Rae Woods: From Advisory Board, we are bringing you A Radio Advisory. My name is Rachel Woods. You can call me Rae. Rae Woods: We've been living through the COVID-19 crisis for nearly a year now, and while we're all waiting for herd immunity, one thing is certain, many of us are not going to be going back to the office any time soon. So in this episode, I want to talk about how managers can keep their teams engaged and productive at home, and what we all can do to keep a little bit of our sanity. Rae Woods: So to do that, I've brought to HR and workforce experts to the pod, Serena Bernthal-Jones and Rachel Zuckerman. Rae Woods: Hey, Serena. Hey, Rachel. Serena Bernthal-Jones: Hey, Rae. Rachel Zuckerman: Hi, Rae. Rae Woods: I feel like this is a very good moment where I go by my nickname. I'm been going to do my best not to answer my own questions that I have directed at Rachel. Rachel Zuckerman: I know we always have the same problem when we're on the same call. Rae Woods: How are you two holding up staying home, working from home for almost a year now? Serena Bernthal-Jones: Yeah. I think we're almost hitting that one-year mark, which is kind of crazy. I know we packed up our bags back in, what was it? Early March last year. We thought we'd be gone for a few weeks and now we're almost at 12 months. So time flies. Rae Woods: I know it's been a long time because in the early days of the podcast, I use to reference the number of weeks that we had been recording remotely in quarantine, and now it's just become a normal part of life up to this point. Rae Woods: All right, well, let's get into it. Before we talk about kind of the future of the workforce, I do want to talk a little bit about where we started. Pre-pandemic, how would you describe the state of the healthcare workforce? Serena, what do you think? Serena Bernthal-Jones: So to give you the 15 second version, Rae, I would say engagement, we were doing pretty well. That had been trending up for the last half decade or so. And when compared to out of industry benchmarks, healthcare really was blowing other industries out of the water. On the other hand, retention and burnout, definitely rising issues that were on every workforce leader's strategic agendas. Turnover was on the rise, burnout also, especially for nurses and physicians. Rae Woods: Did I hear you correctly that the healthcare workforce pre-pandemic was highly engaged, but at the same time, turnover and burnout were on the rise? Those things feel like they are in conflict to me. Serena Bernthal-Jones: Yeah. That's a great point, and actually ties really well into what we're talking about today. I think you can say that those high rates of burnout and growing turnover were in part symptoms of the fact that we weren't offering much flexibility in terms of when, how, and where people were able to do their work. Rae Woods: And I suppose that you can have somebody who's super engaged in their job because they are working really hard and taking on a bunch of extra tasks, but on a long enough timeline, those things lead to burnout, and ultimately, turnover. Serena Bernthal-Jones: Exactly. Rae Woods: Rachel, what would you say about the kind of pre-pandemic workforce? Rachel Zuckerman: I would agree with Serena and just kind of echo that even before COVID hit, the workforce was not an imperfect situation. I think in addition to seeing higher rates of emotional exhaustion and burnout, we were also seeing a lot of fierce competition for a very limited talent pool. And so employees were being pulled away from their traditional healthcare providers, especially to new kinds of healthcare organizations and startups and companies that offer kind of different benefits and work-life balance. Rae Woods: We've talked before about the lack of flexibility in the healthcare workforce, particularly when it comes to what a lot of women are facing in the childcare crisis that's happening at the same time that we have this COVID crisis, but within flexibility, I guess I want to know specifically how common was it for employees to work remotely? Serena Bernthal-Jones: Not all that common. I think the way that flexibility was viewed, especially remote work, as something that was earned as a privilege. I think that's even kind of how we thought about it within Advisory Board. Of course there were exceptions to this rule, but I think when you compare healthcare to other industries, we definitely, in healthcare, took a more conservative approach. Serena Bernthal-Jones: For the data nerds among us, we were tracking at around 43% of the industry before pandemic times had access to some form of remote work. Now, that's compared to 72% in other industries like IT. So healthcare was definitely lagging here. Rae Woods: So less than half of the workforce had access to any kind of remote work pre-pandemic. Help me square this with what we're seeing today. Obviously the three of us are working remotely, we're recording this podcast remotely, but how does that compare with what we're seeing in the rest of the healthcare industry right now? Rachel Zuckerman: Yeah, I think that for a lot of industries, including healthcare, the pandemic has acted as this sort of proof point to prove that a lot of people can do their work remotely. And we're seeing that with a lot of our member organizations. I would say that pretty much every healthcare organization that works with Advisory Board has some percentage of their employees working remotely since the start of the pandemic, and have expanded their options for remote work. Rae Woods: And the question that that brings up for me is how much of that is going to remain permanent or should remain permanent moving forward? I guess when it comes to the healthcare workforce, do we know what kinds of environments lend themselves to this type of ultimate flexibility? Rachel Zuckerman: It's a good question, and we're probably not going to see what we've seen with some tech companies like Dropbox, which has said that all of their employees will be a hundred percent remote going forward. We're probably not going to see that in healthcare, but I think when we're talking about who's remote, we're seeing a lot of administrative and nonclinical roles that are still working a hundred percent remote today. Serena and I work with a lot of HR leaders and learning and development professionals, and a lot of those folks are still working remotely now. Serena Bernthal-Jones: So to give you an example of a few different models of what this is actually looking like, some organizations, for example, are letting folks opt in now to permanent remote work, Advisory Board did that back in the summer, or having the option to occasionally come into the office while most of your job is remote. We're calling that the hybrid model. Some organizations at this point are delaying any kind of permanent decision, but remaining remote for the foreseeable future, and then are going to ultimately reevaluate once the pandemic passes. Rae Woods: I have to believe that a lot of the change here isn't just because of the crisis itself, right? It's not just because we have to maintain social distancing. It's not just because schools are closed, or maybe unpredictable is the better word, but I have to believe that people just kind of like remote work more than they expected. I mean, I personally fall into this category as somebody who maybe wouldn't have chosen to go remote full-time, but almost a year into this, it's actually hard for me to imagine going back to the old way. How much does preference play a role in making some of these changes more permanent? Serena Bernthal-Jones: I think a lot. And this was something we were talking about even pre-pandemic times of employees demanding more work-life balance and flexibility. Flexible work arrangements are a big part of that. Even before the pandemic, employees were leaving their employers to find more flexible work arrangements elsewhere. And I think now, like you said, that people have really experienced the perks of working remote, that is only going to become more and more commonplace. Rachel Zuckerman: Yeah, I agree. Rae Woods: I know I just said that preference matters, especially if you, as a leader, want to cement yourself as the employer of choice, but preference also can't be everything, and I imagine that is especially true in healthcare. The pushback I'm imagining folks will have is that, at some point, roles in healthcare have to be in-person, especially when I think about clinical roles. Serena, how do you respond to that pushback? Serena Bernthal-Jones: Yeah. So it's certainly easier to do with administrative staff. To give you just a few examples that we've been hearing. Last I heard, Mayo was still delaying any final decisions, but they were continuing to have about 1500 nonclinical staff working from home, but with the vision of eventually hoping to adapt a more hybrid model in which staff will alternate between the office and working at home. Ascension, on the other hand, decided to keep 1200 of their staff members working from home permanently and just occasionally having them come into the office. And then Geisinger, they're going to continue to have their nonclinical staff working from home, and their long term plan is to have 30% work from home permanently and 30% utilizing more of a hybrid model, where they'll work from home some days and come into the office on other days. Serena Bernthal-Jones: But Rae, I actually want to put this back on you, as I know you work with physician executives, and really curious to hear your perspective on how this is looking like for clinical roles, which are tougher. Rae Woods: Yeah. I mean, you're totally right about the administrative staff. I can think of exactly zero executives who have continued to build administrative office space, as an example. Even if they're not going full-fledged to some of these hybrid models that you're suggesting, they're at least buying themselves some time while they think about what to do. Rae Woods: I absolutely see a role for kind of permanent work from home positions in the clinical space. I would also point to organizations that did this pre-pandemic. There were a lot of virtual care companies, people would probably think of them as disruptors, who were offering really amazing work-life balance by letting people work from home. We also saw it as a way to boost capacity. I can think of a lot of organizations that took, as an example, their clinical psychiatrists and said, "You're going to be working full time remotely so that you can see as many patients as possible for your home office." And I expect to see a lot more examples of the virtualist clinician, not even just the physician, but the virtualist clinical role as part of the future of healthcare. Rae Woods: One piece of the pushback here is how appropriate is it for certain roles within healthcare, but I think in general, there's this broader commentary about working from home as having a bad rap. I would say I especially hear this when I speak to the C-suite, when I speak to executives. Why do you think working from home has this kind of bad reputation? Serena Bernthal-Jones: Well, to tell a short story here, Rae, I on the phone with an HR leader the other day from an organization that just made the call to have all their administration staff work from home permanently going forward. For context, this was actually a pretty big deal because previously, like you said, they'd really struggled to get C-suite buy-in for any type of remote work before. What's interesting though is the pandemic, like many organizations, forced them to pivot and actually see the benefits of remote work, to the point where they want to hold onto those gains. So they were really intentionally utilizing these last 11 months as a test case to show internally, to win over stakeholders, that yes, our workforce can be as productive remotely, and to intentionally hold onto this going forward. Rachel Zuckerman: I think it's interesting you use the word productively, and that is one of the major pushback I hear about working remotely is this fear of reduced productivity if employees are working remotely, I think that is one of the things that gives remote work a bad reputation, right? As you mentioned. Rachel Zuckerman: And I think the other pushback I hear the most is this fear that it will kill a company culture and that there will be a decline in engagement because people just aren't interacting in person. And it's hard to have that cohesive culture when people aren't together. Rae Woods: So let's actually talk about both of those things. Maybe let's start with the productivity angle. If there is a fear of productivity dropping off, what can managers actually do to make sure that productivity remains high? Rachel Zuckerman: Well, I would start by saying that I think there's a bit of a misconception possibly that working from home automatically means lower productivity. I think the concern comes from the fact that when you're remote, you can't necessarily see what your employees are doing. And if you can't see it, you can't know for sure that it's happening, which can be tricky as a manager and employer. But I don't think that equates to lower productivity and there are things you can do as a manager to kind of give your team the best shot at working productively from home. Rae Woods: My productivity is totally higher working from home. I don't know about you guys, but I feel like I can get a heck of a lot more done when I'm not commuting to the office every day. Rachel Zuckerman: I agree. I feel like I am very productive, almost too productive. It's hard to step away from my computer sometimes because I'm just in this office all day. But I think there's this divide between what you're doing at home and what your manager can see, and sometimes that's hard to square as manager who's responsible for a team. Rae Woods: Rachel, I want to go back to the point you made about not being able to step away from the computer. And when I think about productivity, I'm also starting to be more acutely aware of the cost as well. And I think working from home, while it's definitely been a benefit to a lot of us, it also has the potential to really blur the lines between work and home, and making work-life balance I think even harder to achieve sometimes. And that worries me when I think about the burnout trends that we mentioned earlier. Rae Woods: So I think when we think about the role of managers here, not only keeping tabs on your team's productivity, quote, unquote, but also keeping an eye on are they online all hours? Are you modeling good email behavior of sending emails only within set hours? So that's just something I think we need to be more acutely aware of and talking about moving forward as well. Serena Bernthal-Jones: That's such a good point because everybody is worried about productivity going too low, but what you're saying is you should be maybe equally worried about productivity being too high and setting expectations for both a floor and a ceiling, especially if you want to keep these people around. Rae Woods: Absolutely. I think when it comes to setting kind of this floor and ceiling, the role of the manager becomes perhaps even more important than maybe the rules of the road that are set by the organization itself. Any advice for actual managers out there? Serena Bernthal-Jones: Yeah. So when we're working with leaders, we give them a few questions kind of to just gut check what are your productivity expectations? So for managers on the line, I'd say ask yourself, how am I actually measuring individual productivity on my team? Have I explicitly shared that with them? So are they aware of how I'm measuring it? And then finally, and this is big, how are you actually helping your team prioritize what is the most important work and what actually needs to get done? So three things very much in a manager's control. Rachel Zuckerman: I would echo just how important it is to really clearly define how you're measuring productivity. Because I think especially remotely, it's really easy to fall back on indicators like how often are they online or how quickly are they responding to emails, when those might not actually be indicators of what you want them to accomplish. Rae Woods: And we should also say, in a world where some in the workforce are also dealing with crises of their own at home and managing school or taking care of kids or family members, it should not be a knock on them if their kind of green light isn't blinking at the right time. Rachel Zuckerman: I agree. And if I can add just kind of one more thing on this point of productivity, I think I would encourage managers to just recognize the extraordinary circumstances that we're all living through right now. We're living through a pandemic, political upheaval, social inequity that has become really apparent this year, just unprecedented amount of illness and death, and that is all unavoidably going to impact our team's productivity. Rachel Zuckerman: And I would argue that it should impact our expectations for productivity as well because, I mean, yes, we're all managers and employees, but ultimately, we're all humans living through a really challenging time. And I think as a manager and an employer, you're going to be better off in the long run if you give your employees the flexibility and support to navigate just the incredible number of stressors that they're dealing with right now. Rae Woods: Yeah. So one of our colleagues and friends, John League, who's been on this podcast a couple of times before, actually shared with me something that he does as a manager that stuck with me so much, I wrote it down on a post-it and put it in front of my desk. And it says that productivity is a result of mental health, not the other way around. And I think about that all the freaking time. So thank you, John. Serena Bernthal-Jones: Rae, one other quote to add to that sticky note potentially a friend said to me early on in the pandemic is we are not working from home, we are at home during a crisis trying to work. Rae Woods: Yeah. Serena Bernthal-Jones: So I think just grounding in that and resetting that expectation both for ourselves and our teams is a really important one as well, to Rachel's point. Rae Woods: Let's talk about the other big kind of challenge with remote work that Rachel brought up, which is culture. And I have to believe that there have been some maybe well-intentioned examples of boosting company culture over the last 11 months that maybe fell a little bit short. I'm thinking about all those remote happy hours and coffee hours and things that maybe we had on our calendars. Do we actually have any advice on how to boost culture, boost engagement in a remote environment? Rachel Zuckerman: Well, I personally am not a fan of big virtual team happy hours. So this is a big one that I think is really hard to solve virtually, but I think that ultimately, engagement at work, a lot of that comes from social connection. And it's hard to replicate that virtually, but I think the key is recognizing that meaningful social connection is going to mean different things to different people. So while someone might not enjoy those team happy hours, they might really get value from a one-on-one conversation with a friend or a mentor, whether that's in person or virtually. Serena Bernthal-Jones: Another really simple shift too I would say is shifting those quote unquote team fun activities to during working hours. Rae Woods: Yes. Serena Bernthal-Jones: I don't know about you guys, but the last thing I want to do is get on another Zoom call at 5:30 after a day of Zooms. Rae Woods: Oh my God, yes. Serena Bernthal-Jones: So, simple, but I think even just the way that Rachel and I's team do it, we do them during our existing team meetings. So it doesn't have to be another add-on. It can be an icebreaker at the beginning. It can be really as simple as that. Serena Bernthal-Jones: Another organization we were talking to a few weeks ago shifted the focus. They had a weekly nursing leadership meeting on Fridays that used to be an hour long, operational updates, and they actually just shifted it to be a space for peer-to-peer connection to talk about what was hard, what was going well, both in work and outside of work. And I think going back to Rachel's point of this doesn't have to be team fun necessarily, we're trying to build connection and what is meaningful to some is going to look different. So creating the space for connecting with coworkers in the way that you would in a lunch room or in the hallway, but aren't able to in this virtual world as easily. Rae Woods: And it's hard because we can't pull on the same levers that we are used to pulling as managers and as leaders, and that has to also have an impact on just managing a team virtually. In what ways is that really different from in-person management? Serena Bernthal-Jones: Virtual management is definitely tough. I mean, you think of all the things that can go wrong with technology, feeling isolated, both for your team and yourself, never-ending days, back-to-back meetings, Zoom fatigue. It's definitely tough. So when we're talking to leaders, I like to ground in what are the things that you as a leader actually do have control over and what does your team need from you right now? Serena Bernthal-Jones: So I like to think about this in terms of four things, of clarity, autonomy, sense of belonging and connection to mission. So on the point of clarity, clearly communicating what are the most important priorities right now for you and your team. In terms of autonomy, like we've been talking about, being flexible about when and how the work gets done as long as they're meeting deadlines. Sense of belonging, like we were just talking about, creating that space for team collaboration and feedback, and really engaging still in this virtual environment. And then finally, connection to mission of regrounding in the why. What are we doing, what are we contributing to, and also recognizing team. Serena Bernthal-Jones: And I really want to underscore that point on recognition. This is something we've always known to be a big engagement driver, and I think it's even more important in the virtual world now. So really intentionally setting aside time for recognition in the work day as well. Rae Woods: We've been talking about the fact that working remotely, tricky as it may be, is something that's actually a value-add for a lot of employees and that it can happen without sacrificing productivity. But I have to believe that there are other reasons that employers are considering moving to a permanent or a hybrid remote working environment. What are those other factors? Serena Bernthal-Jones: Well, a big one is cost savings. Companies that have implemented remote work are seeing reductions in real estate costs, reduction also in terms of absenteeism and employee turnover. Rae Woods: Wait, turnover has gone down since folks have worked remotely? Serena Bernthal-Jones: This is based on companies that have been remote for a while. I think it's probably not fair to say that yet. Rae Woods: Ah. But maybe that's something that we should be watching for over the coming months, maybe even years, as folks transition to remote work. If turnover was on the rise in healthcare, flexibility, as we said, could be a reason to kind of stop that. Serena Bernthal-Jones: Absolutely. And we'll be tracking that work, collecting our 2020 benchmarks right now for turnover. So quick plug to all those E-Track members on the line to submit their benchmarks. I don't know if I'm allowed to say that. Rae Woods: You're allowed to say that. So cost savings is one big one. Serena Bernthal-Jones: Yeah. Rae Woods: Are there other reasons? Rachel Zuckerman: One other opportunity that remote work may help with is creating a more diverse and equitable workforce, which we know is a big focus area right now for a lot of organizations. At a baseline level, offering remote roles will allow you to look for new candidates just beyond your immediate neighborhood. So it will allow you to open up your organization to different people than in the past. Beyond that, with remote roles, we have an opportunity I think to open up access to people who previously wouldn't have even applied for the role. So I'm thinking about someone who doesn't have easy access to a car to get to the office, but they can work remotely, or some sort of hybrid model that might work for a parent who has to be home to provide childcare one or two days a week, but then they can be in the office the other days. It just kind of opens up the possibilities a bit more. Rae Woods: Yeah, that is such an important point. And I think in this world where employers are competing for the best talent, whether that's administrative talent or clinical talent, I also have to believe that flexibility in general is a part of positioning some of these companies as being the employer of choice. How important do you think flexibility is for that mandate? Serena Bernthal-Jones: I'd say incredibly important. I think when we were talking about this in the pre-pandemic state, we talked about it as a perk or a nice-to-have, or even a differentiator. I don't think that's going to be the case anymore. I think it's going to be a baseline requirement. I think that organizations that don't embrace flexibility in all its forms, remote work being one of those flexibilities, are going to be at a disadvantage from their competitors. Rae Woods: Yeah. Rachel Zuckerman: Yeah. I completely agree with Serena. I think that flexibility will just be a really important differentiator for employers going forward, or I don't even know if differentiator is the right word. I think it will be an expectation from employees, and they're going to look elsewhere if they're not getting it from your organization. Rae Woods: Well, Serena, Rachel, I want to thank you for having such an important conversation on Radio Advisory. I feel like we're giving a message to our listeners and to healthcare leaders, and you're also giving a little bit of a message to me as a remote worker and a manager and somebody who likes virtual happy hours. You know what's coming, my final question, what should our listeners be focusing on right now? Rachel Zuckerman: Well, we're heading into basically a year of working remotely at this point. And I think this is actually a great moment to reflect on what you've liked about being remote. Being remote is not all bad. I would love for everyone listening to this conversation, whether you're a manager or an individual contributor, to just take a few minutes to reflect on what you've actually enjoyed about working remotely or leading remotely, and have that discussion with your team as well. Rachel Zuckerman: I think there's sometimes this temptation to try to replicate the in-person experience online, and that's obviously going to fall short. And while there's no question that we do lose out on some important things, when we're virtual, there are major gains as well, as we've talked about, and I think now is a great time to kind of take stock of those and lean into them. Serena Bernthal-Jones: To answer this question from the organizational perspective, I would say and just reiterate the point that if you truly want to position yourself as an employer of choice, so both to attract, retain and really engage your workforce, flexible work arrangements like remote work are going to be key. I'd go so far to say that they're going to become a necessary part of the employee value proposition going forward. Serena Bernthal-Jones: So I think organizations that see this as a win-win and actually truly embrace flexible work arrangements like remote work, they're going to be best positioned to really build the workforce for the future. Rae Woods: Thanks, Rachel. Thanks, Serena. Rachel Zuckerman: Thanks, Rae. Serena Bernthal-Jones: Thanks, Rae. Rae Woods: As Serena and Rachel said, flexibility is no longer just a nice-to-have, it is a need to have. But it's important to keep in mind that it's not just about organizational policies. The manager plays an incredibly important role here, both in leading their teams towards the future and in making sure that everyone is productive, and engaged, and sticking with the workforce over the long-term. New Speaker: Here's what else our research team is watching. As expected, Democrats are pursuing opportunities to expand Medicaid coverage. But because Medicaid expansion is expensive, they are proposing some creative ways to offset the costs. A proposal from the House Energy and Commerce Committee aims to lift the cap on rebates that drug makers already pay to state Medicaid programs. They are targeting manufacturers whose drug prices rise faster than inflation, something the pharma industry obviously opposes. The additional money would be used to extend Medicaid coverage for new moms. Going from only 60 days, to twelve months. New Speaker: The committee is also considering new ways of incentivizing Medicaid expansion in those states that haven't expanded Medicaid yet. Again, this is expensive, so that’s why they are proposing a boost in the enhanced federal matching rate for the first 2 years. States that expand Medicaid now would benefit from a federal match at 95%, instead of the typical 90% match. New Speaker: More relief money might be coming for providers. Biden’s original $1.9T proposal had left out additional provider funding, but this notable absence has been partially amended as part of the budget resolution process. The budget resolution from two weeks ago included language for $35B additional funds for provider relief, including a good chunk for rural hospitals. We will have to wait for the final version of the stimulus bill to know if relief is actually coming and who gets it. We expect the answer before mid-March. But in the meantime, as always, we're here to help.