By Thea Campbell, MBA, RHIA
When I first started talking about leadership in the remote or virtual workspace, it was pre-COVID-19. Imagine that there even was such a thing! The goal in my own learning and subsequent discussion about the topic was focused on my immediate leadership team at Cedars-Sinai, of whom half had remote teams already in a hybrid configuration. Hybrid for us means teams in multiple physical locations, organizationally and home-based across multiple states. Our early adoption of this model had been fueled 10-plus years earlier by three primary factors:
- The commute time in Los Angeles and somewhat difficult to get to location of our organization;
- Competition for coding professionals who were being offered work-from-home options as electronic image capture/records usage increased; and
- The fact that I, as the department director, commuted from another state.
We started discussing leadership with a remote workforce more formally in late 2019 after my latest “Hey, I am reading a great book” moment. I suspect my team shudders when I say that, and I have even gone on record saying that every time I utter those words, I would buy the person I am talking to lunch. Needless to say, I owe a lot of lunches right now.
Back to the topic at hand, which has exploded as companies worldwide moved many workers remote overnight when faced with mandatory COVID-19 lockdowns. Our organization went from fewer than 250 remote workers—over 100 who were in the health information department—to over 6,000 seemingly overnight. I am slowly beginning to realize that there is no perfect answer; rather, there is just a need to be flexible and adjust as the demands of our environment and teams change. Our work environments have forever changed and, as a result, it would make sense that leaders may need to change some of our tactics and hone some new skills. However, what is defined as good or remarkable leadership hasn’t changed as much as how we lead to achieve results.
The Many Types of Remote Work
Let’s start by defining the remote or virtual working concept and how that title doesn’t adequately describe what we are seeing. The easy answer is that working remotely means you work from home in your loungewear. Working remotely could possibly mean homes in different states and is made more difficult by parental and educational duties. The more complex answer is that working remotely means when one or more of the members of a team are not in the same physical proximity as the others, including their supervisor, manager, and alike. While this concept is a bit more foreign in the provision of healthcare (sans the explosion of telehealth), it is not so unusual in the practice of health information if you consider the current coding and transcription model, as well as secondary (outside of the hospital walls) locations many health information management departments occupy. As I said, there is no one answer to what it means, and, as leaders, we are only challenged by what may or may not be working for us when we consider the complexity of the topic. I would also posit that we need to consider the opportunities it provides, as well.
Here are a couple of the most common working remote or virtual models:
- Office based
- Office based with work-from-home option(s)
- Remote team in one time zone or state
- Remote in many time zones, states, or countries
- Distributed team with nomads (e.g., consultants, project teams)
I prefer to think of the configuration of options afforded to teams in terms of where and how they work with an assumption of having at least some remote teammates. With that in mind, there are:
- Fully remote teams – all working in disparate locations
- Hybrid teams – some on-site or co-located with others remote
- Flex teams – teams with options as to schedule and work location depending on business, operational, or client needs
It is important to consider the design of your team in their current state as well as the longer term. It is tied to many of the operational and technical questions that we may be struggling to answer. Our organization is readily trying to develop a work-from-home strategy for the long(er) term.
The authors of The Long-Distance Leader, Kevin Eikenberry and Wayne Turmel, provide us with a model of how to address the differences of remote work teams. They first start with the concept that leadership does not change when your team is remote. What makes us a great leader still includes learning continually, championing change, communicating powerfully, building relationships, solving problems, and making decisions. What we need to do is get to the “how” part of the changes to our leadership skills given a distributed workforce.
The Three O Model of Leadership
Eikenberry and Turmel propose the Three O Model of Leadership, with considerations for:
- Outcomes (the work that leaders are hired to do)
- Others (the team that we lead to do the work)
- Ourselves (how leaders contribute to the success of the team)
We can use this model to be aware of the following differences or concerns in a virtual environment:
Outcomes – isolation or the creation of silos can impact many things, the lack of environmental cues can lead to misunderstanding, and messages are not repeated as frequently because we lack the “water cooler”
Others – out of site can mean out of mind, your assumptions become your reality when you don’t have information to disprove them, and even when you focus on the team, they might not know it because they can’t see you working, either
Ourselves – our assumptions can cause problems, our mindset greatly impacts our success, our intention is not enough when others judge our behavior, and making a decision can be more difficult with sometimes limited information
You are now probably wondering what exactly we can do to translate this evolving work need the here and now. An overarching theme I believe is important as we address the actions we can take as leaders is the concept of intentionality. We need to be even more aware of the possible challenges noted above.
When I attempt to make sense of all of this information and apply some intentionality in my actions, I look at three key components: communication, collaboration, and connection. These are the things that keep me up at night and on my search for answers in my effort to be as effective of a leader remotely as I can be in person.
First, let’s talk about communication. There is a model adapted from Bettina Büchel Palgrave’s Using Communication Technology (2001) that looks at communication in two aspects: the richness and the scope of media. Richness speaks to the completeness of communication or the multiple dimensions (visual, audio, physical, etc.) that communication can have, while scope addresses the aspects of our intended audience ranging from one person to mass communication.
It is not new that we need to consider the most effective method when we communicate to get our point across. It is new that our expanding virtual environment is adding new ways to do that. The leadership challenge in this is that we tend to use what we are the most comfortable with when it comes to technology and not necessarily what is the most effective or impactful for our audience. This can be a big problem when your team is highly distributed.
For example, how many of us cringed at the thought of being on a webcam? Have you gotten over that yet? This maybe an unintended benefit of our COVID-19 challenges. Webcams and video conferencing technology has become the norm and, dare I say, the expectation. The richness of our communication is greatly improved using webcams. It is not perfect, but it is greatly improved.
Again, there are no magic answers when it comes to communication, and we are challenged to get it right. We, as leaders, need to push outside our comfort zones and use some of these new methods. You don’t need to be an expert on Teams or Zoom, but you do have to have enough skill to look competent and to get your point across. The following are some quick tips to consider when conducting a virtual meeting to make it effective:
- Determine the purpose for your meeting – this will drive the number of participants that you can effectively manage
- Craft a meeting agenda that actively seeks to avoid virtual fatigue – more breaks, set times for all activities, add more individual exercises to engage participants, use a variety of feedback methods, and leverage breakout rooms
- Know your technology and practice – seriously consider a co-facilitator to manage a chat box or assist with flow and timing
- Have a technology support plan – to mitigate “what ifs,” make sure there are various methods to participate as an alternative should an emergency occur (like someone’s internet being down)
- Start the meeting with an orientation of technology and the participation rules for the participants – for example, cameras on, staying on mute until speaking, how to raise your hand, etc.
- Use the tools at your disposal – chat, virtual flip charts, polling, discussion prompts, individual exercises, or group exercises in breakout rooms
If you are interested in reading about all the challenges of virtual communication, I would recommend the book Can You Hear Me by Nick Morgan. He illustrates in an easy-to-understand model many of the challenges of virtual communication. These include: the lack of feedback, the lack of empathy, the lack of control, the lack of emotion, and the lack of connection and commitment. He also has some great tips from overcoming communication challenges across the various digital platforms or channels.
Consider that not all virtual communication has to be structured; many groups leverage “coffee chats” as a way to recreate informal discussions or the use of “office hours” or open channel time to work together while in different locations. While it may start out a little strange, we can quickly adapt to use casual video calls to help us connect and communicate with others. On a personal level, think about how many family Zooms or friend social hours you had over the pandemic. It didn’t replace being there in person, but it ticked some of the feel-good boxes. We will discuss more about the different aspects of communication as we explore the other critical components, because they are all intertwined.
Next, we can look at collaboration. There is lots of buzz around the fact that it is harder to collaborate virtually, and with that realization, there is concern raised about the impact of virtual environments on innovation and creativity. I would offer that while it is harder to collaborate virtually or digitally, it really becomes more about being intentional in how we facilitate opportunities to collaborate with and among our teams.
First, we must set the expectation that, as a team, we do collaborate. Breaking down silos and isolation through intentional action is so important. Some high trust and cohesive teams naturally figure out how to collaborate, while others will struggle and need support to do so. As a leader, call out when teammates or groups are doing great work through collaboration. We can also make assignments that force collaboration until it becomes more natural.
There is an aspect of technology in this collaborative effort, as well. A plethora of applications have sprung to life or increased their presence in the market over the past 17 months in response to the demands of the market. At the end of the day, it is less about which technology than it is about using what is available in the best way possible. As part of using a video conversation software, we have become aware of such tools as chat, whiteboards, breakout rooms, etc. We must use them! In my experience, you can enhance the inclusivity of the people who contribute in a meeting by providing options for feedback. No one has ever accused me of being shy about my opinion, and that hasn’t changed in the virtual environment. I still must work on not talking over people, pausing for input, and generally being comfortable with silence. I have gone as far as putting a timer next to my computer that I start when I ask a question to make sure I give enough time. That said, some of the less assertive teammates out there can be empowered by using the chat features. It is amazing the engagement and ideas that can flow in a chat box! It is sometimes hard to facilitate, speak/present, and watch a chat box, which ties to the earlier suggestion about a co-facilitator.
Another way to promote collaboration is to encourage people to open a meeting, even if they are just working on a shared goal. It can be called office hours or open mic time where teammates can jump on to ask questions or just be together. Teams can also be prompted to use breakout rooms to discuss a particular issue or part of a project. A good health information management example might be for coding professionals to have a Q&A session at the same time every week, simulating asking the co-worker the next desk over what they think. You can assign different team members to be the leader or have them submit questions ahead of time.
There are also tools like “channels” or “teams” in some applications that allow there to be running dialogue on a subject. These can even function like an internal blog seeking feedback and discussion.
We use several features to facilitate our third aspect of the virtual work environment: connection. We as human being seek connection or belonging with others. We must realize that the richness of connections—like expression, voice tone, physical presence, etc. — are hindered or at least impacted when facilitated by technology.
For now, we must except the reality of trying to connect while physically apart, but it should be noted that when we gather in-person again, that it is only one method of connection that we can use. When you have a remote team, bringing them together quarterly or annually may be important to creating that connection. It is a powerful one with the maximum level of richness and some significant scope opportunities, but it is not the only one and should be part of the toolkit for connection. That ship has sailed, and I am somewhat relieved. As someone who has worked at least part time from home for more than 15 years, the COVID-19 disruption has actually made me more able to participate—and participate in a more meaningful way than just being on a speaker phone at the end of the table or on the wall. I would hazard to guess that the shift in focus to include distributed teams is a welcome change for some of our long-term remote colleagues.
The following are a couple of things that can aid us in creating and maintaining our connections with our teams:
- Schedule and keep those one on ones – consider, however, that not everyone needs the same level of interaction depending on their preference, experience, etc. It is OK to have a different cadence with different team members as long as the needs are being met.
- Beware of the sometimes dreadful “Have you got a minute?” instant messages that turn into larger or heavy conversations – rather, use more focused scheduling of appointments when it cannot be discussed in a minute or two.
- Set clear expectations about staying connected being a two-way street – it is not only the manager’s responsibility.
- Remember to think about growth and promotion opportunities for your team – including the teammates who are remote. It can sometimes be hard to be noticed with you are physically distanced.
- Foster an environment of trust thru clarity – clarity of expectations, deadlines, deliverables, etc.
Human beings are adaptable. As the time stretches on with our fighting of the pandemic and companies adopt more long-term work from home strategies, new problems and practices are popping up. The skills needed for being a leader of a remote team or in a virtual workplace haven’t necessarily changed. I am confident that we, as leaders, can use this opportunity to stretch ourselves and learn new ways to adapt what we already know. Now, for some more good news, almost everyone is grappling with the future model of their workforce, which means we will all be learning as we go, and there will be plenty of opportunities to use our adaptability skills. So, let’s give ourselves some grace and rise to the challenge, as we have a wonderful opportunity to really lean in to this new way of working. We do not need to have all the answers, but we do need to be brave enough to ask the questions, really listen to the answers, and uplift our teams. Good luck!
Thea Campbell, MBA, RHIA (firstname.lastname@example.org) is the executive director of health information at Cedars-Sinai.