise Tiffany’s trust in our partnership. 

For many Yale scholars engaging in community engaged research, or CEnR, this is unfortunately an ongoing reality: the process of paying community partners is needlessly slow and this undermines the strength and effectiveness of critical community partnerships.

CEnR describes the process of partnering with communities to co-design research projects and address matters important to the members of those communities. This approach is essential for promoting positive health behaviors in cancer care, particularly in marginalized communities.

Yale is undoubtedly enthusiastic about CEnR. Community engagement was at the forefront of President Salovey’s address to the Yale College Class of 2023 and CEnR is regularly showcased to applicants of its graduate schools.

While enthusiasm is great, CEnR has to be done right to be effective.

A central tenet of CEnR is that there is an equal partnership between institutions and the community. These partnerships, which take tremendous effort to develop, hinge on unwavering trust and respect for the knowledge provided by community members. Delayed payments to community partners who devote considerable time and effort to academic projects threaten to erode this trust and respect.

Jose DeJesus, a New Haven resident and community engagement coordinator at Yale, has experienced this first-hand. Every summer, Jose organizes walking tours of New Haven neighborhoods. These tours, which are designed for researchers considering CEnR projects, are led by community leaders who spend hours preparing and sharing information about their neighborhoods with Yale researchers. But it takes months to get them paid.

“Although these tours happen in the summer months, it’ll be February, March, April and I’m still fighting to get my people paid.” Jose says.

Like me, Jose has to find workarounds.

“I’ve had to pay people out of my own pocket and then wait six months to get reimbursed,” he added. “I really think the reason community relations have not gone sour yet is because the personal relationships exist or else they [community leaders] would have said ‘F’ the university.”

Jose himself previously served as a community partner. In December 2023, he recorded Spanish-language voiceovers for a cartoon video designed to support clinical trial recruitment. He told me that he was not compensated by the university until nearly a year later.

The current system for reimbursing community partners is identical to how most research-related expenses are managed. The research team submits an invoice to the departmental business office who then processes it and dispenses funds to the appropriate individuals. This seemingly straightforward sequence of events is fraught with administrative hurdles. There are usually months of back-and-forth emailing between the research team and the business office to address simple issues such as invalid demographic information, inadequate receipts, or requests for additional documentation.

“People know about red tape, but at Yale we have blue tape,” Jose says. “The holdup is usually something stupid that a phone call or email could fix right away. It sits in someone’s inbox and then someone forgets about it.”

But these administrative hurdles don’t apply to everyone. Jose notes, “When we do outside catering or order t-shirts for an event, those companies get paid right away, but the communities who provide such critical services, those are the people who get paid later.”

To be sure, business offices have a challenging task overseeing large budgets and paying invoices for hundreds of individuals. If there isn’t some administrative “blue tape,” the consequences could be dire. 

In 2022, a Yale administrator was sentenced to nine years in prison for stealing over $40 million from the university in an elaborate scheme of fictitious financial bookkeeping. In response, the university adopted additional measures to ensure the integrity of business transactions.

Still, the university can and must do better for the community. Our partnerships with community members like Tiffany and Jose represent invaluable resources. Administrative processes should not get in the way of preserving these partnerships.

There are practical ways to improve how we compensate community partners.  In 2020, the NIH granted a group of California institutions $12 million to support engagement with communities affected by COVID-19. A recent study from that initiative revealed that university-level administrative barriers, much like those at Yale, caused payment delays and eroded trust in these critical partnerships. Importantly, the researchers proposed concrete solutions: directly involve community partners in designing and overseeing funding mechanisms, train business managers on CEnR principles to emphasize the importance of timely payments, and provide targeted support for administrators who manage CEnR projects to streamline payment processes.

For Yale, my ask is simple: pay our community partners in a timely manner and show them we respect their time and effort. At a time when university budgets are facing intense scrutiny, we cannot compromise on our values. Yale’s pursuit of “light and truth” has always depended on strong community partnerships. Let’s not let bureaucratic “blue tape” dim that light.

SAFRAZ HAMID is a general surgery resident at the Yale School of Medicine and a postdoctoral fellow in the National Clinician Scholars Program. He can be reached at safraz.hamid@yale.edu.