In this episode, Lisa Sander, SBO Director at John Muir Health in Walnut Creek California, discusses her experience in initiating a remote work standard at her hospital.
Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast.
As business needs of all, technology has made working remotely a possibility, more and more hospitals are experimenting with work from home options for their financial teams. My guest today is Lisa Sander, SBO Director at John Muir Health in Walnut Creek, California.
Lisa was recently part of an initiative to establish a remote work standard at her hospital and is here today to share her experience. Lisa, welcome to the show.
Lisa: Thank you very much.
Mike: So first, why don’t you start off by telling us what prompted the need to consider a remote work option for your SBO staff?
Lisa: Absolutely! This was something that was in the background as we were looking at a major initiative that was going to be happening for our organization that would require some temporary staff and some reassignment into a different location of other staff. And as we stepped back to take a look at our space needs, it was determined that, in order to fit this group for this larger project, we have to go out and lease some space which is a cost, and/or take a look at what are some alternatives.
So, our CFO said, “Well, we have a lot of technology. Why can’t our alternative be having some of our administrative services staff work remotely and see if that will work?”
Mike: And how was that idea initially received?
Lisa: Initially, the departments who were mostly going to be hit—which honestly was our SBO department, our Single Business Office here at John Muir Health, because they felt that this was definitely an area where 1) we had a fair amount of staff because we support three hospitals and about almost 400 positions. Our staff size was pretty reasonable for them to think, “Okay, if we can send half of those people home, that would be nice.”
The leadership of our team—so myself, the managers and the supervisors—were absolutely against it. We had no desire to move to that. We felt that we couldn’t keep track of our staff well enough, that there were lots of reasons that we needed to have them in the office, because we had to meet with them. We were absolutely against it.
We had a big meeting, and sat down and did the pros and cons, and let my boss know, “You know, we’re not so sure we like that idea.”
Then our CFO challenged us—as we do these days in the healthcare field—and said, “But if you could, how would it work? And what job duties do you feel could go home and work from home?”
So, my team and I met again and we looked at it from that standpoint. “Okay, let’s play the devil’s advocate.” And that is, if we sent people from home, what are our challenges. We did the pluses and the minuses and what we needed to overcome and not overcome. And we felt a little bit better about it after doing that and sent that list up to our CFO and said, “Okay, here are the job duties we feel could actually work from home with these caveats. We need x, y and z, for example, if it was this role.”
And then, I went out on a medical leave, and they did it while I was gone!
Mike: So, let’s dive into the meat of the program because, ultimately, as you said, you did move ahead with the initiative and the planning was rather thorough and detailed. Can you briefly walk us through the guidelines and process you and your team established to enable those remote workers?
Lisa: Yes, there was some work that we did with our project management office who came up with having worked with HR in the background, some guidelines that every remote worker would have to follow.
It wasn’t as well-planned out as we had hoped because there was just the push to get people out. And initially, the way it worked was after we got some guidelines from our HR department, we then got the guidelines for agreement to do the work and what technology would be needed from home and did the assessment of whether these technologies would work. The CFO had just opened it up.
And that’s the part that I would not recommend doing in a future installation. He just asked staff, “If you’re interested and want to work from home, sign up for it, and we will assess you and we’ll determine whether you can go or not.” But unfortunately, the way they heard it was, “You tell us if you’re interested, and we’ll let you work from home.”
So, there was a little bit of a mad scramble about some of the people who we ended up having to say, “We just can’t have you work from home because of your role” and/or honestly, we did have to take a look at those staff that needed either more attention or not as productive even in the office, were barely needing QC guidelines (quality control guidelines), and we had to have that conversation with them to say, “I know you want to work from home, but it’s not necessarily the best thing for these reasons.”
We then sat down with all of the paperwork that the staff needed to really assess. There were specific guidelines. There was a work-from-home agreement that they had to sign that they were going to be able to have a space dedicated to the desk, the computer, the phone that was going to be coming into their home. They had to agree that, if they had small children or elderly parents that were being taken care of in their home, that there would be someone there who would be taking care of those individuals while the individual was working.
They had to agree to let a dedicated line come into their house for the phones because phones still needed to look like they were calling from John Muir Health when they did an outbound call.
Things like that that they all had to agree to in order to do the process. So, we had them sign this agreement and then started on that next step.
And the next step was getting their house assessed to assure they had that space necessary—either a separate room or a place in a room that items could be locked up for those folks who lived in one-bedroom apartments. If they had a corner where the desk could be definitely locked and items put away and not be used by anyone else in the household.
From there, we then did the at-home assessment. Someone went out and looked at their location at the home, determined it would work. And the employee was then set up to contact the Internet provider of their choice in order to get that Internet connection set up that was going to be so crucial to the process.
Did you want me to stop? And did you have any other questions on some other things that we did with that?
Mike: It sounds like it was a very thorough process. And I know that you let that play out for a period of time, and then did some retrospective analysis on it.
So, why don’t you share with us perhaps some things that went well and not so well in that first six months?
Lisa: Sure! Some of the things that went well was that it brought a lot of staff satisfaction which was great. The staff was excited. It was something new. We live in the Bay Area of California which has just horrible commute hours. So folks who lived a little further out felt like they now had an opportunity to be more productive and have a decent balance in life because they weren’t going to have to be commuting for an hour to an hour and a half just to get to work. So that was a real positive.
We determined that we had good controls in our EMR that we do our billing in in order to monitor productivity, that we had the technology in order to have immediate conversations with our staff as we had Skype. We could do huddles with our staff and have those good conversations that we were afraid we were going to lose touch with when the staff went working from home.
Some of the things that did not go so well were some of the technology. There were some elements that we hadn’t thought about. Some of the Internet providers, the lines that they have were much scratchier and noisier. So staff on the phones when they’re making phone calls to insurance payers, for example, they couldn’t hear. They kept getting cut off. We had to re-step back and look at what kinds of technology we really needed to look at.
We had initially planned to let some of our customer service folks work from home because we had a sophisticated telecommunication system that they could still be on a phone tree and be able to answer calls so we could still monitor that.
What we couldn’t make happen was making a credit card work. So, the technology necessary to allow them to use the credit card readers from home just didn’t work. So we couldn’t allow those folks.
There were a couple of departments who did indeed allow those staff to go home. Again, all they had to do was sign up, and they were put into that position where they were going to be working from home. And they had to do workaround processes. So as they’re talking to a patient for pre-service for our hospital stays, and they needed to take a deposit, if they’re working from home and had been in contact with that patient, they have to do what we call a soft transfer to one of their co-workers in the office in order for that co-worker to take the deposit.
It’s not the best patient satisfier, but at least we were able to find a workaround.
There were some HR elements that we haven’t thought about. What if the network goes down? If people are at work, we’re able to find some things for them to do. For those folks who work from home, if the network is down, there’s absolutely nothing they could do. They’re dead in the water.
So, how do we pay those people? Are those people paid for the downtime or do we mandate that they have to come in.
Those were some things we hadn’t thought through as we were looking at the program. We were thinking more of productivity, quality assurance, technology. But there is those other elements of the day-to-day work that we had not thought about that we did have to put some processes in place after the fact when the situations occurred.
Mike: And you mentioned some of the staff satisfaction around commute times. What were some of the other possible outcomes that you’ve experienced so far.
Lisa: We have seen an increased productivity from the folks who work from home. They’re not interrupted quite as often as they are in the office. They don’t get distracted as easily because of different noise. We are in a very large office with cubicles. So obviously, noise around the area can be difficult.
We have found that the interactions with the team are actually somewhat better because now they’re not in each other’s space all day long. But when they need to talk to them, they Skype them, they email them really quick. And there’s a quick turnaround time. It seems like the cohesive of the team—which I never would’ve thought working remotely—would work.
We did set up what we call “hotel space,” so that staff could come in and do those functions, for example, a refund or credit staff. They cannot print the checks from home. So they had to come into the office once a week in order to get the checks, make sure everything is together and ensure they get in the mail because that can’t happen from home.
So, we set up hotel space, and they liked that. They like that they have their dedicated space. They liked that they know where they’re going. They’ve given us the list of things that they need when they’re in the office because their desk became used by another team, the whole reason we had this. And there was a shell of a desk.
So, what are some of the things they needed? We were able to provide that which made them happy.
People who were this type that weren’t necessarily happy in the office, now when they walk in, they’ve got a big smile in their face, and they’re doing well from home.
Mike: That’s fantastic! So, it sounds like this is a program you’ll continue with going forward?
Lisa: Yes, they are assessing as with anything in healthcare. We’re taking a look that there’s a return on this investment—because there is an investment. Every employee who went to work from home, unless they already had a desk they really wanted to use, we provided a desk; obviously, a PC with dual monitors, a phone, and some other chair. So, all of those things, we had to purchase, and then put into their home.
Each site is a little bit different. We do have a little stipend that we pay them for their Internet if they had to add Internet and a couple of other things that we do pay for.
Right now, we’re in the phase of assessing whether or not the cost to do this was really worth the activity. Everything I’m hearing is that, yes, that’s the path that’s going down, that this really has saved us because we’re able to save on lease space which is so expensive.
And we would definitely allow more staff in different functions now that we see how it works go and work from home if that’s what they wanted to do.
Mike: Lisa, great insights! Thank you for sharing them today and for joining us on the Hospital Finance Podcast.
Lisa: Absolutely! Thank you for inviting me.