Martin Moll, founder and advisor, Breakaway Bookkeeping and Advising
As hospitals across the country prepare for the new normal that will emerge from the COVID-19 crisis, including reopening key operational areas that were shut down because of the crisis, administrators and physician leaders find themselves addressing many first-time challenges.
Consistent with published guidance, it remains safe to recommend that non-patient-facing staff continue to work remotely as a way to minimize potential spread of COVID-19 between staff and patients. It also is true that the fewer staff working in an often-overburdened clinical environment, the easier it is to practice social distancing.
Along with the finance team, non-patient-facing staff include dedicated phone staff, nurse triage (non-patient-facing) personnel, and referral and billing staff. Prior to the crisis, most of these team members typically were physically present during traditional operating hours. Therefore, these staff members, as well as clinicians, are in a position where they must quickly learn how to effectively manage and communicate remotely.
The following tips reflect key lessons learned regarding what works and what does not from healthcare organizations that have long-standing experience in managing remote accounting teams.
1. Continue constant communication
Finance executives should maintain a consistent cadence of communication with their staff —especially with the offsite finance team. If the team is used to Monday morning huddles, these meetings should not cease just because the finance team is now remote.
It is all too easy for at-home workers to accidentally miss important information related to a practice’s day-to-day operation, including information that might not seem to be directly applicable to their job function but is still important to the decisions they make.
For example, there might have been a shift in referral patterns or a delay in lab results. Or a physician might be behind on charting. Team members could benefit from being aware of all of these factors, which could have financial consequences. It is important to create a routine way for group sharing of this type of information.
Because there are multiple channels for remote communication, having an informal communication protocol can be useful to encourage constant communication and get questions answered. The protocol should identify the different types of communication channels available to employees (e.g., informal, question, alert, chat/IM, meeting) and which channel is best to use for each type of circumstance. Otherwise, depending on the size of the practice and number of remote workers, simply managing all the emails, texts, workplace chat apps and phone calls can end up being a full-time job.
2. Identify inefficiencies across the practice and fix them
Adjusting to a remote staff environment can exponentially magnify the weaknesses of an inefficient financial operation. Those that have not mapped finance and billing cycles will find themselves at a significant disadvantage. If the finance function is not well-mapped, an important first step is to create a detailed map that flags those functions now being performed remotely. Look for weaknesses in the handoff of information, especially regarding exchanges that may have previously occurred informally in water cooler conversations.
3. Create detailed job descriptions
In a traditional clinic setting, few positions are dedicated. Many staff are cross-trained or have served in other positions. But when most or all of an operation’s back office finance staff are working remotely, it is important for the team to know exactly what is expected of them.
Because of the fluid nature of healthcare, job functions change regularly, and strong staff regularly adapt to those changes. But with remote staff, it can be difficult to be aware of the need for change (or that the change has happened).
Job competencies for remote workers also can be different than for on-site workers, which may mean that some valued finance team members will not thrive as remote workers. The path to helping team members adapt, and then thrive, in their new remote work environment is similar to any workforce change management process. Consistently seek feedback and listen to your team’s struggles, create mentors among staff who have succeeded in their new role and ask them to share best practices and consistently remind your team (and yourself) that any sudden holistic change in work environment will inevitably create friction.
4. Beware of the “linchpin employee”
Author and workplace guru Seth Godin writes about the “linchpin employee” as someone who has become so valuable to the organization that they simply cannot be replaced. The downside of a linchpin is, whether intentionally or not, they obtained that status by hoarding information and centralizing control. When a linchpin is part of a remote team, this downside becomes apparent. A well-crafted job description can amend this effect, as can ensuring work is divided among teams and information is shared often.
5. Productivity measurements can be challenging
In the best of circumstances, monitoring and measuring a finance team’s productivity is difficult, but doing so with remote workers is even harder. To truly understand competency and proficiency, managers must possess a baseline understanding of what the job requires. Consulting with someone who has direct experience with the job function can help in providing this information.
6. Understand remote work can be lonely
Even before the COVID-19 pandemic, workplace loneliness was on the rise. In his book Together: The Healing Power of Connection in a Sometimes Lonely World (Murthy, 2020), former U.S. surgeon general Vivek Murthy writes that loneliness should be viewed as a public health concern that affects our health, our workplace performance and our overall feeling of societal engagement. The lack of meaningful human connection has been associated with an increased risk of heart disease, dementia, depression, anxiety and sleep disturbances. Although one can be “lonely” in the workplace, obviously being physically remote can intensify this feeling. The better your team’s mental health, the better their engagement and, ultimately, their productivity.
Moreover, like any emotion, loneliness is contagious. Even one team member’s anxiety and loneliness can potentially affect many others in an organization, leading to reduced morale and engagement, which also reduces a practice’s productivity and profitability.
Although they can sometimes be burdensome and tiring, virtual happy hours, chat rooms, a robust intranet and regular check-ins can promote a positive social connection when cultivated appropriately. Like any social event, remote social connections need to be intentional. Having specific start and stop times, desired outcomes and online facilitators all add to the level of connection and engagement.
In addition to promoting general social hours, it is important to make sure the remote finance team has regular direct exposure to the organization’s physicians — not only for casual conversations but also to understand the practice’s long term strategy and vision.
7. Keep in mind the benefits of a remote team
Although having remote staff can be challenging, the benefits can outweigh the challenges. For rural practices and practices located in areas with a high cost of living, finding qualified healthcare professionals with relevant experience is difficult (and will likely continue to be even in this new economic climate). Yet there are many professionals with relevant healthcare finance backgrounds whose life circumstances (spouses, parents, affordability) simply do not give them the flexibility to move. Removing geography as a “filter” can allow an organization to find qualified applicants with deep, often specialty-specific skills and experience. Similarly, by carefully defining and communicating a job description and performance metrics, an organization can find that job sharing among two or more qualified candidates can be easier to manage. Despite having team members who are remote, this increased flexibility can improve job satisfaction and retention.
Finally, any analysis of the challenges and corresponding benefits of a remote workforce has to include the long-term cost savings associated with a reduced physical footprint. Healthcare practices need to be located in office spaces that are attractive to patients, which contributes to generally higher facility costs. Allowing a finance team to work from home, however, can help to reduce those costs while also potentially freeing up space for patient-facing activities.