How I Learned to Stop Worrying and Love Telecommuting

Benefits

To evaluate the implications of flexible work arrangements on productivity, employee satisfaction and IT staff providing remote infrastructure support, we ran two pilots: one with our desktop engineering team and one with our medical record coding team.

One of our desktop engineers worked from home four days a week and in the office one day a week. This particular engineer is responsible for developing the desktop images used on Beth Israel Deaconess Medical Center's 8,000 managed workstations. His work demands a quiet, controlled environment where he can concentrate on complex programming, configuration and testing activities. From a management perspective, his deliverables are deployable software images for specific configurations of PCs that are due on specific dates. During our pilot, he used e-mail, IM and teleconferencing to stay in touch with management and customers. He met all of his deadlines, and no one complained about his availability, work habits or responsiveness.

For medical record coders, one employee worked from her home in California and the other three worked from their homes in Massachusetts. The Massachusetts-based coders came into the office on average twice a week for work distribution or meetings. From home, they did all the work they would otherwise do in the office: They reviewed and applied diagnosis and procedure codes on path reports, operative reports, lab reports and notes in our ambulatory medical record. They used e-mail very frequently to communicate with their managers and to clarify with clinicians issues in the medical record. During the pilot, they coded 10 percent more records than they typically code when working in an office.

Coders are challenging to hire in Boston due to the large number of hospitals competing for a small number of qualified employees, so flexible work arrangements enable us to hire without geographic restrictions. Given the IT job market and the difficulty of recruiting replacements, the benefit of such flexibility cannot be overstated when you have a seasoned employee who knows your systems well. We were able to retain a coder who moved and we included her in our pilot. For medical record coders, the pilot program was very successful. In the spring we will expand the program to in-patient coding.

We observed many other benefits. The flexible work arrangements improved employees' quality of life. They're not stressed or tired from commuting so much, and they're saving money on parking and gas. The flexible work arrangements have also freed up office space. In addition to these benefits we observed, we learned some important lessons about implementing flexible work arrangements and managing remote employees.

Lessons Learned

Flexible work arrangements work best for highly responsible, productive employees with good track records who don't mind working alone. And employees' personal preferences play a large role in the success of such arrangements. One coder who lives by herself said she felt distracted at home and missed the social interaction with coworkers. Another coder who also lives alone loved working at home since she experienced no interruptions and got more done.

When you begin offering flexible work arrangements, it creates the expectation that everyone will be able to work from home. Clearly, this is not the case. Some employees' jobs may not be conducive to working outside the office. Some employees may not be trusted to work from home. Our answer to these issues is to use a flexible work arrangement framework, such as the one we adapted from Blue Cross Blue Shield of Massachusetts, as the basis for discussion. Employees can understand objectively how a flexible work arrangement may or may not work for them. If a flexible work arrangement, once started, does not work out, it's easy to refer back to the framework document to understand how expectations were not met and to justify the suspension of the agreement. For those who cannot do their jobs remotely but who require flexibility due to long commutes or family demands, you can let them work different schedules, such as 10 a.m. to 6 p.m. or four 10 hour days. That way, more people can participate in flexible work arrangements, which eliminates much of the friction among staff in different roles.

Flexible work arrangements will also be hard to extend to new employees who don't know the people, processes and policies well enough to work effectively on their own. I recommend waiting at least six months to let new employees work from home.

One thing my staff and I learned is that we're not as likely to call someone at home because we feel that we are invading a private space. If we create a sense of connectedness that goes beyond a geographic location, we create equivalence between home and office. If you need to reach a person by voice, you dial a number, not knowing or caring if they are onsite or remote. Cell phones would work, but even they have a stigma of urgency that can impede a casual conversation. In our case, by connecting our office PBX system to a phone in the home office, we create five-digit dialing that eliminates any hesitation to call a colleague who may be working remotely.

Flexible work arrangements also challenge traditional command-and-control methods of management: It's hard to manage people you can't see. You can't walk into their office or cube to ask them a question or give them a new assignment. By changing the culture to make e-mail, phone calls, IM, blogging, wikis, and WebEx the means of communication and management control, the need to walk into a cubicle lessens. On the employee side, regular status reports to the manager ensure that there are no surprises about the employee's performance.

Of all the lessons learned, the most important is that employee and manager create a written plan for the flexible work arrangement and describe specific expectations for performance. Both employee and manager need to constantly communicate and be comfortable with the basic technologies I outlined here: e-mail, IM, phone conferencing and remote presentation.

Conclusion

Flexible work arrangements are not only possible for me and my staff, they are necessary in 2008.

Some technologies are ready to support telecommuting. Ideally the technology should run on any operating system and with any browser, be compatible with firewalls, be usable on a wide variety of bandwidths and require minimal support. The technologies I have chosen to keep using after my three months of investigation are:

1. E-mail via BlackBerry as my principal means of asynchronous communication.

2. IM for interaction with some companies and workgroups. I have elected to use meebo.com as a free, cross-platform, web-based client for IM text exchange. Meebo supports all the major IM service providers.

3. Video teleconferencing over IP using a Polycom H323 appliance. This resolves any issues with client software running on my Windows computers that aren't Windows-based.

4. Blogging via Blogger.com for external communications.

5. Twiki for creating shared documentation wikis.

6. Accellion for Secure file transfer.

7. WebEx plus audio teleconferencing for virtual meetings and presentations. We use WebEx's conference calling, and Ready Conference and Intercall for ad hoc conference bridges.

8. Juniper for SSLVPN, including access to file shares and remote desktop control.

9. Citrix for access to client/server applications needed remotely.

10. For infrastructure I use a Macbook Air, which can run all these tools.

Although these 10 technologies are empowering, it's the policy changes and management framework supporting flexible work arrangements that are most important. We learned that creating a flexible work arrangement template and encouraging a cultural change in favor of remote and asynchronous communications (over in-person meetings) were key to our successful pilot of flexible work arrangements.

Now that we've completed the initial technology and policy evaluation, we'll expand our pilots over the next few months. I'm optimistic that we'll meet all three goals for the project: increased productivity and lower costs, improved employee recruitment and retention and better use of space. I'll report back on our progress. In the meantime, I'd love to hear about your experience with flexible work arrangements.

John Halamka is the CIO of Beth Israel Deaconess Medical Center and Harvard Medical School. He frequently contributes to CIO.