Rae Woods: From Advisory Board, we're bringing you a radio advisory. My name is Rachel Woods. You can call me Rae. This time last year, nearly every employer, healthcare included, made claims that office space would never be the same, but after almost a year and a half of working remotely, many employers are starting to eye an official return to the workplace. The question now is will leaders go back to the old way of operating or will they actually be able to make a hybrid model function effectively? To answer that question, I've brought industry expert, Miriam Sznycer-Taub , and workforce expert, Alex Polyak. Hey Miriam. Hey Alex. Miriam Sznycer-Taub: Hey Rae. Alex Polyak: How's it going Rae? Rae Woods: It is going well. It is hard for me to believe that we're going on, gosh, almost a year and a half of working remotely. Did either of you actually think that we were going to be in our home offices for this long? Alex Polyak: Absolutely not. Miriam Sznycer-Taub: Nope. It finally set in when both my husband and I had to set up separate desks in our shared office, so we could each have our own space instead of leaving things on each other's computers. Rae Woods: I'm afraid to go back to the office and see... Well, I don't think I left anything too bad on my desk. But part of me is a little bit worried about an open bag of pretzels that I forgot about from March, 2020 or something like that. Miriam Sznycer-Taub: Think of working something with like a piece of fruit. Open bag of pretzels, at least it's just crumbs, like fruit you'd have like a science experiment going. Alex Polyak: I've been back a few times and I tell you that the craziest feeling is that as you're walking, and the moment you see someone else, it's akin to seeing a survivor of a ship wreck, [inaudible 00:01:53]. You look at them like, "You made it too, Oh my God." Rae Woods: So here we are summer 2021, but before we start talking about the future, I actually just want to take a moment to ground this conversation in where we were this time last year. So take me back to summer 2020. What were the two of you actually hearing about the future of office space itself? Miriam Sznycer-Taub: I think it wasn't the future of office space at that time, it was just what are we doing with the projects with the space that we have. So I spend a lot of time talking to people who are planning facility projects and in the summer and spring of 2020, everything stopped. The only facility projects that were going on or kind of critical things that had to be done or building field hospitals or setting up things for COVID. Anything else like building a new tower that had administrative offices had to get put on hold. Rae Woods: And you're right. That was more a cashflow problem than any kind of strategic decision about what makes the most sense for our workforce and for our business. Miriam Sznycer-Taub: Yes. Rae Woods: Well, how about this? One year later, have some of those paused projects resumed for the folks you speak with? Miriam Sznycer-Taub: Yeah, some of them have, I think on the kind of clinical side, we're seeing a lot of healthcare construction, particularly a lot of new ambulatory spaces being built. I think administrative spaces is a little bit trickier. I think some organizations have decided they do want to move ahead and build a space where they can bring folks together to work in one big office building and others have decided, "Now we're actually going to just rethink what kind of office space we need all together and put those projects kind of more permanently on hold or cancel them all together." Rae Woods: And this is the conversation that I want to have now because, right, so many companies pivoted to remote work, ours included over the last 18 or so months. And I was starting to hear some proclamations of folks saying we are never going back to the way things were, right. Office space is never going to be the same again, we're going to be thinking about our workforce in a fundamentally different way in the future. But let's be honest. That was also in a moment where COVID safety was a big concern. And I'm going to knock on wood, as I say this, that is not the driving factor of these decisions today. Alex, what are you hearing from employers right now? Alex Polyak: You're absolutely right, that there was sort of a zeitgeist, especially think about fall, winter, when more or less the kinks have been sort of fixed related to remote work and everyone thought this is the future. And now this year we are seeing a lot of organizations begin to return staff in much greater volumes than they had anticipated back to the office. I do think almost every organization has determined that some workers, some roles, will remain fully remote. There's no organization I think that has actually decreased the number of roles compared to pre pandemic. But by and large, most are either a hybrid or almost entirely now in person. Maybe they have a little more flexibility around one or two days a week, especially Fridays just choosing to work remotely or not. But typically it is now back in person. Rae Woods: And it's kind of this middle ground that I want to talk about because I think a lot of the news stories are being taken up with the extreme cases. We've pivoted completely to remote work for the foreseeable future, like what you're seeing out of some tech companies, or maybe the eager executive who says, "I do want to go back to the way things were in the before times," whatever that was. I want to talk about the reactions from executives themselves. Why is it that leaders are pushing for us to go back after many different parts of the industry kind of had this prove it moment of, we can do it anywhere. Alex Polyak: So I have probably looked at more surveys than I ever thought possible on this topic. And what's fascinating to me is that regardless of industry, regardless of country, but preferences across the workforce are almost universally the same. About half of all employees want some form of hybrid approach, partly remote, partly in person. One quarter of them want full-time remote. One quarter of them want full-time in person. And as I say, that doesn't really change from place to place or from industry to industry. Alex Polyak: So what's interesting then, I think it had been a long ahead, it's all too often what executives want. And traditionally executives, what they want is stability and control. And I'm not saying that as a bad thing. I think especially after this long upheaval, it makes a lot of sense. And that's what they're familiar with. Even after a year remote work, most organizations, frankly, hardly any organization has really looked at it from the performance management or sort of talent management viewpoint. We know how to run logistically a hybrid workforce or a remote workforce, but we're not there yet in terms of how do we build career mapping, career planning, performance management, hiring, and all of the other sort of kinks that come with that. That has yet to be decided. Rae Woods: And that's I think a lot of the lack of control that executives and leaders are feeling today, and I think it's perfectly reasonable to say, "I want to make sure that my workforce is happy and I want to make sure that they're productive." And for a lot of folks, they might think it is easier to determine those things when I am physically seeing my workforce in person. But does the data backs that up? Is it better to be in the office or is it better to let folks work remotely or do we know the answer to that question? Alex Polyak: I think the honest answer, despite some amounts of data to this question is that we don't have a conclusive answer. And that is very subjective. What I do think we have the answer to is that in-person and remote are not win all situations. When it comes to productivity by and large productivity did not decrease, but certainly I think everyone knows a colleague or how to direct report, who they were concerned, what they saw productivity decreased for them. And in many people's minds that one instance can be out of proportion. Rae Woods: Or the opposite by the way. If you know somebody is just grinding themselves into the ground and we know that that's not sustainable for a long period of time. Alex Polyak: Absolutely. And the other thing I'll just quickly note is that a lot of people were afraid that on top of all of the burnout and the upheaval culture would be completely eroded by sort of a workforce that was more physically disjointed than it ever had been previously. I have spoken to at this point, probably hundreds of organizations, almost all of them saw some of their best engagement scores in their entire history. And I would argue not in spite of remote work, but actually in due part because of it. Rae Woods: It doesn't sound like there is clearly a right or a wrong answer here. Miriam. What do you hear when you speak with leaders across the industry about this remote work problem? Miriam Sznycer-Taub: I think it's a question that every executive is wrestling with, like you said, across every industry. And so in the same way that healthcare organizations are thinking about their hybrid models, when I talk to an architecture firm, they're also thinking about which of their architects need to come in, which of their staff can be remote. How does that impact meetings with clients? And so it's actually really an interesting kind of universal struggle and there's definitely not a right answer. It's a right answer for every individual organization. Rae Woods: And part of this has to be the point in the pandemic that we're in right now. If we were having this conversation even a few months ago, the hybrid model was really all about balancing COVID safety, right? It was actually a dangerous decision to put all of our employees back into an open office floor plan where the windows don't open. But with that being much less of a concern now, especially if you're in a community with high vaccination rates, what is the right way to think about the strategy behind a hybrid workforce model? Miriam Sznycer-Taub: I think that there is still definitely a role of the physical space for the workforce when it comes to like actually safety. I think even though some of the kind of direct concerns have gone away, I think a big way that employers can promote an interest from their workers and coming back is making them feel safe. And so some of the things that that folks put into place during the pandemic, they should think about continuing. And so, whether that's continual cleaning, whether that's responding to people being like, "Hey, there was historically never any soap in this bathroom. Can we make sure that there's always soap? So I feel like I can wash my hands." Miriam Sznycer-Taub: So I do think that there are things that we can do and that employers can do to keep people feeling safe, that is about their physical space. Rae Woods: But I keep coming back to this kind of business goal mentality, is a way to strategically think about these decisions beyond the acute kind of moment, that is the crisis that we're living through? Miriam Sznycer-Taub: Absolutely, and so I think if we're in a world where not everyone is coming back into the office every day, I think everyone, all employers, healthcare organizations included now have to decide what space do I have and what space do I need that is for my workforce. Right? And so historically, a lot of provider organizations thought about their space as administrative or clinical. Sometimes we would talk about it as onstage or offstage and kind of like what the patients saw or not. But I actually had a really interesting conversation with someone a few weeks ago, and they started talking about their space as revenue generating and non revenue generating. Miriam Sznycer-Taub: And it was the first time I'd ever heard it and so I've really been thinking about it since, because it's such an interesting way of really saying, does this space make any money or is this space just straight against my overhead expenses? Rae Woods: So what would be some examples of non revenue generating space? Miriam Sznycer-Taub: Yeah, it is tricky. And there's definitely not a box that you can put around some of these spaces, you can be pretty sure that your staff break room, your respite rooms are non-revenue generating. We should not get rid of those. Like this is not a space in which we should pull back. You can say pretty, with a lot of confidence that your exam rooms are revenue generating. Then you can get into some sort of tricky gray areas about your cubicle area, where your billing staff sets. Miriam Sznycer-Taub: They are certainly making money in their jobs, but is the space that they're in fully revenue generating or could you use that space for something else? And that's where I think every healthcare leader really needs to take a look and say kind of, "Of this space, am I using it in the best way possible? If I didn't have these people sitting here, doing scheduling or doing billing, could I use this space for more exam rooms? Could I free up more capacity that actually would be more directly revenue generating." Rae Woods: And I liked that breakdown because it's very obviously about the business model. And you're pointing out the fact that these decisions aren't necessarily just going to live directly with the head of HR, they are actually conversations that you can be having with design teams, with architecture firms, your CFO should be involved in these decisions. But I do want to come back to the HR implication for a moment because we have a workforce expert with us. Alex, how are you pushing leaders to think more strategically about the hybrid model on behalf of the workforce itself? Alex Polyak: Well, the thing I really want to hit on is absolutely how Miriam was saying, this is not just something you're talking about with the head of HR you're about it with designers and the like. But truly the most important conversation you should be having is with your workforce. And I know that might sound trite, but truly the most progressive organizations I saw were the ones that drastically increased the amount of pulse surveys, the amount of communication channels they had with employees, especially around those early conversations about safety. Because this is a very different question. Do you feel safe, than is our workplace safe? One is subjective. One potentially can be a little more objective, but frankly, even if you get a designer and you get public health experts who say you're safe to come back, if you don't feel safe, you're not going to come back. Alex Polyak: You don't want to come back. And at a time now, when we're hearing about sort of this great resignation, it is an employees market. It is not an employer's market. So I'm saying really, I think at the heart of what we need to be doing as workforce executives, we need to be talking to our staff and figuring out what it is that they expect from us in terms of coming in, in terms of being an in-person worker or a remote worker, or somewhere in between. Rae Woods: I'm kind of having this aha moment about it being an employee's market right now. But I don't think we should swing the pendulum entirely towards the workforce as much as we should absolutely be focusing on their needs and their desires. How do you recommend leaders kind of match up what employees want and frankly, what employers need? Alex Polyak: It's a great question. And when I think about sort of the notion of an in-person meeting, I think we are starved for connection. We are by and large... Even some of the introverts among us might say, "It's gone too far. I need at least to see my colleagues once in a while." And I totally get that. And we also see that there are certain types of collaboration that are better served by being in-person. But what I really encourage executives, especially those who are gung ho about being in person to think about is what is the cost of an in-person meeting. Alex Polyak: And I'm not just talking about overhead, I'm not just talking about heating and AC and the like, but also what does that cost in terms of commute time, in terms of overtime? And then when you get to a really granular level... I've talked to some CEOs in the Northeast of the country who say, "We had employees come in on roads during blizzards who are now, if I look at it, we were having them risk their lives." And if I'm being honest too I used to drive to work. There were days when I should not have been on the roads, whether foul weather, wherever I was sleep deprived. So there is a real almost safety costs regardless of the pandemic at certain times. And when I asked this question to executives, to Madras, to just friends, their answers are really telling because each individual has quite a lot of costs that they can think up when it comes to being in person. Rae Woods: There is clearly a case for giving the workforce more flexibility, whether it's a hybrid model or the ability to work remotely. It's something that we've talked about on this podcast before, frankly, but I don't want to pretend that there are perfect or easy answers here. In fact, I'm thinking that there might be some unintended consequences that leaders are going to have to deal with over whatever decision they make when it comes to the workforce. I'm curious, what is the equity impact around the decisions to return to in-office work? Alex Polyak: It's such a good point. And initially I think the biggest thing we ran into was the equity perspective of... It is an intrusion in a sense, right? Remote work, when you have to have your camera on, you might not have a space that's conducive, like we're talking logistics, wifi, a good desk, monitors, whatever it is to that. But on the other hand, even beyond that, you're showing people your home and different people have different lived experiences, frankly. For some people it's highly embarrassing to have their kids run in on the camera. Other people are perfectly happy with that. Some people have pets, some don't, but even on a sort of basic socioeconomic level, not everyone's home is built equally. And that can be really alarming because you now essentially no longer have the ability to project a certain self in the workplace. Rae Woods: Yeah, I totally agree. I think that it's tricky because on the one hand, we know that flexibility is something that helps a workforce in a lower socioeconomic status. But at the same time, we can't assume that everyone has a lived environment that is conducive to this type of work in the longterm. Alex Polyak: Absolutely. I just want to quickly note in-person has a lot of hidden inequities that we often don't think about. The one that I'm sort of militant about is how many organizations healthcare providers don't subsidize parking fees for their workers, particularly in inner cities where this can be quite expensive, metropolitan areas. And if you think about the people who often have to drive into work, they're environmental service workers, they're the nurses. And if you look at these astronomical parking costs, they can easily add up to being almost 15, 20%, even of someone's take-home pay just spent on parking in order to do the work that you're being paid for. And frankly, that is an enormous inequity that's not talked about often enough. Rae Woods: I'm going to go ahead and make the assumption that for most organizations across the healthcare ecosystem, some portion of their workforce is going to be working in person at least some of the time. When it comes to that in-person space, how should we think about changes to the actual physical environment that they are working in? Miriam Sznycer-Taub: So pre pandemic, we saw this move away from individual offices to cubicles, to open office spaces. You saw that across a lot of industries and healthcare was no exception. Even physicians moved away from having their own offices to kind of an open office set up. And that was honestly not great during COVID, right? It actually really the push to get everybody home, even more urgent, because it was very difficult to keep people six feet away when your desks are only three feet away. So I think there's going to be a rethinking of, what office space should really look like? Miriam Sznycer-Taub: And, again, how healthcare organizations specifically should use their space. And then beyond that, I think there are some really kind of specific needs that provider organizations are going to have, particularly as they're thinking about more virtual visits being done, where you have a clinician in a healthcare facility, who's doing a virtual visit with a patient, they can't do that from a big open office space. For one, it's not a great experience for a patient if someone walks behind, there's also a lot of HIPAA issues. It's not a great environment for a clinician. And so I think that we're really going to have to think about how do we use our spaces to both be for in-person visits, as well as this new virtual visit world that we're in? Rae Woods: And to your point, not to think about administrative and clinical space separately because in some cases they will actually be mixed. Miriam Sznycer-Taub: Yeah. I think the line is going to get even more blurred between those spaces. And again, it's going to force executives to really think what they need their space for. Rae Woods: So this is not a moment where every organization is going to be able to build from scratch. Frankly, even if they had the money to do that, that would be a huge upheaval after a year and a half of extreme change. So what recommendations practically speaking, do you have for folks that are going to be retrofitting existing spaces to this new reality? Miriam Sznycer-Taub: I think it's important to just think about the space that you're asking clinicians to take a virtual visit in. I think virtual visits while they feel like they're all about the technology, they actually have a facility impact. They have a facility implication to them. Is the room that the clinician is in, does it have a good background so that there's nothing distracting. Do you have a setup where this clinician can look at the patient, look at the camera, but also be able to see their EHR so they can look at whatever they need about the patient without the patient feeling like they're not paying attention. Do you have a room that is closed off, that is fairly soundproof, that has good acoustics so that the sound experience is good? Miriam Sznycer-Taub: For some organizations they're going to decide they want to retrofit space, they want to create a tele-health pod. I think others are going to say, "Hey, is this office... Can we use this office as our tele-health space?" What do we maybe even need to do within an exam room? If we're going to use an exam room for a virtual visit, what changes might we need to make to make sure that it's a good experience? Because you know where that clinician is sitting, even though the patient isn't sitting in the room with them, it's still an important part of the virtual visit experience. And I think it can make or break that connection with the patient. Rae Woods: We've been sort of skirting around a question that I think is on our listener's mind, right? We've been talking about the fact that these decisions are going to impact the entire healthcare ecosystem. And we've sort of been talking about a mix of administrators, of staff, of clinicians, but I can't help but think that there is going to be a part of the workforce. And it's probably the clinical workforce, that doesn't honestly have a choice here and is going to have to come back to, or continue to work in-person. And that has to be tricky for leaders who are right now talking about all of the benefits that come with working remotely. Frankly, the benefits that we've been talking about in this discussion, how does a healthcare leader actually grapple and come to terms with those kinds of two opposing thoughts? Alex Polyak: Now this question makes me chuckle just a bit, because it reminds me of sort of the open secret in healthcare that we're relatively good at recognizing changes that are on the horizon absolutely awful at estimating when we'll have to grapple with them. And I answer as simply that, absolutely. I do not think, certainly not for the foreseeable future, that we will get to a place where we don't need clinicians be at least part-time in person. But what I would really encourage everyone to think about is the fact that almost every clinician will likely much sooner than we expect be working or flexing across both a virtual and an in-person environment. I've spoken to so many CMOs who said that tele-health was something we knew we would one day have, but certainly we were putting it off five years from now, 10 years from now, they put it together. They made it work within six months. And now almost every single- Rae Woods: Some people within six days, Alex. Alex Polyak: Even better. And the same is true to a lesser degree for virtual nursing. And so I say quite honestly, I think within the next 10 years, there will hardly be any nurse or physician who does not have perhaps even at least one day a week working virtually. Or if it's not one day a week, think about it this way. We know that nurses are in all likelihood going to be flexing across different units. And one of those units is going to be virtual telehealth. So it might be that for six months, you work on the ward for six months after you work virtually. And this is actually phenomenal for retention, especially for older workers who simply can't deal with the physical loads of the job. So of course, and I will note, we don't necessarily have the solutions for environmental service workers. They in all likelihood will continue to have to come in in person. But I would just encourage executives to really think about, is the horizon perhaps closer to us than we've anticipated when it comes to flexing clinicians across both virtual and in-person. Rae Woods: And let's be honest, we're talking about a strategic way to be thinking about this, a strategic way to be thinking about a benefit to the workforce. So I guess my push to our listeners would be remote work is one benefit, and if you know that you're not going to be able to give that to your entire workforce evenly, then you have to start thinking about the other benefits, the other kinds of flexibilities that you can give. Well, Alex, Miriam, this is one of those hairy topics where there are not best practices, but I do want to give each of you a moment to kind of speak directly to our audience and give them an action item. When it comes to returning to in-person work, what's the one takeaway that you want to leave our listeners with? Miriam Sznycer-Taub: We spent a lot of time pre pandemic making healthcare facilities really patient friendly and patient centric and that was so important and we should keep doing that. But I think this is a really good opportunity to think about how do you make your healthcare facility staff centric too? So what are the, that you can make the in-person experience for staff better, whether that's thinking about the options they have for getting healthy, nutritious, fast meals, is it making sure they have appropriate respite spaces? Is it making sure that they have a good workplace, that they can set their things? And I think this is the time to rethink your space and think about how do you create that really good physical environment for your staff who are coming into your facility. Rae Woods: Alex, what about you? Alex Polyak: It might not be satisfying, but this is a journey. The cubicle was invented in the 1960s. The idea of an open floor plan in the late 1990s. We don't know what this is going to look like in 10 years, 20 years from now. And that may not be satisfying but unless we are able to be flexible about our strategic expectations of what the workplace will look like 5, 10, 15 years from now, we're just going to be shooting ourselves in the foot repeatedly. And it's not going to be the type of wound that some clinicians are going to be able to fix just like that. Rae Woods: I hope you're here in 10 years to be able to tell us what the next evolution of office spaces, no pressure, but you'll be back to tell us about it. Alex Polyak: Alex Polyak reporting from space. Rae Woods: Well, Alex, Miriam thanks so much for coming on Radio Advisory. Miriam Sznycer-Taub: Thanks Rae. Alex Polyak: Thank you so much. Rae Woods: We'll be right back with what our research team is watching this week. COVID cases are back on the rise in almost every state, which is a reminder that this pandemic is not over yet. Nationwide cases of COVID are nearly double what they were two weeks ago with major hotspots in Arkansas, Florida, and Missouri. The spike is likely due to the spread of the highly contagious Delta variant in areas with low vaccination rates. All this is intensifying conversations around adolescent vaccination and vaccine mandates by employers and the potential for booster shots in the future. Another thing that might be with us a little bit longer than expected are Medicare's tele-health flexibilities. Last week, CMS released its proposed 2022 Medicare physician fee schedule, which includes plans to extend some tele-health flexibilities through 2023. Rae Woods: The extension will give CMS more time and data to evaluate the effect of these flexibilities and whether or not they should be made permanent. And finally, the story of the controversial approval of Biogen's Alzheimer's drug aduhelm continues to evolve. Earlier this month, the FDA narrowed the population it recommends receive the drug from all Alzheimer's patients, which is about 6 million people to the approximately 1.5 million patients with only mild memory or cognitive troubles. This change supports insurers in restricting drug coverage to a smaller population, potentially saving the federal government, billions of dollars in drug spending. And it's not just the payers that are worried. Prestigious provider organizations like the Cleveland Clinic and Mount Sinai have said they won't administer aduhelm. Rae Woods: Another sign of concern over its approval. In response, the acting FDA commissioner has called for an independent investigation into the approval of the drug, an important step in understanding how the FDA and pharma companies can, or maybe can work together in the coming years. That's what we're watching, because remember, as always, we are here to help.