The pandemic-driven migration of work from the workplace to the home has accelerated health care companies’ movement towards the future of work, opening up opportunities for innovation, greater diversity, equity and inclusion, and a focus on well-being.

Executive summary

AT the start of 2020, few health care organisations imagined that within months, most of their nonclinical (and in some cases, clinical) workforce would be working from home. COVID-19 has accelerated and catalysed 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 organisations 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 organisational 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 Labour Statistics,¹ in the autumn of 2019:

• 85% of employees never worked from home
• 8% occasionally did (i.e., once a month or less)
• Less than 3% worked from home one to two days a week

Almost overnight, COVID-19 forced many health care organisations 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 organisations 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, organisations should harness this opportunity to transform the way they work. We found:

• Organisational culture is the top concern for employees and leadership. Fifty-nine per cent of employees feel less camaraderie with coworkers after transitioning to remote work—and the top concern raised by leadership in our interviews was that virtual work hinders culture and connectivity. For many organisations, the physical workplace was a big part of the culture and workplace design was a priority for several years. Organisations focussed on designing physical spaces that promote collaboration and sustainability to enable culture and teaming. Now, there are concerns about what the loss of the physical workspace will mean for the workforce, the culture and the mission. Leaders are challenged with how to replicate in-person mentoring and development in a virtual setting. There are no easy answers, but an analytical approach using network data and applying data science to reveal collaboration, performance, productivity and other metrics can help organisations go beyond the traditional organisational chart and illuminate strategies to build resilience and evolve into an Adaptable Organisation.
• Organisations are leaning in to the social consciousness movement and working to increase diversity, equity and inclusion (DE&I) strategies and priorities in a virtual environment.² For many years, organisations and workers avoided discussing race and ethnicity in the workplace due to discomfort or fear. But times are changing. CHROs told us the shift to virtual work was an opportunity to revisit the status quo and traditional networks and invite new ideas and foster an environment of inclusion and belonging. Leaders said the shift to virtual work has shone a light on what capabilities, including relationship-building, empathy and managing through change, are needed for organisations to succeed in the future of work. Organisations can use this opportunity to tap into data to identify who is isolated or has less access to leadership. These insights could give organisations the chance to hear diverse perspectives and make better decisions around developing talent and recruiting new hires.
• Not all employees are experiencing virtual work the same way and leaders should plan accordingly. Our survey showed that younger generations feel more productive at home and are more satisfied with the level of leadership communication compared to baby boomers. However, when it comes to performance management, younger generations grapple more with how they will be evaluated in a virtual setting compared to baby boomers. Organisations should consider using data to assess ways to increase engagement, experience and productivity in the new reality. It’s critical that everyone in the organisation has a work environment that enables success—and the environment might look different for different populations.
• The shift in how and where we work has prompted health care organisations to innovate and this mindset should serve them well as they prepare for the future of work. Prior to COVID-19, only 9% of employees said their employer was introducing new ways of working. Since virtual work has become the norm, 78% of employees reported their employer was planning to or has already introduced new ways of working. Our research indicates leaders are learning that virtual work is not about replicating in-person work online, but rather leveraging new technology to rethink work, teams and culture. Health care organisations should continue harnessing the changing landscape to consider new ways of working.
• Mental and spiritual health and well-being are paramount and require different strategies in a virtual environment. Heading into 2020, employees’ mental and spiritual health and well-being were top of mind for global organisations across industries, including health care.³ Not surprisingly, our interviews showed that health care employers have a strong desire to address these issues while in a virtual setting. Organisations are exploring different benefits to help employees better manage responsibilities at home, including child- and elder-care support, strategising around avoiding burnout and exploring ways to help employees make meaningful connections with each other.

The rapid shift to virtual work has impacted us all personally and professionally, but this shift could also bring opportunities. As health care organisations 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.

What have health care organisations learnt about virtual work?

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:

• Tools to help employees connect in real time with their colleagues and those outside the organisation (such as videoconferencing and instant messaging)
• Tools that make remote access as seamless as if they were in the office
• Tools that allow file and document-sharing
• Technical support tools
• Productivity and task management tools
• Privacy and security tools

Though most organisations have the basics in place, health care organisations are learning that virtual work doesn’t mean replicating in-person work online. Rather, they should leverage new kinds of technology to make work, team and culture visible to relevant team members all the time. Many health care organisations 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 realisation that virtual work can work. Given this reality, organisations 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 organisations 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.

Loss of organisational culture is a top concern for employees and leadership

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 organisation’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.

On the flip side, the COVID-19–driven shift to virtual work can enable organisations to recognise that traditional organisational 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 organisation design. Deloitte’s research on the Adaptable Organisation describes how value emerges from assessing informal structures within the organisation.⁴ This horizontal network consists of relationships, power, connections and informal communication, which can be very powerful in influencing behaviour. So, organisations aiming to improve culture cannot do so by changing just the formal system. Adaptable Organisations simultaneously manage efficiency and flexibility through centralised and decentralised teams. Leaders of these organisations recognise that organisational design is not static and they shift teams according to work or environmental dynamics. In the current landscape of rapid change, Adaptable Organisations 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 analyse where the networks are, where connections are happening and where they are not. In short, they want to make the invisible networks in the organisation visible.⁵ In virtual environments, there is likely more data flowing from the “digital exhaust” of digital interactions. In some cases, organisations 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.

Organisations 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.

Organisations are leaning in to the social consciousness movement and working to increase diversity, equity and inclusion strategies and priorities in a virtual environment

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 organisational performance.⁶ Organisational efforts have historically focussed on making every individual feel respected and treated fairly in an inclusive work environment. Now, leading organisations are forging a stronger link between belonging and organisational 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 focussed on ensuring that their organisation 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 organisation, especially in information technology (IT). Data from the Bureau of Labour 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 organisations, compared to male employees.

Research has shown that diverse and inclusive organisations outperform competitors, are more innovative and resilient: organisations 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 organisations 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.

Consider that not all employees are experiencing virtual work the same and plan accordingly

When considering DE&I strategies, organisations should realise 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:

• Measuring outcomes-based productivity. Productivity is no longer a simple equation of outputs and inputs. Leaders should be proactive and explicit in making the desired outcomes of their work visible to one another to achieve them. Teams should work to produce, analyse, or create, rather than to complete a series of tasks and the impact of their work should be obvious.
• Mentoring and development in a virtual environment. Just as many organisations have shifted training, candidate interviews and new-hire orientations from in-person to virtual, they should think about how to create virtual opportunities for mentoring and development.
• Providing flexible work arrangements. Some of the CHROs we spoke with acknowledged that, moving forward, work will be more flexible. The shift to virtual work has compelled employers to move away from the traditional thinking that productivity is contingent upon set hours in an office. Employers should encourage teams to have conversations around what their norms will be, based on who is available (and when) and individual circumstances.
• Making sure employees understand—and are in the habit of using—the technology and tools available to them. Employers should make sure there are adequate opportunities for every employee to get trained on available technology and tools and establish norms around using them.

The shift in how and where we work has opened up opportunities for innovation and new ways of working

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 organisations 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 organisations 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 organisations 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 organisation 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 minimising or getting rid of low-value tasks.

Some organisations are exploring new technologies. Many health system CHROs told us the shift to virtual visits has reverberated throughout the organisation 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 organisation is exploring augmented reality (AR). Though even before COVID-19, this organisation 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

Mental and spiritual health and well-being are paramount and can require different strategies in a virtual environment

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 organisations 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 focussed 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 organisations. ¹² Deloitte’s Caring for the Caregiver report discusses how health care organisations 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:

• Drive adoption of employee assistance programmes (EAPs): Organisations should encourage utilisation of EAPs and explore available virtual offerings, including apps, that help connect employees to therapists, support groups, or tools like meditation exercises.
• Expand coverage for mental and behavioural well-being and encourage utilisation: Expand benefits to include programmes to support well-being and resilience.
• Address short-term caregiver needs: Alleviate external stressors by expanding benefits with child care and elder care or food delivery.
• Enable operations with virtual and artificial intelligence (AI) platforms: Use next-gen technologies to reduce redundant, repetitive work and amplify human capabilities.
• Activate a culture of recognition: Embed recognition into existing meetings where staff can acknowledge the contributions of colleagues and build a sense of community.
• Encourage meaningful connections with each other: Plan and build in time for digital and virtual activities and have check-ins and huddles with smaller groups as needed. Consider ways in which the organisation can use virtual platforms to encourage employees to interact in meaningful, intentional ways.

Implications for health care organisations: Reimagining the workplace in a rapidly changing world

While the shift to virtual work happened quickly, the return to work for many organisations 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 time-table.

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 organisation 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 organisations should consider implementing:

• Identify and adopt the technology that enables the work of each team and function. Videoconferencing platforms and document-sharing sites will likely be table stakes. Augmented workforces using voice technologies and AI can alleviate the need for colocation. AI can also help employees navigate around existing benefit programmes. With remote-work platforms, shared services can be sourced from anywhere. Organisations will likely rely more on cloud applications and services. To continue remote work in the long run, companies should take a closer look at how many (and which) cloud apps and services in which they are investing. Organisations should prioritise spending on cloud security and governance tools, virtual-desktop infrastructure and other key instances that can securely support their remote workforce. ¹³
• Use data science and predictive analytics to explore and improve networks and collaboration. Data on how individuals and teams interact and collaborate can help organisations look beyond the traditional organisational chart to strengthen and expand networks and collaborations, nurture new ideas, and help foster a culture of inclusion and belonging. This data is especially powerful when paired with performance and productivity metrics, as well as pulse surveys or assessments that allow organisations to hear directly from employees. To build an effective and strong corporate culture that expresses the values of the organisation, businesses should continuously promote connectivity and interventions that can prevent isolation among employees.
• Prioritise DE&I as a core enabler of culture and organisational performance. Organisations should be deliberate about fostering DE&I, engaging employees in their work and in the mission of the organisation, and offering opportunities for training, development, and growth. While our survey provided some data around generational and gender differences, organisations should do their own assessments and find out who in the organisation needs what to feel included, be productive, and grow in their role. Mentoring and development will likely need to go virtual.
• Reimagine your physical and remote space—using analytics and smart-building technology. Some organisations are looking ahead to how employees will use office spaces in the future. With more people working virtually, can they reduce their property footprint? When it is safe to return, do they need to think about having fewer dedicated individual workstations and offices and more room for meetings? Organisations should consider using analytics and smart-building technologies to think through property needs and reimagine their long-term plan to optimise the workplace. Organisations are also helping their employees rethink their workspaces at home to be more productive and comfortable.
• Develop enduring human skills that make for a more resilient organisation. Nurturing human capabilities is different from skills training. Employees should still acquire basic knowledge and tactical, context-specific skills. But they should also hone enduring capabilities, such as creative problem-solving, collaboration, and critical thinking, which can be best developed through real-life application and practise. This shift can require organisations to revisit traditional notions of training. Organisations can start by treating workforce development as a strategy for building resilience—equipping workers, and thus the organisation, with the tools and strategies to adapt to uncertainty.

One of the first steps for organisations to meet the challenges ahead and embrace the future of work is to recognise 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, organisations have started to recognise that a siloed approach delivered only marginal results. Exponential impact starts when organisations address the human experience—aligning and connecting customer, workforce, and partner experience to shared values. The workforce is the face of the organisation. 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 organisations are striving to create.

Deloitte’s Life Sciences and Health Care Consulting Services

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.

Learn more