Assessing place and time: Hybrid and remote work models provide growth potential for practices and flexibility for staff

In fall 2019, 93% of U.S. workers reported that they never or occasionally (once a month or less) worked from home.1 This percentage was likely even smaller in the healthcare industry, which lagged other areas in offering flexible work arrangements. “We did have some employees who worked remotely before the pandemic, but it was a very small number, just a handful,” recalls Beth Austin, vice president of operations, Spectrum Healthcare Partners (SHCP), South Portland, Maine, which has approximately 400 non-physician employees.

That all changed when the COVID-19 pandemic forced medical group practices to update public health safety measures in March 2020. As clinical and non-clinical staff left the office to work off-site, practices began to spend more time evaluating hybrid and remote work arrangements, particularly for non-patient-facing staff. What they often found was that employee productivity and morale increased, while rates of stress and burnout decreased.

Many healthcare leaders have begun to recognize the advantages of these work arrangements and how they can benefit the organization and employees. This is reflected in a PwC US Pulse Survey conducted last fall, in which 32% of healthcare leaders said that they strongly agreed that employee preference was the most important factor in developing their return-to-work plans, 7% higher than industry-wide numbers.2

The future of work arrangements

A Feb. 9, 2022, MGMA Stat poll revealed that 59% of respondents said they shifted workers to permanent remote or hybrid settings during the past year.3 As one practice leader noted, work arrangements have changed a lot during the past two years: “COVID-19 propelled us into the future and now [remote work is] a retention and recruiting essential.”

Beyond retention, practices noted that productivity and space constraints factored into their decision, often concurrently: “We need to maximize clinic space and found that these folks [chart prep, prior authorization positions and financial counselors] did not need to be in the office to be productive,” offered another practice leader.

In the poll, practices cited billing/coding, call center, scheduling and administrative positions as the most frequently remote/hybrid. But is there a way to determine which positions are the best fit for hybrid/remote work and which individuals should be considered?

A 2x2 axis of place and time

A good place to start is to look at the work of Lynda Gratton, PhD, professor of management practice at London Business School, who leads the Future of Work Research Consortium, which, in 2008, brought together more than 100 companies to examine the ways work is shifting and how organizations must change in the coming years to prosper.

Although the group’s focus has been on researching future trends, identifying best practices and learning from trial and error, recently the FoW has homed in on how work arrangements have been affected by the pandemic. What the FoW discovered is that hybrid and remote work models enable organizations to help make “work lives more purposeful, productive, agile, and flexible.”4 However, according to Gratton, the most important aspect of designing hybrid and remote work arrangements is to look beyond institutional concerns, focusing instead on individual human concerns.

Organizations should start by assessing place and time. Being place-constrained in an office setting versus being place-unconstrained by having the ability to work anywhere is what most workers have grown accustomed to during the pandemic. However, the shift to asynchronous work, or not working at the same time as their coworkers, has also become more common during the pandemic.

For years Gratton has used a straightforward 2×2 matrix arranged along place and time axes (see Figure 1). In reviewing this matrix when assessing flexible work arrangements, organizations can plot certain positions in each quadrant, correlated to four factors:

1. Jobs and tasks
2. Employee preference
3. Projects and workflows
4. Inclusion and fairness.5

 
At SHCP, a handful of employees worked remotely prior to the pandemic, but the organization didn’t set out to create a work plan until well after the pandemic started. As Austin relates, SHCP first conducted a secondary literature review on remote work across industries and held informal interviews with HR leaders and executives in other industries.

Jobs and tasks

According to Gratton, organizations should look at positions on a case-by-case basis, based on their roles and tasks and the factors that drive productivity. For example, these could include focus, coordination, energy and/or cooperation.6 Organizations should ask how individuals in certain roles could be affected by work environments when factoring in place and time.

Using this as a basis, Austin, along with SHCP’s chief human resources officer, Julie Wheeler, SHRM-SCP, SPHR, determined whether their organization’s employees could work remotely or were better suited to be on-site. They then considered whether each employee had to work during standard hours (e.g., 8 a.m. to 5 p.m.) or could work any time, day or night.

“One of the key parts of our work was to get alignment from the senior leadership team,” says Austin. “People were all over the map — from those who thought people should be in the office all the time to those who thought we should let them work remotely all the time and everywhere in between.”

For practices, personas can be created for each position, which can then be slotted in one of four quadrants, depending on how constrained the position is related to place and time (see Figure 2). When creating these personas, Austin says practices should consider:

• Job description (including diversity of role)
• Degree of need for relationship building
• Management/coaching responsibilities
• Inter- and intra-departmental collaboration needs
• Technology requirements
• Regularity and timing of interface with clients (internal and external).

 
For example, as illustrated in Figure 2, an executive assistant needs to be in the office during standard business hours, while an application developer doesn’t necessarily need to be in the office or work during standard business hours. Most staff positions have flexibility, particularly where they work.

An ideal work-from-home candidate such as an application developer would be categorized as having/being:

• Narrow job responsibilities
• Tech-savvy
• Lower requirements for interpersonal interaction or relationship building
• Focus on cognitive thinking, problem-solving, or data processing and analysis
• Further along in career development and able to work independently or on non-collaborative projects
• Limited needs for special equipment.

Employee preference

Once they received buy-in from senior leadership, Austin and Wheeler sent surveys to employees to determine their preferences. They first asked, “What is your work arrangement preference?”:

• Working fully from the office (five days a week)
• Working mostly from the office (three to four days per week)
• Working mostly remote (one to two days per week in the office)
• Working fully remote (five days a week).

 
This was followed by gauging employee preference with meetings (in office, remote, no preference and not applicable):

• Attending large group meetings
• Meeting one-on-one with people you supervise
• Meeting one-on-one with your supervisor.

 
Once they received feedback from approximately 90 employees, Austin and Wheeler worked with the employees’ supervisors on developing a work plan for each, based on supervisor recommendations, employee preference and employee personas.

When considering employee preference, it’s also crucial to consider employee experience with your organization. Much like positional personas, organizations can create personas for the same or similar positions based on experience. Compare Beth, a new hire in the billing department, to Kate, who has worked in the billing department for 10 years.

Projects and workflows

Gratton contends that organizations also need to address how work gets done, who is doing the work, and where the work is done, all of which can again be determined by looking at personas.

The how

For those who work remotely, how does their role engage and interact with other roles and departments? For instance, Austin’s application developer primarily works independent of other departments and roles. One of the most important productivity drivers for that position is focus. Conversely, the executive assistant is likely working across many departments and utilizes two of the most important productivity drivers: coordination and cooperation.

The who

Looking beyond personas, organizations should invest time in assessing the individual and their role and then ask the following questions:

• Are they self-motivated?
• Can they work independently?
• Are they well-organized?
• Are they reliable?
• Are they effective and efficient communicators?
• Can they manage their time?
• What’s their personality type?

In speaking to several practice leaders, there are also specific requirements they consider. As Cathy Faulkner, administrator, Peerless Pediatrics, Cleveland, Tenn., points out, her criteria for qualifying for remote work is straightforward: “My strategy is that it has to be … someone with a good work ethic, someone who has been with us three to five years,” noting that she has been very selective in deciding which employees can work remotely. They are “someone that I feel comfortable with allowing them to work at home because efficiency and productivity are important,” she added.

Faulkner helps keep her organization’s remote employees engaged by requiring them to spend time in the office two or three times a month for staff and team meetings. She sees remote work as an effective retention tool, as the individuals in her organization value their ability to work from home. “The people who are currently in those positions, I don’t see them giving that up anytime soon,” she says.

For Toby Hoaglund, MBA, CMPE, practice manager, Carson Tahoe Health, Carson City, Nev., her organization has always had a telecommuting policy, determined by each department. Within the groups she oversees — cardiology and psychology — remote workers are primarily phone schedulers. “You have to work phones internally in the office for six months and be at a certain percentage and meet those benchmarks in the office before you can even qualify to go remote,” she says of the criteria, which is measured by managers. Employees also must sign a remote working contract, which defines their commitments and responsibilities.   

Similarly, Jim Padley, MBA, CMPE, chief operating officer, ID Care, Hillsborough, N.J., says that his organization has a 90-day training period during which employees are evaluated to determine whether they are suitable for remote work. ID Care began looking at remote work options prior to the pandemic, so they were able to transition employees to remote work efficiently.

Padley noted that ID Care started with billing and call staff and received provider relief funds from the government, which allowed the organization to upgrade to a VoIP phone system for remote workers. According to Padley, ID Care continues to evaluate all job functions for remote work suitability and recently shifted its prior authorization staff out of the office. 

The where

To be productive, remote employees need to have a dedicated workspace, preferably a separate room where there are limited distractions. It’s also important to have a comfortable chair and a desk large enough to accommodate a large monitor or two.

Padley notes that his organization tries to provide everything that employees would have in an office setting, such as two monitors for easily opening multiple documents for review.

To remain productive and engaged, remote workers should also consider:

• Creating a routine, including getting dressed for work and symbolically leaving for work — even if that simply entails going to the home office — to help enhance productivity, and ending the day at a specific time by leaving the home office.
• Taking breaks away from your desk throughout the day to recharge, including taking a walk, doing laundry or playing with a pet. When doing so, use status settings to let people know your availability.
• Using communication tools such as Microsoft Teams chat and engaging in virtual coffee breaks, lunches and happy hours can help bring remote workers closer together.7
• Promoting casual conversation when remote employees yearn for more connection by establishing a “virtual water cooler” such as a daily group check-in or discussion board/chat room where individuals can catch up.8

Inclusion and fairness

Gratton suggests organizations should obtain feedback from as many employees as possible in the remote plan design process. Not taking the pulse of employees can result in feelings of alienation, which can hurt productivity and collaboration and potentially increase turnover. She also points out that hybrid and remote work models should be an organizational initiative and should not be left up to individual departments.9

In addition to the employee surveys SHCP sent out, Austin and Wheeler asked managers to speak with their direct and indirect reports in one-on-one meetings and during team discussions to obtain additional feedback from employees. However, through the research the organization conducted, they determined it was best for the management team to gain organizational consensus on the framework (Gratton’s model) and criteria (using personas and asking key questions to employees). In addition, as Austin specifies, SHCP has prioritized ongoing discussions with the management team regarding culture and employee engagement for remote workers.

Productivity and benchmarks

Many organizations have reported higher levels of productivity and engagement with remote workers. The basis for this may simply be employee gratitude and reduced stress. “[Knowing] that they can perform those functions at home, if necessary, it relieves a lot of emotional and mental anxiety,” says Galyn Damiani, SHSMD, senior director, brain & spine and critical care, Centra Health, Lynchburg, Va.

Less interruption may also boost productivity; some of Padley’s remote employees report fewer conversations with and distractions from other employees. Being near high-traffic areas, such as the kitchen entrance or a conference room, can also affect productivity for employees whose focus is a significant driver.   

It’s relatively easy to gauge productivity, because there’s no reason for goals to be modified. “The ways we interact with employees might be changing, the way things get disseminated or played out varies, but in terms of what we measure, it doesn’t change,” Austin says.

Paul Berkley, president, Health Management Systems, Montville, N.J., adds that practices can set quotas and measure benchmarks the same way they typically do for on-site workers. “In looking at A/R, people who are doing verification, you can count numbers,” says Berkley. “I gave you 25 to do, and you did 25.”

Likewise, for positions such as call center staff and billing and coding staff, for example, there are measurable metrics:

• For the former, efficiency, first-call resolution response time, customer satisfaction rates
• For the latter, charts reviewed, claims coded, claims submitted, denials appealed.

 
Berkley notes that one of the biggest challenges to sustaining and improving productivity is maintaining rapport with employees. “The challenge … is setting up new communication systems so that you’re able to talk to your people and they’re able to relate and talk to you,” he says. “You really have to make yourself much more available because it’s not like they can see us sitting at the desk around the corner.”

Culture

Communication is an important driver of engagement, which can contribute to a stronger organizational culture. For SHCP, the management team wanted to assess how culture would change in a remote setting. By identifying the organization’s core values, the team was better able to exhibit that culture to new hires. “Culture is based on modeling behavior,” explains Austin. “So you’re going to have to demonstrate the behaviors differently in a remote environment or a hybrid environment.”

To help introduce new hires to SHCP’s culture and to sustain it for remote employees, Austin noted that they employ several tactics, including:

• Icebreakers at the beginning of every meeting to help employees and new hires get to know one another
• Being more intentional through quick one-on-one conversations on Microsoft Teams rather than via email.
• Replacing longer meetings with shorter meetings with fewer invitees.

 
At Centra Health, Damiani notes that flexibility and concern with well-being has helped boost employee engagement scores. “Culture is what underlies executing on the strategies that we put in place,” she says. “If we don’t have a great culture and great engagement, then we’re not going to be able to effectively and efficiently execute on what we need to get done.”

To maintain these connections, practices have instituted monthly in-person staff and team meetings, virtual daily huddles, virtual happy hours and virtual games. For some, seeing their coworkers’ faces may be enough; however, others may yearn for something more fulfilling (see sidebar below).

Emphasizing empathy and supporting the needs and concerns of each employee can go a long way in helping to make everyone feel as though they have a voice. Damiani says that her organization makes sure that they understand how each employee functions as part of the team. As such, they are continually discussing how to effectively work together as a team in their staff huddles.

“Having those real conversations about what that looks like and not waiting for a problem to arise before addressing it are some of the ways that I feel are very important to help make sure that you maintain that culture,” she says.

Mayo Connections

Prior to the COVID-19 pandemic, 5% of Mayo Clinic employees worked remotely. Today, 25% of the staff work remotely. So how did an organization with approximately 74,000 employees sustain its mission, purpose and culture during a time when some employees may have felt isolated? Two key ingredients were being deliberate in maintaining connections and focusing on the well-being of employees.

Launched in mid-2019, Mayo Clinic’s Bold. Forward. @Work strategy is made up of six workstreams, including Mayo Connections. It was designed to ensure staff are connected and committed to the organization and each other as part of the workforce of the future.

According to Cathy Fraser, MBA, chief human resources officer, Mayo Clinic, the program is composed of well-being connection groups, professional development groups and social affinity groups:

• Well-being connection groups: Groups of 10 to 15 employees who meet weekly on Zoom for up to six weeks. Groups are led by a Mayo Clinic wellness coach who helps the group examine well-being resources, establish goals to boost well-being, work on resiliency skills and connect with colleagues virtually.
• Professional development groups: 12 sessions on various topics (for example, career progression) during which executive team members led small group discussions for approximately 50 employees for 45 minutes on Zoom. These groups were designed to reconnect senior leaders to staff and share the former’s career progression, while they network with employees who are interested in similar career paths.
• Social affinity groups: Employees who have a desire to start groups based on shared characteristics, interests, life experiences or social identities can create a single zoom event or a series of events. Fraser says that these groups help foster community by promoting social interaction. 

All groups are designed to bring employees closer together as part of a community that extends beyond work. A key facet of this is a culture geared toward flexibility in meeting employees where they are.

“Every individual is different, and it’s very naive to believe that you’re going to hire a ton of people and offer them a single value proposition,” Fraser says. “You can’t force people into a box and say, ‘This is your box.’”

Staffing and recruiting

In the Feb. 9 MGMA Stat poll, respondents mentioned the necessity of offering hybrid or remote work to non-patient-facing staff to retain talent. And for some job candidates, it’s a non-starter if practices don’t offer remote work.

For Padley, the remote work option has been an important means for attracting candidates, given ID Care’s location in one of the less-populated areas of New Jersey. “Recruiting was becoming an issue because people didn’t want to commute out to [us],” says Padley. “So that was already becoming a request … it’s now enabled us to recruit much wider, because we can offer remote work for people.”

Austin echoes those sentiments, saying that many job candidates strongly prefer remote work. “We have found that it has helped with our recruiting efforts, because for certain positions it doesn’t matter where they are geographically,” she says. “It’s allowed us to open up new opportunities there.”

Space concerns

Practice leaders cited space constraints as a significant factor in optimizing clinical space for providers. Padley notes that ID Care’s revenue increased significantly during the pandemic — 25% in 2021 and just under 20% in 2020 — so shifting some employees to remote work made it possible to do more clinical work. “We had two years where, because of remote work, we didn’t have the pressures of adding space, but probably sometime before the end of this year, we will need to add space to accommodate the staff,” he says.

Like Padley’s practice, Hoaglund says space is a big issue for Carson Tahoe Health. “As a group, we are out of space and we always have been, so the thought is not really consolidating, but how can we get more workers and push more people remote to be able to get the throughput we need from our providers and get stuff done without increasing our physical space,” she maintains.

Austin also points out that facilities were another key component of SHCP’s remote work plan, as the organization was able to consolidate into one building. “We recognized that we also needed to reconfigure some of our workspace to … maximize collaboration at times when people were in the office,” she added, which included moving cubicles and setting up collaborative spaces.

Finally, for Damiani, she notes that the pandemic has been a significant driver in Centra Health’s space planning, particularly the desire to build a new facility for the neurosciences service line and determining which employees need to be on-site.

The pandemic has also been a catalyst for new approaches to existing spaces, such as telehealth-specific rooms, Damiani says, noting that the organization does scenario planning in which they assess their needs for a time when 50% to 70% of their visits could be virtual. If this comes to fruition, it could also potentially close the distance between patients and providers, which Damiani says begs the question: “Could we potentially have hubs in other regions we serve … in which we could provide telehealth services so we’re not bringing everyone to the mothership?”

COVID-19 ushered in a new way of working for practices. By continuing to offer flexible work arrangements, practice leaders can address the needs of their staff, reinvigorate recruitment efforts, and potentially grow their practice.

Notes:

1. U.S. Bureau of Labor Statistics. “Job Flexibilities and Work Schedules News Release,” September 24, 2019. 
2. PwC. PwC Pulse Survey: Next in work. August 2021. Available from: pwc.to/3vad4t2.
3. Green C. “As practices turn to remote and hybrid work models, engagement and culture are key considerations.” Feb. 9, 2022. Available from: bit.ly/3Hak1wt.
4. Gratton L. “How to do hybrid right: When designing flexible work arrangements, focus on individual human concerns, not just institutional ones.” Harvard Business Review, May-June 2021. Available from: bit.ly/3JIVDUj.
5. Ibid.
6. Ibid.
7. Millard N. “A practical guide to successful homeworking.” April 24, 2020. Available from: bit.ly/3p2dvSf.
8. PwC. “How to stay connected when working remotely.” Available from: pwc.to/3JIVRe7.
9. Gratton L.