And again, I have nothing to disclose. We'll start with a few questions, and this is relative to remote work and hybrid work. What effects has the pandemic had on remote work? What have we learned in this social experiment? What are the pros and cons? How can we successfully implement remote work and hybrid work options in our practices? What's really applicable to healthcare, right, in your practice? And how can we create win-win scenarios? So we'll have another polling question. Do you currently have employees working fully remote? Interesting. So it's 50-50. Interesting. All right. Do you currently have employees working a hybrid schedule? So that would be partly in-person, partly remote. Oh, that's interesting. 42%. All right. It has certainly been the case for us and for many organizations that we realized we were able to embrace change faster than we thought was possible. I'm on the board of a local nonprofit company that pre-pandemic was fully in-person and had a strategic plan over three to five years to implement virtual engagement of customers. And that happened 100% within four weeks. And obviously, things can happen fast. I think many companies realize this. When change forced upon us, we can adapt and we can change with it. This is just a quote. Virtually all projections anticipate the post-pandemic workforce will be relatively more remote. That is, nearly all firms will experience an increase in remote work relative to the pre-pandemic baseline levels. This is an interesting slide. It's looking at what's happened pre-pandemic and during the pandemic peak, and we can talk about what may happen for the future. But pre-pandemic, only less than 6% of US workers were fully remote. About 15% were part-time remote, but about 75% had never worked remote. And during the pandemic peak, about a third were completely remote. So, it's fascinating statistics, but also keep in mind that there's a lot of people that have worked remote and obviously now have that experience. So survey of a number of large organizations asking the question, what were the most meaningful actions you took during the pandemic to support remote work in your organization? And these were some themes that we will talk about subsequently, communication, obviously providing needed technology, providing emotional and social support to the remote workers, promoting their work-life balance, doing what you can to maintain productivity and engagement and ensuring their well-being. Some pandemic myth-busting, and I have to say, I think this is a global recognition for organizations. It certainly was the case for us pre-pandemic. We really were worried about whether or not we could have remote workers working successfully. It turns out that our staff can work flexibly. We can monitor our staff at home. We can make the technology transitions faster than we thought and more seamlessly. Remote workers can be happy and they can actually be as or more productive. And most employers have reported that it has worked better than they expected. There's three phases I think we can consider relative to remote work if we ignore the pre-pandemic state. There was obviously the emergency scenario last summer, for example, where some of us had to or chose to move certain people remotely, either fully or with a hybrid schedule. The worker shortage, that's really where we are right now. So there are some advantages to offering remote work or one way or the other, potentially in your organization relative to the staffing challenges that we're having. And then the next is really, what's the sustainability model? So how do we plan for the future? It's not going to be the same as the past. So what is that sustainability model? And again, we need to be proactive and we can't just go with the flow on this one. So where are we and how can we innovate for the future? So how does this apply to our practices? And I'll discuss how it's applied to our practice. And so obviously we're patient-facing businesses, right, in our clinics and our ASCs. So there's only a certain number of people that can work remote or either fully or via a hybrid schedule. We have our call center and scheduling department fully remote right now, 100%. Most of our billing staff is 100% remote. Our administrators may or may not be remote. Some work a hybrid schedule. They work at home part of the time and they work in the central business office some of the time. We happen to have some triage nurses and a few of those are fully remote. We have not moved MAs into a hybrid schedule yet or it's difficult to do a fully remote schedule for MAs, obviously, but we are thinking about doing that now relative to some of our staffing challenges and possibilities. What do employees want right now? It's pretty clear from surveys that they want remote options and they want job flexibilities. Again, this only applies to certain types of positions, but it certainly applies to some of our employees. And as I mentioned, many have been doing it and they like it and they don't want to go back necessarily to in-person work. They are willing to look for other jobs or join other organizations depending upon whether or not these needs are fulfilled. And there may certainly be a disconnect between what the employees expect and what the employees expect, especially now that they're wanting to bring everyone back. Commuting has never really been a joy, I think, and I don't know how much we really considered this in the past, but pre-pandemic, U.S. workers spent an average of 40 minutes per day commuting. And that has an impact, you know, in addition to just the time and the cost and wear and tear on your cars and cost for gasoline, et cetera. People are fat, stressed, and unhappy is what the surveys show, and it's time away from their family and friends. And so commuting is not a job satisfier, obviously. And so many people now are taking this into consideration, right, either they don't want to commute or they want to commute less. Notably there are over 10,000 books in the English language on Amazon and virtuality remotely at a distance, and I think that tells us it's not necessarily easy. Another polling question, Eden, do you have a formalized plan to successfully implement remote work in your practice right now? Okay, so about one out of four. And so hopefully we'll talk about some tips about how to do that and some ideas here. So we should take an audit, right, like where are we right now? And so not everybody has remote workers, but, you know, it's really key to understand whether or not you have the infrastructure capabilities to do that, right? You know, whether it's, you know, software, hardware, do the employees have what they need at home? What type of work? You know, classically, independent, less collaborative and work that requires less coordination is ideal for remote work, but that's just not the reality, you know, for our employees. I mean, collaboration and coordination is required, but it can still work. Which employees? And I mentioned a few that I think it's applicable to in the previous slide. It's certainly not all can work remotely. What's the right mix of in-person remote work and can we embrace hybrid models? Obviously many people are doing that, and that can be done in different ways. There could be a shared structure in a department where some days are in-person, some days are off-site. In a given department, some employees might work fully remote, others fully in-person. You might need some cross-training and flexibility with seasonal changes or stress-stabbing changes where you need to have the ability to bring people back if they're working remote. It's important to make it clear which positions are applicable. If you're not going to offer remote work to MAs, they need to know that because they might look at the billers and the schedulers that are remote, and they would like that as well. But that just may not work for your practice, but you need to let them know why that is. Pre-pandemic, I would say that we were planning on getting more space for our central business office with the lease renewal in 2022, and right now we are planning on reducing it. We will have employees that will remain fully remote, and we need less space. This is generally low-rent-type space for a central business office, but it's still overhead, and so we will be paying less money for that going forward. I think we need to remember, really importantly, and remember that less than 6% of remote workers were remote pre-pandemic. We had no remote workers, and so this is a new skill set for our managers. It's not intuitive, necessarily, how you manage remote workers, and so we have done our best to try and educate our managers where it's applicable, giving them articles on success tactics and challenges, discuss with them continually, getting feedback, and we've really been learning together how to do this well, but we've done it actively. We can't assume that they know how to manage remote workers. You may need to bring people on site for training before they go remote. We do that with our call center staff. It's definitely attractive to hire people now if it's a remote position that actually have remote experience rather than having to teach them how to work successfully remote because, again, that's not something that happens right away for employees when they first go remote. I think the real key is employee support as well, in addition to manager support. They have to learn how to navigate work-life priorities and develop a work-life rhythm. What's the right balance for them? What are the routines that they're going to implement in their house? Do they have any technology software issues? Are there background distractions? Do they have privacy? Do they know how to plug and unplug, and really, can they develop that work-life rhythm that works for them? Having a pulse means checking in on them on a frequent basis, I think is really important. There are some core success principles. I think two of the keys are communication and coordination, which really builds the basis for successful remote work and trust, which is important for maintaining culture, which we'll discuss. Obviously, people are not walking down the hallway, talking to each other, going to each other's cubicle. There's a different type of communication that happens, but there's multiple avenues. Depending on the complexity of what needs to be communicated, phone calls all the way down to various texting, but you're moving from instant communication when you can go talk to someone to something that's more asynchronous, and you need to find the right balance. What's the right balance for voicemail or phone calls or messages, and when do you need to have virtual meetings? I think it's important for the managers to give regular updates, respond to messages promptly and be available, but you need to set norms and patterns. In our experience, this is something that actually happened without too much difficulty, and I'll talk about that. From a coordination standpoint, it can be more difficult. One article I read said it could be like choreographing a troop of blindfolded synchronized swimmers when you throw everybody remote, and we want it to be better than that. Again, I think it's a key for the managers to really articulate the mission, assign roles and responsibilities, and make sure the project plans are detailed, everybody understands the performance metrics, and it's available and accessible for everyone. Next slide. Culture may be difficult to maintain when people are not together. This is the shared set of customs that foster trust and engagement. How do you do that when people are not with each other? How do you support that? If you have good communication, good coordination, that does build trust, and that absolutely helps culture. What our manager is doing on their Zoom calls is asking every employee to spend at the beginning one minute talking about what is new and how things are going, and that makes it personal. It's been shown that just small check-ins to see how people are doing can lower their stress, improve their well-being, and increase their sense of belonging. Other options are virtual town halls and water coolers, having lunches, either at the office, in person outside the office, and again, pulse check surveys, I mean, how's everybody doing? Do what you can to kind of promote culture and not keep people feel too isolated. In-person interactions do play a role, right? So when you can, it's important to try to bring people together, whether it's team lunches, office meetings, we do provider education sessions, and those types of things. The value of time is different when people are at home, and, you know, there may be a tendency to have a lot of Zoom meetings and just to keep people connected, but there is Zoom fatigue, as we know, and hopefully that's not too much of an issue today for all of us, but it's real, so you need to limit meetings, limit Zooms, and doing when you think it's value-added. There are some potential downsides, and so it is good to have a plan, you know, considering who should be remote, how can you implement that, what do you need to make it successful, all the way through, right, all the resources that you need, you know, from technology to the managers and down to the employee support. There may not be buy-in, some may not want to be remote, right? Some people may feel isolated and disconnected. There's a risk it could degrade relationships and culture. Some people may be embarrassed when they're on Zoom meetings, depending upon where they live, right? I think really importantly, employees need to be able to adapt their work-life balance, their work-life rhythm to make it successful, otherwise it's going to be difficult. There are some potential human resource considerations. Remember that the challenges of going back to work may disproportionately affect low-wage workers, minorities, and women, if you're going to force people, for example, to come back. Minorities were more likely to have lost their jobs during the pandemic. Women often have more child care challenges. And notably, some workers may have the legal right to remain remote, right? So if they've been remote for, for example, for a year and you force them to come back, evidence of permanent accommodation, not due to undue hardship of the employer may exist, right? And so you need to take that into consideration. You may need to modify your human resource policies as well if you haven't had remote workers before. This is actually a survey that my, I have a manager that manages both the scheduling department and the call center, and they're all 100% remote. And so this is an actual survey from our practice from a few weeks ago. And, and these are some consistent themes in their responses. It's 15 employees. Generally speaking, they, while they all said they enjoy working remote, only one out of 15 reported feeling isolated, which is important. So we need to understand why is it that employee feels isolated, but the rest didn't. They felt that communication was adequate or getting better. Their manager is supporting them. They feel mostly more productive. There are some technology challenges that are happening, and they do see value to having in-person interactions. Notably, a number commented they thought it was helping recruiting, and there were two on the survey that said they joined our practice because it was a fully remote position. So that gets to the staffing challenges and how you can be more competitive. These are some comments that I took from the survey, but I think they're telling. Saves time and money on car maintenance and gas. I don't miss commuting. I feel most productive when working from home. I have a good workflow at home. I am more focused at home than in a cubicle with chit-chat distractions. The silent environment helps me really to tune into my work. I'm so grateful to be able to work remotely. It helps out in many ways. As a mother, it helps me be there for my son. It allows me to focus on work in the comfort of my own home. I feel safer. I have persons at home that are high risk for COVID. I don't have to leave my dogs at home for eight hours now, and I enjoy wearing comfy clothes when working. These are just some examples, but I think they're telling. Next slide. So to close, some practice pearls. I think we all know the pandemic has forced change that we did not think would be easy, and I think this is another consistent theme for us today. It's forced change, but how can we move forward and innovate because of that? It is time to reimagine how and where work can be done. The workforce understands the value of remote work, and some expect it. Remote employees can actually be happy and productive or not, depending upon how it's implemented or the particular employee. I believe it can make us more competitive going forward. We understand that it's only applicable to certain employees, but it is applicable to some of our employees, right? We need to plan, reassess, replan, or it may not create the outcomes you hoped for. Final slide. I think this is a good quote from William Blake. It's applicable. What is now approved was once only imagined.

remote work

lessons learned

hybrid work models

healthcare

workforce flexibility