How to Start Designing for Life in a COVID-19 World
It’s time to develop new ways to work – and to make what’s ahead our finest hour
Over these past six months, we have heard from a host of brilliant and brilliantly candid subject matter experts from the United States and Europe about how COVID-19 can – and eventually will – change where and how we work.
We’ve listened, learned and shared their insights about the emerging, interdependent relationship between human enterprise and human wellness; and the material changes that must occur – quickly – if we want our businesses to prosper and our workforce to thrive.
And we’ve confronted, finally, a truth laid bare by COVID-19: For the workforce to thrive it must be healthy, productive and fulfilled.
We contend that this can be our finest hour and a watershed moment of the 21st century. To make it so, we must identify the social norms that have, since the First Industrial Revolution, inveigled us into believing that there is only one way to think about how and where enterprise – i.e., work – happens in any sector.
Our working theory of holistic preventative design describes the optimization of both man-made and natural environments for human health and wellness (physical, mental, emotional) in order to promote the long-term financial health and wellness of an organization.
The theory represents our foundational thinking regarding a new way of configuring the workplace, work culture and work itself around the health and well-being of the people who perform it. This requires, in part, breaking free of the norms of individual, diagnostic wellness toward something more comprehensive, proactive and preventative.
Our first step in this process employed Greentarget’s consultative, qualitative approach to research. By speaking with leading minds in a variety of fields – commercial real estate, architecture, design, healthcare, innovation – we got a handle on some of the most innovative things happening when it comes to the intersection of work, wellness and space, as detailed in the multipart series released over the summer and early autumn.
But we view this as an inspired beginning, one that will form a new line of questioning, informed by what our experts have taught us and aimed at exploring ways we might modify the existing norms that create the biggest barriers to innovation.
Or to abandon them completely.
To guide this line of questioning, we turn to GreenHouse’s Innovation Dynamics. It relies on a set of six lenses to identify social norms – those rigid, tightly limited social expectations that shape our perspectives and govern our behaviors – in order to help us see how to deviate from them. When we do so, and the deviation is distributed through a sufficient number of social groups, we achieve social change.
Identifying and subverting – or changing – social norms through deviation is the one true path to innovation whenever and wherever people are involved. It’s also the path to a new concept of work, wellness and space, configured for the health of the business and for the people it employs.
So – how do we do this?
Step 1: Identify the Norms
Leaders and their teams can begin to identify the social norms related to the concept of the office and offering within any organization by asking some questions related to, for example, actors:
1) What groups of people (actors) within our organization have a direct relationship to the challenge of working in a physical office?
2) What observable behavior are they exhibiting in relationship to this challenge?
3) What do those behaviors suggest about those groups’ interests and concerns at this stage of the pandemic?
Your answers to question 3 will reveal a norm (or norms): what each group of actors thinks they should do or not do now based on what they have observed and heard from other actors in their group; and what they themselves believe normatively.
Once identified, the norms that are no longer relevant or required will begin to surface (e.g., all employees must be at the office by 8:30 a.m., lunch hour is between 12 p.m. and 1 p.m. and so on), given both the conditions caused by the pandemic as well as new employee concerns, needs and logistics.
Then we can begin to see the norms that have been impeding our progress and resisting innovation.
Step 2: Seeking Deviation
Our next step is to design a way to deviate from, or subvert, those norms – tactically. Which necessarily leads to a new way of thinking about how to not only configure an organization under these unique conditions but also how to engage with the concept of work in an altogether different way.
Leadership might start by asking, for example:
1) What behavior by existing actors in our organization is already challenging the norm?
2) How might that behavior express itself among other groups of actors?
3) What new behavior, from a new actor introduced into our organization, could further challenge or dismantle the norm?
Step 3: Diffusion
When those deviations from the old way of thinking are distributed or diffused through a sufficient number of groups in an organization, a new organizational norm or norms will emerge.
Let’s say a single consulting firm adopts a new remote-work model; leadership rolls out a new set of guidelines that enable the vast majority of its employees to work from wherever they please, with a core group of managers reporting to work in the home office every day. That firm’s success in both client acquisition and retention and, most dramatically, recruiting and retaining the market’s best players leads one of its competitors to adopt the same model. Another follows, and soon this “Mission Control” model – a few key workers on the “Earth,” everyone else in “space” – has become the common model for consulting firms. Seeing the success of the model, perhaps a few clients of those firms begin to adopt it as well.
A new norm is born.
As the deviations take hold, you will behold a social innovation, one that may make thinking about work as a process and less of a place that much easier, though this is not to say that the office of old will become obsolete. It may be used for different reasons – as a place where employees don't necessarily show up merely to work, at desks, but a place to gather when collaboration is called for on certain projects; or simply to socialize with co-workers, in real time and in real life – to serve the human factor that is so necessary to building trust, respect and office relationships.
Inspiring Change
The inverted “Mission Control” model described above is, obviously, only one of many possibilities that become available to us when we have the right data, with the right social context, that we need to identify and challenge the social norms that dominate our perspectives – hence, our thinking – about the problems we face, circumscribing the actions to be taken to solve them.
Yes – we know now, thanks to the subject matter experts who participated in the inaugural Immediate Frontier initiative, what corporate America must do to evolve and adapt to forge ahead, in spite of or perhaps because of the challenges wrought by COVID-19.
But inspiring the plurality of actors related to these challenges to enact and embody change requires identifying and changing social norms. Or creating new norms altogether.
Innovation Dynamics enables us to see that the possibilities of our future are not, by default, an unforgiving negation of the best of what we call “the present.”
They are instead an encouraging reminder that our present can, in fact, be transformed into something that for too long we couldn’t imagine, simply because we didn’t have to, putting well within our grasp something better than what we once thought was the best of our now, which was really the best of somebody else's then.
Innovation Dynamics™ is a registered trademark of The Brador Group, Ltd.
Work Is Where the Wi-Fi Is
There is one inescapable conclusion when it comes to the past seven months:
Work is where the Wi-Fi is.
Since March 11, 2020, millions of us have found ways to work from home/to live at work – mostly successfully.
We’ve also had time to think – and rethink – about how things were configured before our work-from-home exile; to ask why concepts like school and work largely looked the way they had looked since the Industrial Revolution. We pondered if there was another configuration better suited for the modern world, one that inures to the benefit of all groups of actors in it.
The pandemic, of course, has been – and remains – an outsized tragedy. It’s as if we’ve been handed the Spanish Influenza, the beginnings of the Great Depression and, given the deep, violent social and political divisions in this country, a cold Civil War, all wrapped into one trying, unprecedented and – for more than 210,000 Americans and counting, fatal – experience.
But what could actually compound the great tragedy of COVID-19 is if we emerge none the wiser – if our only response to life in the age of the novel coronavirus is to shrug our shoulders and send the kids back to school while we trudge off to work, just like we did in the good old days before COVID-19 hit.
If it is not evident by now, this inaugural Immediate Frontier effort was designed and executed because we refused to accept “Go back to work!” as the only answer to the challenges of COVID-19. Indeed, we hoped the pause necessitated by the pandemic might give corporate America time to rethink how things could change, and improve, going forward.
[When] to Office or Not to Office?
If we’ve learned nothing else – through this initiative and, collectively, as a nation – we know that work and school are experiences, not places that demand our physical presence. There are financial reasons to get people up and out of their homes – as our economy is designed for a world in which people are going and getting and spending.
There are also important social reasons why we, as pack animals, must come together to reap the benefits of feeling less alone. And meeting face to face hardly seems obsolete, particularly in the case of schooling, where an at-home format not only detracts from the aforementioned socialization benefits but also places a heavy burden on both students and their caregivers to conquer an array of logistical and technological challenges.
But in the age of COVID-19, something that is considered as essential and fruitful as in-person collaboration could be a job hazard.
“The way those meetings happened before the pandemic meant people sitting around the same table and breathing the same air,” Willie Hoag, co-founder of Tether Advisors, told us in Chapter 3. “So, the most important thing and one of the crucial functions of the office – collaboration – might be dangerous to pull off.”
Given that – and the success over our screens since March – the next logical step is to think hard about and research when and where it is beneficial to come together and for how often and how long. And when it is neither beneficial nor necessary.
“The office is not dead, but how we use it, manage it and derive value from it is fundamentally changing,” said Elizabeth Nelson, Ph.D. candidate and author of The Healthy Office Revolution and co-founder of the Smart Building Certification. “We need to measure what matters, action the insights and help people to navigate a new normal around the office. We need to build smarter offices.”
Abhorring a Vacuum
Those insights will help us better understand the ratio of together time versus alone time, based on industry, age group and other considerations and needs. This could mean, among other upshots, that management companies will seek other ways – and other customers – to keep office buildings at capacity when they’re not being used in the traditional sense by traditional actors.
Some physical structures might never see their former tenants darken the doorways again, creating a void. And the market, like nature, abhors a vacuum. This will be particularly notable for brick-and-mortar retail, which was already wobbly before the pandemic.
“If a place is no longer a restaurant or a shoe store, it has to be something else,” said Ari Klein, executive vice chairman of Cushman and Wakefield, in Chapter 6.
Experts see healthcare filling some voids – and in many ways, the timing could not be better. As healthcare shifts toward value-based care, providers will be incentivized for results while emphasizing the importance of healthy living and overall wellness. The pandemic placed that issue front and center, and with it the realization that medical services must become more of the “one-stop-shop variety,” and that proximity and access will be increasingly important.
Beyond Physical Wellness
When we return to work – and, indeed, as we likely face a hybrid combination of working from home and going to the office, organizational focus on wellness must go beyond physical health. Even in a deep recession, resources must go toward mental and emotional health.
“We’re kind of in this terrifying space that could either paralyze us or it could be seen as an opportunity,” said M. Todd Puckett, founder of Skycrest, which provides performance and life enhancement services to executives and other high-performing businesspeople. “I truly think it’s about having a team of people. It’s not just going to the doctor. Maybe you go to the doctor, your massage therapist, your yoga person, your regular therapist or a strategist – and you go to all of these different people in one space.”
That space, Puckett said optimistically, can be the workplace.
As detailed in Chapter 3 and Chapter 5, the workplace is beginning to look quite different in other ways: The norms of office culture will be very different, too. Showing up sick will no longer signal Cal Ripken-like dedication, but rather a sign of careless indifference toward one’s own health and the health of one’s coworkers.
“Now, you will work from home the moment you are sick – and that will be looked at as a good thing,” said Bobby Benson, design principal at CannonDesign.
That mindset goes further as business leaders commit to limiting threats of ailments. To be clear, a failure to address health preventatively isn’t new – the CDC reported that 90 percent of the $3.5 trillion of annual U.S. healthcare expenditures go to chronic and mental health conditions. But the dangers of COVID-19 have emboldened advocates of what Eden Health CEO Matt McCambridge calls a “health-forward” approach.
Considering the severity and complexity of the problems we face, experts say preventative approaches must be adopted broadly: by the healthcare system, by companies across the economy, by employees and by innovators in the space. But that works best if all those actors are serious about optimizing publicly shared spaces for productivity and profitability.
Managing Virtual Space
Learning how to manage a more intentional division of home/office life is a big part of the equation, but it isn’t exactly intuitive, and there is no precedent. As uncovered in Chapter 4 from insights shared by Dr. Michael Horowitz, president of TCS Education System, anyone who didn’t think there were too many meetings before the pandemic probably thinks so now.
“Video meetings are tough and fatiguing,” he told us. “For maximum impact and productivity, we are learning the right cadence and quantity for our remote environment. When is it important to have the whole leadership group together? What could be better addressed in a quick, one-on-one conversation? We need to be purposeful with our time and virtual interactions right now.”
Work-from-home scenarios can affect workers differently. Introverts, for example, might be suited for remote work. But that’s only true up to a point, said Monica Hakimi, the James V. Campbell professor of law and the associate dean for faculty research at the University of Michigan. “In some ways, introverts are well set up for it. But the fact that this is their M.O. could lead to more isolation,” she said.
Managers must relearn how to effectively engage with workforces given the nuances of remote working – not to mention the bevy of other crises. Check-ins are essential for all employees amid growing feelings of isolation and uncertainty, said Nicholas White, managing director of Learn Adapt Build (LAB)/Amsterdam. “Without clear direction, coaching or guidance, people are often left to navigate this difficult journey on their own,” White said.
As is our practice with Work, Wellness & Space, we identify social conflicts to close each chapter:
A Workforce of One: Workers not only deserve but will require more autonomy to make decisions for themselves and their health, including when they feel safe about commuting to an office, especially one that may not yet provide ample protection against COVID-19 and other viruses. As desirable as a “choose your own work experience” model is for individual employees, it will create new burdens and challenges for CHROs and other executives charged with developing and enforcing universal office guidelines, as well as designing and maintaining a unified office culture. How can the C-suite maintain a sense of cohesion – and that much-needed team spirit – among employees with vastly different schedules and supremely individualistic modes of interacting?
The Healthy Commute: Even if business leaders are able to introduce the latest safety measures into physical office spaces – air purifiers, plexiglass shields, floor plans that allow for social distancing, etc. – there is still the challenge of the daily commute, especially for workers who rely on public transportation. Yet most, if not all, of these transportation systems will not be safer – or smarter – when they are again running at capacity. What can business and city leaders do to ensure that the trip to the office is as safe for commuters as the office itself?
A “Real World” for Everyone?: The present generation of executive and senior leadership is still ruled by old office norms related to management – specifically, the expectation that an employee must be seen to be managed effectively. In the most extreme cases, managers have demanded that video cameras keep visual tabs. But that is neither practical nor reasonable given that remote working is occurring in what once was the privacy of one’s own home. How can remote working management be optimized at no further expense to an employee’s right to privacy?
Cities Face a Tough Road – and Even Tougher Decisions
Rommel Sulit isn’t sure, but he thinks he got COVID-19 at a construction site in July. What he does know is that what happened next was pure hell.
Sulit, founding principal of architecture firm Forge Craft in Austin, Texas, spent the next few weeks at home, mostly in bed. He lost his appetite (everything tasted bitter) and 15 pounds. And, most dangerously, fever rocked his body, sending his temperature to 103 degrees, then plummeting down as low as 96 while he shivered uncontrollably.
But Sulit learned to adapt, keeping cold compresses at the ready in the afternoons and late in the evenings, when the worst fevers would strike. Drip-dry shirts and layers of blankets and towels helped him control the low end.
“I was able to track my progress,” he said. “I would go through cycles, but the extremes wouldn’t be as high – because I started to know what I was doing.”
Now, mostly recovered, Sulit sees his experience as a microcosm of what civic leaders must embrace as they seek to guide the world’s urban centers through a crisis that has turned cities’ most fundamental characteristic – population density – against them, with catastrophic results. If they want cities to emerge from the pandemic with their statuses as talent hubs intact and, more importantly, healthier, leaders must learn and adapt on the fly and rethink how to use technology, how to approach philanthropy and how they work together.
“Governments and businesses working collaboratively to help cities through these difficult times is part of a broader trend toward an emerging enlightened C-suite,” said Elizabeth Nelson, Ph.D. candidate and author of The Healthy Office Revolution. “We are seeing some decision-makers surrounding themselves with an unprecedented amount and variety of data. Companies with these leaders will have an important and significant head start in a different way to lead.”
That is the focus of Chapter 7 of Work, Wellness & Space.
COVID-19 a ‘Lubricant’ for Smart Cities?
In many ways, COVID-19 is already changing life in cities around the world, and some experts predict smart cities – where Internet of Things sensors are used in hopes of improving many elements of civic life – will gain more traction. Smart city initiatives could pave the way for more quantified standards, which can lead to a healthier, efficient, sustainable and performance-driven infrastructure, advocates say.
But not everyone is convinced of the benefits of smart cities or COVID-19’s effect on them. Many “urban prophets – with or without much empirical evidence – expect that COVID-19 will act as a lubricant for smart city initiatives,” said Klaus R. Kunzmann, professor emeritus and the former head of the Institute of Spatial Planning at the Technical University of Dortmund, Germany. “For a few years, COVID-19 will be the standard argument and pretext for supporting public and private decisions on almost everything, though particularly for making cities smarter by using digital technologies,” he said.
“Smart” concepts aren’t new – in 1620, Dutch engineer and inventor Cornelis Drebbel built a chicken coop that regulated light and temperature to increase egg production. London was among several European cities heralded in 2019 for smart city initiatives, and advocates across the continent that digital technologies will help make public services more efficient and reduce transportation congestion, air pollution and energy and water consumption. That, in turn, could help cities focus more on creating walking and bike lanes, adding greenways and parks and improving urban gardening. But there are related concerns about privacy and what Kunzmann called “unbalanced digital infrastructure development” – meaning most of the benefits could accrue to the affluent, while those without means fall further behind.
The pandemic has already hit vulnerable residents hardest, even those who haven’t been directly affected by the virus, said Tanarra Schneider, managing director, design at Accenture Interactive/Fjord. She points to unequal broadband access for low-income schoolchildren and the fact that reduced downtown activity hurts the homeless who depend on change from office workers to survive.
That should provide context for business leaders, even as they struggle to stay afloat amid a recession. They should commit to broadly helping cities where they operate and rethinking some old assumptions. For example, just because universal Wi-Fi becomes available, Schneider said, doesn’t mean every business should use it.
“When I look at what it means to empower every citizen to have the tools they need with distributed Wi-Fi, this is a massive opportunity,” she said. “But if you, as a business or an individual can afford to, please pay for that access – so we can make sure that those who can’t afford it can get it.”
Rethinking Corporate Philanthropy
Given the front-row seat they’ve had to the pandemic-induced economic pain, now is the time for businesses to step up financially, like Salesforce did earlier this month by committing $18 million to support Bay Area public schools, experts say. “That’s the future of the company’s workforce – or somebody’s damn workforce,” Schneider said. Salesforce described their actions similarly: “Public schools are the backbone of our communities – the heart and soul of our neighborhoods.”
Salesforce’s move, and others like it, has some experts hoping that civic-minded business leaders, including those who have been active in community service and investment, might begin to reconsider where they steer their philanthropic efforts.
“Historically, private dollars have tended to go to youth development work, or opportunities for youth,” said Ayanna Thomas, supervisor of grants administration at the Chicago Department of Public Health. “With COVID, it's been a challenge for the city. It’s a really important piece, the relationship-building between corporations and cities.”
Whether the philanthropy is a direct effort like Salesforce’s or indirect, like declining to use free public Wi-Fi, business leaders should be active participants in maintaining and boosting the vibrancy of the cities they call home, said Paul O’Connor, an urban strategist. That means doing more than writing a check – and it can’t be shrugged off as typical talk of business and government working together, he said.
For proof that the world’s business leaders were already changing their thinking before the pandemic, O’Connor pointed to the Business Roundtable’s 2019 statement, which aimed to move past simply prioritizing shareholder interests. A year later, in the wake of COVID-19 and widespread racial tensions across the country this summer, business leaders should know the stakes are even higher. They must see the threat of empty downtowns and talk of flight from cities as reasons to move past “transactional relationships” with governments, O’Connor said.
O’Connor even thinks that corporate chiefs are a step ahead of municipal leaders, who will struggle to cede any control, on the path through these difficult times. But smart business leaders understand the choice before them at this critical moment.
“It’s renaissance,” O’Connor said, “or ruin.”
Finding the Signal
O’Connor and other experts are quick to say that the necessary collaboration isn’t just about business and government. It must involve academia, nonprofits and other members of the community. As an example, O’Connor pointed to INVEST South/West, a Chicago collaborative that seeks to pump more than $750 million into 10 of the city’s most disinvested neighborhoods.
INVEST South/West was created in 2019, with new funding announced as recently as this summer, part of which went to support construction of a 30,000-square-foot surgical center near Mt. Sinai Hospital in the North Lawndale neighborhood. The project is crucial, “set against the background of both COVID-19 and the issues of racial disparities brought to the forefront in the wake of the death of George Floyd,” Karen Teitelbaum, president and CEO of Sinai Health System, said in a statement.
"We’re at a pivotal moment,” she said. “This sort of financial commitment means much more than bricks and mortar; it’s about ensuring vitality, employment, safety and good health in a part of Chicago plagued with disparities,” she said.
Of course, bringing together so many stakeholders isn’t easy. But one story from Chicago’s Department of Public Health offers hope – and perhaps a lesson.
Raed Mansour, director of the public health department’s Office of Innovation, was besieged with calls and emails in March, during the pandemic’s earliest and (so far) scariest days. But as difficult as it was to get to the bottom of his inbox, Mansour was happy. The overload came from key stakeholders – businesses, community leaders, academics, representatives from other government agencies – offering ideas for how to help.
“That was great – but it posed other challenges,” he said. “It’s very noisy, you’ve got a host of experts and ideologies. But we have to find out what is the signal we should listen to within that noise so we can protect the most vulnerable.”
The collaboration that continues to this day helped Chicago tamp down the coronavirus curve, Mansour said. And it’s the kind of collective effort that is crucial, given the challenges that will endure beyond this pandemic.
Almost to a person, experts emphasized that the threat of animal-borne viruses is now a fact of life. That means it would be unthinkable for leaders from cities and other governments, from businesses and all other stakeholders not to collectively take a hard look at the past six months and seek ways to protect our collective health going forward.
Sulit is among those experts, and there’s another part of his own experience that reflects the tricky nature of our current terrain: Sulit doesn’t yet know if he actually had COVID-19. He initially tested negative, but swab tests are only about 60 percent accurate – and based on how sick he got, Sulit and his doctor think COVID was the culprit.
Sulit will soon find out for sure. But with his own experience emblematic of the uncertainty surrounding the pandemic and perhaps the future more broadly, Sulit is already sure of something else – not learning from the past several months would be a mistake.
“Everyone involved will need to come together and look at the data once the dust settles on this pandemic,” Sulit said, “because we need to prepare for the next one.”
As is our practice with Work, Wellness & Space, we identify social conflicts surrounding each chapter’s theme. Regarding the future of cities, conflicts include:
• Can Stakeholders Adapt to Work Better Together? Experts say businesses must reevaluate their strategies for philanthropy, especially given cash-strapped local governments. But at least one expert said city governments should simultaneously relax their controlling tendencies. Given the enormity of the problems we face, what needs to happen first to compel city leaders to loosen the reins and inspire corporate executives to step up or at least change their approach to corporate philanthropy?
• Tapping the Benefits of Smart Cities: Advocates say better data collection can improve traffic, transportation, utilities, water, waste, health and even crime. But there are many privacy concerns and worries about the technology benefitting only the well-heeled. Can cities make smart, strategic and equitable decisions that benefit all, not some, with insight from business and community leaders? And will they make these decisions fast enough to retain or bring back industry, enterprise and commerce, safely and smartly, to urban hubs – thus bringing our cities back from the brink?
• From Noise to Signal: Sometimes during times of crisis, too many stakeholders can come forward with well-intentioned suggestions. What will incentivize government leaders – gatekeepers and go-betweens who often follow the money in the interests of self-preservation – to identify the strongest, most creative ideas while ensuring that those with quieter or weaker voices – and unfamiliar voices from nontraditional actors – aren’t forgotten or ignored?
‘Medtail’: How COVID-19 Accelerated the Convergence of Retail and Medical
With traditional retailers struggling, “medtail” — medical services offered in a retail style — could soon be popping up in shopping centers, commercial districts and office buildings, experts say.
The idea of putting a healthcare facility in most office buildings would’ve seemed excessive even three months ago. Now – with up to 25,000 storefronts predicted to close this year and a growing emphasis on preventative care – it’s just another way life could change as a result of COVID-19.
“Just like there’s a Starbucks on every corner, there’s the potential for a clinic in every office – provided they’re marketed as beneficial and as part of a framework of wellness,” said Todd Puckett, a licensed clinical professional counselor and founder of Skycrest, which provides performance and life enhancement services to executives and other high-performing businesspeople.
Even if clinics don’t end up in every office building, they could soon be on a lot more city blocks, based on some recent trendlines. COVID-19 has supercharged the bets corporate America was already making on healthcare – including Walgreens’ $1 billion investment in July to put hundreds of full-service doctors’ offices in its stores.
These moves are partly about a pivot to value-based models and preventative care, but they’re also about the convergence of retail and medical, what’s now being called “medtail.” That convergence and what decision-makers should know about it as they rethink the workplace are the focuses of Chapter 6 of Work, Wellness & Space.
Out Goes Retail, in Comes Medtail?
The convergence, experts say, presents a multi-pronged opportunity, especially with many traditional retailers closing up shop amid COVID-19. “If a place is no longer a restaurant or a shoe store,” said Ari Klein, executive managing director of Cushman and Wakefield, “it has to be something else.”
That’s where healthcare, specifically medtail, can slot in – a transition that helps surviving retailers in commercial areas because they won’t face as many empty storefronts nearby. But, more importantly, it can improve people’s overall wellness at an important time.
“There’s a real opportunity for medical, commercial real estate and wellness to come together,” said Jack Siragusa, first vice president of the CBRE Retail Advisory Group in Chicago.
People are increasingly likely to seek medical care in retail locations. That’s evidenced by Walgreens’ bet on VillageMD that includes 500 to 700 full-service doctors’ offices in stores across the country – with “hundreds more” to be built. This realignment was already starting, but the pandemic has made it more important than ever that medical services be of the one-stop-shop variety, experts said.
But the shift does not end with increased offerings or services – it ends when care is able to be accessed by anyone who needs it, wherever they need it. The success of medtail operations like VillageMD – certainly when compared with the struggles of bricks-and-mortar retailers – shows a path forward.
“Medtail moving into a lot of spots left empty by traditional retailers is already happening across the country – and Oak Street Health and VillageMD are strong examples of how that trend will continue,” said Willie Hoag, principal at Tether Advisors. “Beyond the benefits of simply filling space, this has a lot of potential to make us a healthier society.”
Changing Attitudes – in Real Estate and Beyond
Medtail’s success, however, will require reframing commercial real estate and tenant expectations. In the past, as discussed in a May webinar by the International Council of Shopping Centers, landlords hesitated to bring medical into tenant mixes. They worried it would attract sick people, depressing businesses such as fitness centers and gyms, which often operate in busy commercial centers.
But it’s important not to paint all healthcare with the same brush, experts said. During the webinar, Chad Pinnell, managing director, Healthcare Solutions at commercial real estate company JLL, said that 80 percent of health visits are “well visits or low-acuity visits.” And Jamie Goldberg, vice president of Real Estate & Development for One Medical, a membership-based primary care practice, said it was helped patients to put healthcare establishments in a “convenient, welcoming environment,” and that doing so wouldn’t spell doom for surrounding businesses.
“When they are coming in for primary care of chronic condition care, they are still able to go to restaurants or other shops within the center,” Goldberg said.
At the same time, more traditional tenants might be willing to recalibrate their expectations. As one executive at a major fitness company explained last spring, “In exchange for rent relief tenants are increasingly willing to back off lease specifications that restricted healthcare facilities from entering the tenant mix.” Beyond tenants, the owners of commercial properties – faced with a down economy – might get creative by bringing in a broader mix of tenants into existing spaces. “Smart landlords are looking at what concepts are going to survive,” Siragusa said.
Survival is also on the minds of decision-makers who run businesses across the country, some of whom might be tempted – especially given the continued realities of remote work – to lean on the increased use of telemedicine. But some experts disagree. “Make no mistake,” Dr. Jim Januzzi, a cardiologist at Massachusetts General Hospital, told the Boston Globe in April, “the very nature of medicine is to see a patient in person.”
That’s an important reminder for decision-makers prompted by the pandemic to reevaluate the very nature of the office and factors like proximity to medical care for employees. COVID-19 “has exposed so many fissures, fractures and true deserts, not just in healthcare but across the board,” said Jason Madsen of Ascend Medical.
“We no longer have the luxury of ignoring those,” he said. “I am hopeful that some systemic change comes out of this.”
So far – and possibly given the craziness of the past several months – tenants and prospective tenants haven’t been rushing to landlords asking whether there’s a medical clinic in their buildings, experts say. That’s probably because of questions about handling employee privacy concerns in a world where clinics are just a few doors from the office, said Pete Billmeyer, co-founder and managing principal Bespoke Commercial Real Estate.
“There is some separation between work and healthcare, where people still want privacy,” he said. “The idea of walking out of a clinic and colleagues seeing you might be uncomfortable. It would depend on the level of medicine and the nuances of the company.”
For decision-makers, dismissing privacy concerns would be a mistake – but so would ignoring the importance of proximity to medical services for employees, Hoag said. Even when offices can eventually reopen safely, it’s highly unlikely that employees will go back to their pre-COVID stance on health and wellness.
“Clinics don’t necessarily need to be in the same building, but employees will want them woven into the fabric and flow of their everyday lives,” Hoag said.
The Conflicts Around Medtail
As is our practice with Work, Wellness & Space, we identify social conflicts surrounding each chapter’s theme. Regarding medtail, conflicts include:
· Privacy Versus Proximity: Can companies walk the line between providing nearby access to medical services and employee privacy? If no balance can be found, will employees ask to work from home more knowing that they’re less likely to run into colleagues on their way in or out of sensitive medical appointments? And will employers be amenable to the request?
· Can a Renewed Emphasis on Health and Wellness Last? The pandemic exposed many issues with America’s healthcare system, prompting an emphasis on holistic, preventative wellness. But will it continue long term? Will the system to improve proximity to care – and will employers find ways to help employees in that regard?
· Not Relying Too Heavily on Telemedicine: Some employers might figure they can avoid having to be close to healthcare because of telemedicine’s surge as a result of the pandemic. But experts point to the importance of in-person care. How can organizations design strategies that allow employees to fully leverage both telemedicine and face-to-face medicine?
Preventative Wellness: A Mid- and Post-Pandemic Workforce Priority
Yuri Teshler couldn’t look away. Instead of taking in a movie with his wife and five kids, he was fixated on a seemingly endless stream of theater patrons with oversized popcorn and sodas. Many of them, Teshler noted sadly, were children.
“We as a culture have just accepted that [this] is the way it is,” said Teshler, practice lead for Healthcare at Moore Strategy & Insights. “And there's no plan that I see that says, ‘this is not good. This is not right.’”
Changing that thinking became a focus for Teshler’s career as he turned to technology to improve an inefficient healthcare system. He and other experts believe that innovative thinking and new approaches, with a focus on preventative wellness, are crucial as corporate America grapples with the effects of COVID-19. That is the theme of the fifth chapter of Work, Wellness & Space.
Wellness as a Top Priority
In-office screening options – think phones that take your temperature – will become common in the workplace. And many companies will ask employees to fill out questionnaires about their health before coming to work, in what is being called “attestation.” Simultaneously, a new mindset is emerging. Reporting to work sick will no longer be a sign of flagging dedication, said Bobby Benson, design principal at Cannon Design. “Now, you will work from home the moment you are sick – and that will be looked at as a good thing,” he said.
From there, thinking collectively, and continually, about limiting threats of ailments is no longer so big a leap. Whereas today, the CDC reports that 90 percent of the $3.5 trillion of annual U.S. healthcare expenditures goes to chronic and mental health conditions, the dangers of COVID-19 have emboldened advocates of what Eden Health CEO Matt McCambridge calls a “health-forward” approach.
This approach will require adoption by the corporate world of new thinking in the healthcare space, away from traditional fee-for-service models and toward holistic, preventative, value-based care.
Ron Barshop, CEO and founder of NeWay Care, points to VillageMD as a sign of where we’re headed: The company recently announced a $1 billion investment from Walgreens Boots Alliance to open up to 700 physician-staffed clinics inside Walgreens drugstores in more than 30 U.S. markets by 2025. He also lauds Chicago-based Oak Street Health, which operates 54 primary care centers across eight states and serves Medicare patients. The company filed preliminary paperwork in July for an IPO.
Their model centers around relationship-based clinics and focuses on building a primary care delivery platform that addresses rising costs and poor outcomes. Patients who need it receive transportation to appointments and are invited to participate in family-centric events. The company shares in the risk for its patients’ healthcare costs, which has equated to a 51 percent reduction in hospital admissions and a 42 percent reduction in readmission rates.
For corporate America, value-based care with a preventative focus is as relevant to mid-career workers as it is for older demographics, particularly in a post-pandemic world. And the good news is that business leaders are taking note: Willis Towers Watson’s 2019 Best Practices in Health Care Survey found that an increasing number of employers are incorporating value-based approaches into their health plans, and 2019 research from the New England Journal of Medicine strongly supported this finding, asserting that value-based care can help solve some of the cost and quality problems that plague the U.S. healthcare system.
“As businesses work to reopen after and amid COVID-19, decision-makers should take a page from innovators and embrace preventative wellness,” said Elizabeth C. Nelson, Ph.D. candidate and author of The Healthy Office Revolution. “Preventative steps are key to improving not only individual health but also the capabilities of doctors and medical offices. After all, much of the human experience is counterintuitive to basic human health. Brain chemistry alone is more aligned with someone in distress or danger than not for the average working adult. Healthcare must holistically shift to preventative health, going way beyond ‘eat healthy and exercise.’”
“This will not only make us more resilient,” she added, “but allow medical professionals to do the work our preventative measures cannot."
A Corporate Mentality Needed in Healthcare?
Traditional healthcare players, typically large organizations that struggle to innovate, are investing in startups to help. The Blue Venture Fund initiative by Blue Cross Blue Shield is one example; another is Humana’s $100 million investment in an at-home primary care startup called Heal, where the two companies will offer value-based primary care to elderly patients through a combination of house calls and telemedicine – essentially bringing preventative wellness to patients’ doorsteps.
Barshop, in his podcast, Primary Care Cures, frequently explores where and how the traditional healthcare model is ripe for change. New technologies and outside viewpoints – particularly individuals with more corporate backgrounds -- are increasingly part of the primary care conversation.
Barshop came to healthcare from finance. McCambridge had a similar path, moving from venture capital to start Eden Health, which features a virtual primary care and navigation platform centered on care teams. The company helps employees across the country navigate the healthcare landscape across insurance, primary care and mental healthcare, and its model has integrated specialties such as behavioral health and physical therapy.
“When you design something around the user, you come to understand what their needs are,” McCambridge said. “It’s the human-centered design approach.”
As CEO of Atlanta-based Ascend Medical, Jason Madsen, who made his name in private equity, has positioned his organization as a virtual primary care platform with mobile diagnostics and imaging. Set to launch in late 2020, the company aims to operate 20 clinics by 2024, focusing on evidence-based medicine, technology, compliance and metrics that deliver optimal outcomes through primarily telehealth and, when needed, in-person visits – declaring that the pandemic has made physical presences less vital and is creating a “land grab that is virtual.”
“There is a reset among patients who have existing relationships with primary care, urgent care and even through retail,” he said. “These patients are going to look for new relationships with provider groups who understand their situations on a long-term basis.”
Putting Preventative Wellness in Individuals’ Hands
Teshler and Barshop are working together on a tool that uses biometric feedback to measure sleep, diet, mental health triggers and other data to provide customized guidance on health and wellness. Only about 10 percent of the process needs clinician oversight, and each individual is responsible for implementing much of the guidance.
The guidance could mean individualized plans for things like weight loss or marathon training, but Teshler and Barshop believe their business model will appeal to employers looking to create healthier workforces, too – particularly now. The tool is poised to fill a growing demand that experts believe has only accelerated as a result of COVID-19, one in which employees and employers use data-driven science to achieve wellness goals and maintain healthy organizations over the long term.
“COVID has shown us that the U.S. healthcare system cannot serve the entire population,” Barshop said. “We need to simplify a user experience that makes healthcare simple and frictionless for every individual to be involved, yet supervised, by a doctor.”
The Conflicts Around Managing Preventative Wellness
As is our practice with Work, Wellness & Space, we identify social conflicts surrounding each chapter’s theme. Regarding the focus on preventative wellness as a result of COVID-19, conflicts include:
· Remember Going to Work Sick? Even before the pandemic, walking into offices during the cold and flu season was like walking into a petri dish – because of social norms that dictated that workers play “hurt.” But a player who comes in sick jeopardizes the health and wellness of the entire team – especially now. Can business leaders enforce evolved thinking and stay focused on providing safe and healthy environments? Can individuals self-regulate?
· Short-Term Thinking to Preventative Care: Organizations will be challenged to overhaul workplaces while simultaneously revamping healthcare and wellness plans. But surviving the pandemic and navigating future health crises depend on committing to collective, preventative wellness. Can we expect traditional or upstart healthcare providers to proactively ease the burden of choice that many organizations feel they must make? How will organizations stress preventative wellness given the office/work-from-home combinations that are likely in the coming months and years?
· Embracing Value-Based Models: Value-based care provides cost-savings and better outcomes for corporate health plan participants. But can busy business leaders, who are juggling even more responsibilities because of the pandemic, take a page from healthcare outsiders and move toward a model that pays for results – similar to what is taking place in the primary care space?
How Can Companies Manage Virtual Space?
During a Zoom call with her company’s chairman, Meredith Heagney’s 10-month-old daughter Lillian screamed. Loudly.
Everyone on the line knew Heagney had a call later with a big client, so she tried to assure them that Lillian wouldn’t be screaming when that started. The chairman told her not to worry about it.
“He was acknowledging that we're people with lives,” said Heagney, 36. "I don't think that's always been okay in business."
Like many around the world, Heagney and her husband Mitch have spent much of the past five months in their 1,700-square foot, two-bedroom condo on Chicago’s North Side juggling their jobs and Lillian. It hasn’t always been easy, but Heagney is heartened to see that, for all its challenges, COVID-19 appears to have prompted a change in attitudes among corporate America’s leaders.
Heagney’s experience sheds light on how companies – faced with a pandemic that will be part of our reality for the foreseeable future – can best manage virtual space and how employees work remotely. That’s the theme of the fourth chapter of Work, Wellness & Space project, a partnership between GreenHouse::Innovation and communications firm Greentarget in collaboration with Learn Adapt Build (LAB)/Amsterdam.
Dealing with Meeting Overload — and Different Personalities
A Gartner, Inc. survey of employers last spring found that 74 percent of employers will shift at least 5 percent of employees who worked on-site pre-COVID to permanently remote positions after the pandemic. For everyone else, working from home will continue on at least a limited basis for a while. Global Workplace Analytics estimates that 25 percent to 30 percent of the workforce will work from home on a multiple-days-a-week basis by the end of this year. It’s the only way most offices – particularly those designed with close quarters in a pre-COVID era – can operate with social distancing.
But many employees would probably argue their performances in the COVID era merits expanded or loosened work-from-home privileges in any scenario. “People are learning, ‘Oh, I'm getting my work done in four hours where it used to take me six hours because I'd have Molly popping by and asking me how my weekend was,” said Dr. Eugénie Pabst, a biofeedback specialist.
That’s not to say the transition to remote work has been smooth or easy. A new study finds that the workday increased by 48.5 minutes since the pre-pandemic and that the number of meetings per person jumped 13 percent. Anyone who didn’t think there were too many meetings before the pandemic probably thinks so now, said Dr. Michael Horowitz, president of TCS Education System, a nonprofit system of colleges advancing student success and community impact. TCS has long embraced online platforms, which made the COVID transition easier. Horowitz’s organization is being intentional about the number and length of meetings to prevent employee burnout.
“Video meetings are tough and fatiguing,” he said. “For maximum impact and productivity, we are learning the right cadence and quantity for our remote environment. When is it important to have the whole leadership group together? What could be better addressed in a quick, one-on-one conversation? We need to be purposeful with our time and virtual interactions right now.”
Organizations also need to be mindful that work-from-home scenarios can affect workers differently. Introverted people might seem suited for remote work. But that’s only true to a point, said Monica Hakimi, the James V. Campbell professor of law and the associate dean for faculty research at the University of Michigan. As introverts are often drawn to academia, Hakimi has had the chance to see how many of them have reacted to working from home over the past few months.
“In some ways, introverts are well set up for it,” she said. “But the fact that this is their M.O. could lead to more isolation.”
To prevent that, the law school faculty two weeks after going remote began checking in with every law student to make sure they were taking care of themselves and getting the assistance they needed. The school also maintains community through weekly faculty workshops via Zoom.
Those kinds of check-ins are important for all employees amid growing feelings of isolation and uncertainty, said Nicholas White, managing director of Learn Adapt Build (LAB)/Amsterdam. In many ways, managers must relearn how to effectively manage workforces with an emphasis on the nuances of remote working.
“Without clear direction, coaching, or guidance, people are often left to navigate this difficult journey on their own,” White said. “Individuals can build stories that overwhelm – am I going to lose my job? Am I doing enough? Is my manager happy with me? This on top of managing everything else at home can be a recipe for disaster.”
The Future of the Home Office
But managing virtual space isn’t just about tolerance of screaming children, limiting video conferences or ensuring remote work doesn’t feed employees’ angst. Companies and employees are probably only beginning to understand what this all means. Some would argue that robust productivity over four months of working from home might justify broad changes – perhaps arguing that an office is no longer necessary. But there still are too many unknowns, said Ari Klein, vice chairman of Cushman and Wakefield, which specializes in representing corporate, legal, and institutional clients with their commercial real estate requirements.
“Right now is not the time for someone to make a possible irrational decision based on data that has not been tested,” he said. “The space needs of yesterday have clearly changed. The space needs of tomorrow have not been defined yet.”
Tim Swanson, chief design officer at Skender, an integrated design and manufacturing company in Chicago., agrees. “Part of the challenge is not knowing what this looks like and what it means. Whether people can be productive in their home space. Open offices were supposedly a failure, especially when your staff feels under supported. If you thought open offices didn’t work, how will you work from home?”
But others think those questions have been answered. Forge Craft, an Austin, Texas, architecture and design firm, recently released The COVID Companion©, a white paper predicting that employees will go to offices about once a week for team meetings and collaborative projects – and that the 9-to-5, 40-hour work week becoming obsolete for knowledge workers.
“We think we’ll see primary or secondary spaces in homes that have to function as offices,” said Rommel Sulit, Forge Craft’s founding principal. “Your home is your single-most important investment – and that’s especially clear now as COVID forces us to optimize the space for work. And the evolution of that space has staying power.”
He envisions a wave of new construction where one side of a house includes a master bedroom and offices, children’s bedrooms and a home school space on the other side and a family/public area in the middle. Of course, the vast majority of housing isn’t designed like that – but workers will probably seek that kind of space, especially after working on card tables or kitchen counters for the past few months.
“There will be more intentional third spaces in apartments for people working from home – like people renting a place with a third bedroom to use as an office,” Swanson said. “But as we go down that path, companies and employees are going to have a little bit of a reckoning asking who’s going to pay for those slightly larger apartments, especially if companies expect these spaces to replace commercial offices permanently.”
A Swiss court ruled in May that companies in that country must help offset the cost of working from home. Even if they’re subject to no such requirements, companies might wonder how much they should change, and how much they’re willing to pay for change. Even if remote work continues in some capacity for the foreseeable future – which is likely – some experts believe employees should provide some basic amenities to home offices.
“People are asking to take their chairs home and they were not allowed – it’s a chair, not a NASA secret,” said Tanarra Schneider, managing director, design at Accenture Interactive/Fjord. “Companies have shifted from saying we should never work from home to doing it because of COVID, but there has not been an effort to truly listen and ensure that employees are set up for success.”
The Conflicts Around Managing Virtual Space
As is our practice with Work, Wellness & Space, we identify social conflicts surrounding each chapter’s theme. The management of virtual space presents these conflicts:
· Zoom Overload: Leaders struggling to manage far-flung employees might overcompensate and schedule too many virtual meetings. But experts said that video conferences can be more draining and cause employees to lose focus in already turbulent times. How can leaders strike a balance between online collaboration and overdosing on Zoom calls?
· Managing Personalities: Can leaders ensure that they’re thinking about how different personalities adapt to remote work – and provide assistance and check-ins to match? While extroverts will likely struggle not being around people, introverts working at home for months might end up dealing with feelings of extreme isolation.
· Amenities vs. Cost: Hopes for a vaccine could keep leaders – particularly in a bad economy – from paying for work-from-home amenities. Will they pay for office chairs, monitors or even subsidize rent when employees need more space to effectively work from home? If not, will employees who can pay for those things have a leg up?