AT the start of 2020, few health care organizations imagined that within months, most of their nonclinical (and in some cases, clinical) workforce would be working from home. COVID-19 has accelerated and catalyzed several aspects of the future of work and the future of health that might otherwise have taken years. The end state is neither clear nor predictable, but health care organizations understand that few people will return to the workplace they knew a few months ago and are exploring strategies and solutions to transform the way we work. Our research shows the challenges are many—with concerns about the loss of organizational culture topping the list. However, there are opportunities to innovate; solidify diversity, equity, and inclusion strategies and priorities; focus efforts around mental and spiritual health and well-being; develop and attract talent and new capabilities; and thrive.
According to the Bureau of Labor Statistics,1 in the fall of 2019:
Almost overnight, COVID-19 forced many health care organizations to revisit traditional ways of working and engaging employees. The Deloitte Center for Health Solutions surveyed 100 employees from health systems and health plans and interviewed 13 chief human resources officers (CHROs) to explore how organizations are maintaining productivity and engagement among remote workforces; developing effective, forward-looking virtual work strategies; and building resilient workforces. Our research shows that while virtual work is working well for both employees and leadership, organizations should harness this opportunity to transform the way they work. We found:
The rapid shift to virtual work has impacted us all personally and professionally, but this shift could also bring opportunities. As health care organizations adjust, we outline ways they can execute to create value and engage more thoughtfully and intentionally with their workforces as well as patients, members, and customers. As we reimagine the new reality of health care and the workplace together, how we leverage this unique opportunity to bring the ecosystem's actors together can define the way forward into the future of work.
The Deloitte Center for Health Solutions surveyed 100 employees of health care organizations around the country:
Topics covered in the survey included the availability and usefulness of tools and technologies respondents had access to while working remotely; communication from leadership and their teams; whether or not their organizations were introducing new ways of working or new innovations since shifting to remote work; and questions around culture, well-being, productivity, and performance management since shifting to remote work.
Additionally, we spoke with 13 CHROs from a mix of health systems and health plans around the country. Our discussions centered around culture, new ways of working, and new mindsets since shifting to virtual work; performance management; communication; mental and spiritual health and well-being; and the biggest challenges and opportunities their organization faced since shifting to remote work.
“We have a beautiful campus! It was so conducive to working together, connecting. That lack of personal interaction—it feels like a loss. People miss their colleagues. But, we are making it work.”
—CHRO of a regional health plan
The pivot to full-time work from home for most employees was almost immediate, with no time for the pilots and gradual rollouts customary when major changes to the workforce are considered. However, as figure 1 shows, most employees felt they had the necessary tools and technology to be productive and collaborate with colleagues when they shifted to virtual work, including:
Though most organizations have the basics in place, health care organizations are learning that virtual work doesn’t mean replicating in-person work online. Rather, they should leverage new kinds of technology to make work, teams, and culture visible to relevant team members all the time. Many health care organizations seem to prefer an eventual “return to work,” or at least the ability to bring people back into the office with a mix of virtual work and days onsite. However, many are deciding against a full return for now, given the risks, employee comfort levels, and the realization that virtual work can work. Given this reality, organizations should solve some of the challenges they are facing and think about where they want to invest resources in the future of work. The good news is the shift to virtual work offers organizations the ability to examine their tools, strategies, and norms around real-time collaboration, building camaraderie, connectivity, and culture; improving well-being; and rethinking traditional networks and ways of working. There are opportunities to refocus and ensure that the tools, technologies, and platforms are enabling employees to communicate and collaborate in meaningful, intentional, and thoughtful ways.
“How do you sustain your culture in a virtual environment? How do you support mentorship and networks—both informal and formal? The health care industry hasn’t figured that out. That is something that keeps me up at night. If we could figure it out, it would improve our industry, and lead to better results and better outcomes, for our employees, patients, and communities.”
—CHRO of a large health system
As we saw in figure 1, most employees and CHROs agree that when they sent everyone home in the spring, employees had the tools and technologies to do their work. But with no large-scale return to work in sight for many, employees and leaders are concerned about how they will continue to build relationships—both personal and professional—and replace the physical part of the work environment and culture. How will we pick up on body language and get our creative juices flowing if we aren’t pacing around the whiteboard? Get new ideas and perspectives if we aren’t running into each other in the halls or having impromptu conversations in meeting rooms?
Figure 2 shows that when we surveyed employees in June, most reported that their company’s ability to innovate and their ability to connect with the organization’s mission did not suffer from the shift to virtual work. In contrast, 59% of employees felt their ability to build camaraderie with their colleagues was less effective than onsite. And CHROs are worried that loss of camaraderie will eventually impact productivity, innovation, and collaboration.
We describe culture as a set of interconnected elements that shape the way people think, what they say, and how they behave. The three levels of culture are beliefs, values, and behaviors. What keeps an organization moving? What keeps it running along, executing on what it should be? Mission, vision, strategy, values, and culture. Culture is a critical enabler for the other organizational cogs, ensuring employees know “how things should be done around here.” Any organizational leader seeking to drive change or encourage behaviors that reinforce the business strategy cannot overlook culture.
On the flip side, the COVID-19–driven shift to virtual work can enable organizations to recognize that traditional organizational charts offer little insight into how work gets done and who influences what decisions and activities. These charts cannot account for the blurred boundaries of the broader ecosystem or the value of informal networks.
A better approach is to understand the interplay of informal and formal organization design. Deloitte’s research on the Adaptable Organization describes how value emerges from assessing informal structures within the organization.4 This horizontal network consists of relationships, power, connections, and informal communication, which can be very powerful in influencing behavior. So, organizations aiming to improve culture cannot do so by changing just the formal system. Adaptable Organizations simultaneously manage efficiency and flexibility through centralized and decentralized teams. Leaders of these organizations recognize that organizational design is not static, and they shift teams according to work or environmental dynamics. In the current landscape of rapid change, Adaptable Organizations are more resilient to disruption.
Many of the CHROs we spoke with are interested in using analytics and data science to identify and unlock these informal networks. Now that most interactions are virtual, leaders want to analyze where the networks are, where connections are happening, and where they are not. In short, they want to make the invisible networks in the organization visible.5 In virtual environments, there is likely more data flowing from the “digital exhaust” of digital interactions. In some cases, organizations are interested in understanding how the data relates to productivity and performance. Such analyses might shed light on targeted strategies to help employees feel more included and connected.
Organizations should also consider ways to improve transparency and clarity of communication, which are now more important than ever. Leaders should host more discussions and transmit their values. At every stage, they should display transparency: they should explain why actions were taken and the options that were considered.
“Where you go to do your work is associated with your identity, how you feel about the work you do, your contribution. But we are having to learn that contribution doesn’t come in a suit or corner office or background of an environment. This new reality could change decision rights and upset hierarchies. As an employee, I like what that could say about the future of work.”
—CHRO of a regional health plan
Even before COVID-19 and the recent focus on racial inequity started gaining momentum in 2020, companies surveyed in Deloitte’s Global Human Capital Trends report said that inclusion and belonging was one of the most important human capital trends, with 93% agreeing that a sense of belonging in the workforce drives organizational performance.6 Organizational efforts have historically focused on making every individual feel respected and treated fairly in an inclusive work environment. Now, leading organizations are forging a stronger link between belonging and organizational performance by strengthening workers’ connections with their teams and fostering their sense of contribution to shared goals.7 They are also considering what it means to advance equity and how to support various populations and meet their unique needs.
Many of the leaders we spoke with were focused on ensuring that their organization not only did not lose ground on their DE&I priorities but used the shift to virtual work to help them gain in this area, as difficult as that might be. The world, to many, feels increasingly less stable, and many leaders are concerned about the mental and spiritual health and well-being of their employees. Leaders are aware that as time progresses and they start bringing more people back onsite as part of a hybrid model of working from home and in the office, they should focus on ensuring equity as to who has access to leaders and teams.
One CHRO saw opportunities in the current landscape to help increase female leadership in the organization, especially in information technology (IT). Data from the Bureau of Labor shows that though more women work in health care than men (80% of health care jobs are held by women), there is a dearth of women in leadership roles, with 80% to 90% of leadership roles going to men.8 Deloitte’s analysis from working with clients shows that while women have denser networks than men, they frequently lack strong connections to the next level of their organizations, compared to male employees.
Research has shown that diverse and inclusive organizations outperform competitors, are more innovative, and resilient: organizations with an inclusive culture are twice as likely to meet or exceed financial targets, three times as likely to be high-performing, six times as likely to be innovative and agile, and eight times as likely to achieve better business outcomes.9 Diverse populations do not equal inclusive culture—and fostering a sense of inclusion and belonging for employees is not automatic. Our interviews showed that many organizations could benefit from using their data to understand how work gets done and if there are underrepresented groups that are cut off from network structures. This could allow for deployment of targeted support to develop an inclusive culture and foster a sense of belonging.
When considering DE&I strategies, organizations should realize that not every employee is experiencing virtual work the same way. In our survey, those who identified as female found working from home led to an easier time balancing personal and professional life (65% compared to 47% of those who identified as male), and they were more likely to report that they found communication from leadership to be more effective than onsite (52% compared to 26%). Female respondents also had an easier time building camaraderie with colleagues in a remote setting compared to those identifying as male.
There are generational differences as well. Younger generations (Generation X and millennials) felt they have the tools to be more productive working virtually, compared to baby boomers. Gen Xers and millennials also reported that they appreciate leadership communication and are more likely than baby boomers to say they find it effective.
With regard to performance management, 50% of millennials reported that they grapple more with how they will be evaluated in a virtual setting compared to 36% of Gen Xers and only 23% of baby boomers. There are a few possible reasons for this, though our survey did not dive into specifics. Perhaps baby boomers feel more confident that they have established the relationships and skills at this point in their careers. It’s also possible that younger generations are dealing with more distractions at home (such as child care or elder care) and are concerned about their impact on performance.
Given these findings, employers should consider:
When thinking about new hires and developing employees to take on new challenges and roles, our interviews showed that the shift to virtual work has led to a realization that organizations should focus on certain skills and capabilities:
“We are facing unprecedented change. Most of our efforts are grounded on being in the building together and engaging face-to-face. How do we pivot and maintain that sense of commitment to our mission? Not all managers are built to lead virtually. We are in the process of assessing where we stand and seeing how we can help.”
—CHRO of a regional health plan
Most employees in our survey rarely worked from home prior to COVID-19 (8% worked from home more than four days a week, while another 8% worked from home two to four days a week). The CHROs we spoke with acknowledged most executives in their organizations thought work should be done in the office. However, our research shows that both leaders and employees are seeing innovation and new ways of working resulting from the shift to virtual work. Prior to COVID-19, only 9% of employees indicated that their employer was introducing new ways of working. Since virtual work became the norm, 78% of employees reported that their employer was planning to or had already introduced new ways of working (figure 4). Slightly more health system employees reported their organizations were introducing new ways of working. This could be because some of the health system employees in the survey were clinical employees working from home, likely doing virtual visits or remote=patient monitoring because of the pandemic.
One constant we heard from CHROs about the pandemic’s impact was how it increased the urgency of operational, clinical, and financial decision-making, and how the shift to virtual work forced their organizations to expedite and pivot their decision-making processes and pivot. Many CHROs told us that while consensus has a role and some decisions do require deliberation, the profound shift in the workplace forced them to execute new plans quickly. In some cases, they were learning to “fail fast.” They also reported taking a more enterprisewide approach to strategies and policies. According to one CHRO, “Before, we had a more piecemeal approach and would let different offices, facilities, or departments make decisions. Now, we are making more enterprise-level decisions.”
The shift has also led to the need for more meaningful—and more frequent—communication and different ways to interact. One organization is helping managers have “crucial conversations” that go beyond tasks, deliverables, and deadlines and get to what the employee hopes to achieve. Many CHROs report that meetings and discussions, when not onsite, must be more deliberate, and they predict this is leading to reduced micromanaging. The focus should be on empowering employees to work effectively, developing a process for streamlined decision-making, and minimizing or getting rid of low-value tasks.
Some organizations are exploring new technologies. Many health system CHROs told us the shift to virtual visits has reverberated throughout the organization and is spurring gains in digital transformation—a shift was clearly happening before COVID-19 (see previous Deloitte research on the hospital of the future).10 For example, some of the health systems and health plan leaders we spoke with were advancing enhancements to chatbots to better serve their patients.
One organization is exploring augmented reality (AR). Though even before COVID-19, this organization was dealing with the reality of travel budgets and the burden on employees, the pandemic spurred leadership to look for ways to accomplish business outside of conference rooms or even videoconferencing. With AR, each person has an avatar, which provides an experience that makes it seem like people are really in the room together; they can see an individual’s body language, hand movements, and whether they are making eye contact or paying attention. People can draw on a virtual whiteboard, just as if they were in the same room.11
Every one of the CHROs we interviewed mentioned employees’ mental and spiritual health and well-being as a concern. Employees have to cope with a lot—the pandemic and concerns about health risks, the social unrest we are experiencing, and the need to adapt to changing routines and norms. Many of the CHROs we spoke with are making sure communication from leadership is constant and transparent. They are scheduling more time for smaller group check-ins and making sure people have access to resources they need. Some organizations are strengthening their child-care and elder-care benefits.
Traditionally, the concern about working from home was that people who are not being “watched” might not work as hard. But the CHROs we spoke with, and many of the news and business-trade publication articles about the shift to virtual work, are focused on burnout from working too much. Without the physical separation between work and the rest of life, CHROs were noticing that many people have trouble stopping work. Burnout has huge costs for employees and their organizations.12 Deloitte’s Caring for the Caregiver report discusses how health care organizations can address mental health and well-being concerns for those on the front lines of caring for COVID-19 patients. Obviously, some of their challenges are different, including stress about contracting the virus or passing it on to loved ones. But, some of the strategies to address mental health and well-being are the same for front-line and back-office workers:
While the shift to virtual work happened quickly, the return to work for many organizations will likely be much more gradual, with many opting for a hybrid approach of virtual work and onsite. In our survey, two-thirds of employees would choose this model, with only 6% wanting to return to the five-days-a-week onsite schedule.
Doing virtual work well means developing and sustaining new strategies and accepting new ways of working. It also means finding opportunities to reimagine the workplace, discovering new ways to innovate, and improving how the organization meets the needs of customers and employees. Now is an opportunity like no other to consider new ways of working and set them up for long-term resilience.
Based on our research, here are strategies health care organizations should consider implementing:
One of the first steps for organizations to meet the challenges ahead and embrace the future of work is to recognize that elevating the customer, member, or patient experience is synonymous with elevating the workforce experience. After years of focusing on customer experience and/or workforce experience, organizations have started to recognize that a siloed approach delivered only marginal results. Exponential impact starts when organizations address the human experience—aligning and connecting customer, workforce, and partner experience to shared values. The workforce is the face of the organization. Every issue that we touched on in this research—productivity, connectivity, culture, mission and vision, DE&I, overall well-being of employees—is important because the workforce is the face of the business and directly and inextricably linked to the customer and patient experience health care organizations are striving to create.
Innovation starts with insight and seeing challenges in a new way. Amid unprecedented uncertainty and change across the industry, stakeholders are looking for new ways to transform the journey of care. Deloitte’s US Life Sciences and Health Care practice helps clients transform uncertainty into possibility and rapid change into lasting progress. Comprehensive audit, advisory, consulting, and tax capabilities can deliver value at every step, from insight to strategy to action.