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?
What Will the Office Look Like?
Offices will look quite different in near future, with the spread of COVID-19 in conference rooms a major concern for companies.
He’s paying thousands of dollars in rent for a lower Manhattan office that’s been sitting empty since March. But Neil Alumkal is committed to maintaining his company’s brick-and-mortar presence through the COVID-19 crisis and beyond.
“You don’t look serious if you don’t have your own office,” said Alumkal, who founded Stuntman PR in 2010. “When a really big brand sends me an RFP, they want to see what the operation looks like – and that I have a real staff and a real office.”
That doesn’t mean Alumkal isn’t concerned about keeping his staff of four safe when they’re eventually back in the office again. He plans to buy a hospital-grade air purifier, abandon conference room meetings and might move to a space in his building with more traditional walled offices.
Business leaders like Alumkal – not to mention millions of employees who are scared and possibly ready for change – are faced with some big questions about what post-COVID offices will look like and even the real reasons for having them. Those questions and the broader future of the office make up the third theme we’re examining in the Work, Wellness & Space project.
The Office Building of the Future?
The average elevator call button has more germs, pathogens and bacteria than a toilet seat. Forty times more.
That’s one of the disgusting but important facts Bob Wislow discovered during late nights surfing the internet in the early days of COVID-19. Wislow’s interest went beyond curiosity. His Fulton East project – a new office building in Chicago’s bustling Fulton Market – was supposed to open in July.
Wislow, chairman and CEO of Parkside Realty, Inc., pushed the building’s opening to August and added an even stronger focus on health and wellness to his launch strategy. For the elevator buttons, Wislow explored a few options – including activation by smartphones and voice commands – before landing on a system that uses buttons activated with toes, not fingers.
That wasn’t all. To reduce cross-contamination risks and clean employee workspaces, Fulton East will use non-thermal, plasma technology that reduces at least 90 percent of viruses, bacteria and mold on both surfaces and in the air, Wislow said. Additionally, many of the original features at Fulton East are less about health and more about wellness, including biophilic design that brings elements of the natural world into offices.
“As a developer you’ve got a fiduciary responsibility to bring a building to market that addresses the needs of the population that’s going to occupy the building,” Wislow said. “And the business decision-makers are going to need to think about what’s going to make employees feel comfortable about coming to work.”
That level of comfort is something employees in existing office buildings may not feel as they report back to their offices in the next few months, said Robert Benson, design principal of Cannon Design. Twenty thousand people a day walked through the lobby of his company’s building at 225 N. Michigan in Chicago before the pandemic.
“The thought of that type of traffic, and then waiting on confined elevators to go to the 11th floor before even getting to the office, is a lot to consider,” he said. “The CDC does not recommend using public transportation, which makes asking our employees to come to work very problematic. Even when the CDC revises that guideline, if our team sees someone on the train without a mask they should not ride on that train, which makes an urban workplace a difficult proposition.”
Fulton East, set to open in Chicago in August 2020, has a rooftop with amphitheater-style seating and a large screen to accommodate meetings. Photo courtesy Parkside Realty, Inc.
Converting Existing Office Spaces
Offices new and old will take on some of the feel of hospitals, experts said. That means enhanced air filtration systems, antimicrobial paint, sneeze guards, hand sanitizer around the office, wayfinding measures (like those arrows on supermarket floors) and fewer dedicated desks to be wiped down every night. Some companies may even take a page from the past and move back into walled offices, scrapping the recent shift to open floor plans.
Detractors say that trend was always more about cutting down space and saving companies rent money anyway. Still, if done right, it had fans. Last year, Jon Talty, chairman and CEO of OKW Architects in Chicago, asked a group of young employees what made them comfortable and productive. They liked workstations in a “benching format,” a lot of breakout space to collaborate and an open and bright environment without barriers.
“We reinvented the office and did a good job with it – then COVID happened,” Talty said.
With social distancing part of office life, at least for now, the close quarters that Talty’s staff championed won’t look the same for a while. But OKW’s office reopened in June at 50 percent capacity, with employees rotating days and some staff members remaining remote. They’re taking other safety measures too, like mandatory mask-wearing when employees aren’t at their desks. “So far, people have been responsible,” Talty said.
That kind of approach – especially amid questions about the death of open offices – might be how modern offices successfully adapt, said Timothy Swanson, chief design officer at Skender, an integrated design and manufacturing company in Chicago.
“What a lot of people are doing is getting rid of the middle seat and pivoting to a functional open office that seats fewer people but allows social distancing,” Swanson said. That works, he said, because the last few months have made decision-makers and workers bigger believers in remote work. Indeed, a Morning Consult poll found that 75 percent of adults who can work remotely would like to continue to do so at least once a week after the pandemic is under control.
But a hybrid solution, where a proportion of employees work from home while others report to the office, brings complications. “It’s understood that our capacity in the workplace has to drop,” Benson said. “But you have to ask the value of being in the workplace at all. My design studio has 40 people in it. If I have 20 there, then I am still jumping on a video call in order to reach the people who are at home, and that doesn’t make sense.”
But not everyone is convinced of that. The past few months have proven that work is not somewhere we go, but something we do, said Nicholas White, managing director of Learn Adapt Build (LAB)/Amsterdam.
“At no other time in history would this exploration of work even have been possible,” White said. “Through collaborative, office and personal technologies, we are empowered to work differently, and we are seeing encouraging data and trends that encourage exploring these alternative ways of working.”
Redefining Communal, Collaborative … and the Entire Human Habitat?
Organizations dealing with COVID-19 and whatever the new normal looks like must “consciously think about and continuously adapt to new information,” White said. But one thing that seems clear is that the office’s main function – what can’t be easily replaced by Zoom calls – is and will forever be collaboration.
Still, many communal aspects of the office – dishes, kitchens, coffeemakers – are likely gone in the near-term. COVID-19 wreaked havoc with the high hopes that many had for sustainability in 2020. Companies’ past encouragement of reusable water bottles is an example of “where sustainability and health and wellness are fighting with each other,” said Patty Lloyd, director of sustainability at Leopardo, a Chicago-based construction company that works with Fortune 100 companies.
“To fill my reusable water bottle, I have to use a communal water dispenser. That touch point might create too high a risk of viral transmission,” she said. “We have to be cognizant of the shifts happening in order to help mitigate any sustainability losses that might occur as a result of health and wellness gains. We also have to try to find a middle ground between health and wellness and sustainability, so we have collective wins.”
Indeed, talk around the water cooler will change when there are no water coolers – or even casual hallway talks. But what about conference rooms? One of the reasons organizations want office life to resume is a belief that in-person collaboration – “reinforcing culture, mission, successes and failures,” as Talty put it – can’t be done as well by video conference. Do in-person meetings in conference rooms run counter to social distancing guidelines?
“Even if you only have in-person meetings five days a month, the way those meetings happened before the pandemic meant people sitting around the same table and breathing the same air,” said Willie Hoag, principal with Mid-America Real Estate Corporation in Chicago. “So, the most important thing and one of the crucial functions of the office – collaboration – might be dangerous to pull off.”
There are ways to make conference room meetings work, some experts say. Wislow’s Fulton East has a rooftop with amphitheater-style seating and a large screen to accommodate meetings. Swanson said companies should limit how many people go into large rooms at the same time and that, in the short term, small conference rooms will become single-occupant offices or spaces where only specific teams work. Talty suggested lots of monitors to allow for many remote participants, and Benson suggested multiple cameras in conference rooms.
Benson also said the “amenities arms race” of recent years is probably over. Urban strategist Paul O’Connor put it even more plainly: “The ping pong table is gone,” he said.
Our understanding of COVID-19 continues to evolve – there’s less concern about germs transmitted via surfaces than a couple of months ago and greater concern about airflow. But O’Connor and other experts believe COVID-19 began a long-overdue reimagining of offices – and perhaps more.
“The opportunity is to really reimagine the human habitat, not just the workplace,” O’Connor said. “To do that, it takes architecture, construction, commercial real estate, urban planners, local government and labor, too. It needs to be a broader conversation.”
Experts agree that this will be a transformative time. No one will come out of this pandemic the same, and many businesses are likely to grow either stronger or significantly weaker during this time.
Collaboration remains the top reason for having an office, experts say. But how can collaboration — which was so easy just months ago — continue given COVID-19?
Conflicts Around the Office
As is our practice with Work, Wellness & Space, we identify social conflicts surrounding each chapter’s theme. The evolution of the office in the wake of COVID-19 presents these conflicts:
· Safety vs. Collaboration: Fostering collaboration at reopened offices will be difficult considering that group meetings often involve close quarters. How will organizations strike a balance between safety and teamwork, especially in ways that can persuade weary employees that coming to the office is both valuable and safe?
· The Half-Staff Conundrum: Further, if returning to the office, as predicted, depends on a split-schedule approach, are we meeting the goals of collaboration? In other words, if half the staff must participate remotely, what’s the point – amid safety concerns – of the others being in the office at all?
· Open-Office Requiem? Critics argued the open floor plan trend was mostly a way for companies to reduce their footprints and save rent money. But some organizations successfully threaded the open-office needle, reducing costs and fostering teamwork. Can that be done in a social distancing environment? And if not, what is the next evolution in financially viable and safe work?
Why a Post-COVID Working World Should Focus on Mental Wellness
When we talk about mental health in the workplace, two statistics from the World Health Organization get thrown around a lot. Depression and anxiety cost the global economy $1 trillion a year, and every dollar invested in treatment for common mental disorders returns $4 in improved health and productivity.
But those numbers predate the worst global health crisis in a century, its corresponding economic disruption and global civil unrest unlike anything we’ve seen in decades. Research conducted in spring 2020 shows a dramatic upswing in the number of adults in the U.S. at risk for serious mental illness.
In other words, already stressed employees are facing a whole new set of stressors, none of which is going away anytime soon. That means mental health and wellness in the workplace have never been more important. It also means smart investments in those areas will pay far greater dividends than ever before.
That’s one of the major takeaways shared by experts from a variety of fields in spring 2020 for the Work, Wellness & Space project.
Accelerating the Mental Wellness Conversation
Alex Simmons spent most of his 20s working in investment banking and private equity. Eighty-hour plus weeks became the norm and after a while, it started taking a toll on him in the form of stress, anxiety and burnout. It’s a common story in modern work life.
Simmons’ wife introduced him to talk therapy, meditation and later coaching. The experience made Simmons realize that the systems in place at most companies to provide mental health services – Employee Assistance Programs (EAPs) – weren’t working. That, combined with the growing mental health epidemic in the United States, led Simmons to start Boon Health in late 2019. The Michigan-based company seeks to revolutionize the way companies think about and deliver mental health services to employees because, as Simmons puts it, employers and workers “need something more – something that doesn’t focus on short-term crisis management but rather preventive mental well-being.”
Simmons assembled a team of 40 ICF-accredited coaches, therapists and clinical psychologists. In the early going, the company has achieved over 20 percent employee utilization for its customers, while traditional EAPs typically yield less than 3 percent, Simmons said.
“If you're a mom working from home with multiple kids and you're having to support those kids and entertain them while trying to work a full day, there's just a whole host of other stressors that have entered your life that never existed before,” Simmons said.
As reported in The Washington Post, approximately 20,000 people texted a federal emergency hotline for people in emotional distress in April 2020, a more than 1,000-percent increase compared with April 2019. That might be why conversations about mental wellness in corporate America are accelerating, experts said. A senior officer at a venture capital fund focused on healthcare, who asked that her name not be used, said that before COVID-19, conversations about mental wellness were “on the upswing.” That’s increased since the pandemic, in part because of technology, she said.
“COVID has accelerated the adoption of telehealth, including telemental health, cognitive behavioral therapy, etc.,” she said. “Because of COVID, employers are even more focused on employees’ well-being – which includes mental wellness.”
That acceleration is making its way to other parts of the reimagined workplace, including workplace design, with architects and designers finding ways to bring fresh air and daylight into buildings, for starters. That could be even more important in a post-COVID society, where “a holistic approach to productivity and human wellness and happiness” should merge mental health and building design, said Paul O’Connor, an urban strategist.
“The best way to drive numbers in a business is not through demands but through employee production – which is the product of happy, engaged people and not drones at a desk,” O’Connor said.
Coaching, not Just Counseling
One issue that has long plagued workplace mental health efforts is the idea that seeking help means something is wrong with the person seeking it. But that mentality appears to be fading as organizations start to look at mental wellness through the lens of coaching employees to augment performance and productivity.
“If C-suite teams can move somebody from bringing in $10 million or a $100 million to half a billion dollars, they’ve just made a ton of money,” said M. Todd Puckett, founder of Skycrest, which provides performance and life enhancement services to executives and other high-performing businesspeople. “But they can’t say, ‘Hey, to get you to a better spot, you need to go see a therapist.’”
A National Alliance of Healthcare Purchaser Coalitions survey in the early days of the pandemic found that 53 percent of employers were providing specialized emotional and mental health programs for their workforce, including changing employee assistance programs, discounting mental health apps and offering more virtual services like remote yoga. Those services are important, but they’re similar to what’s been offered for years. As the new normal around work continues to develop – and if employers take this moment to learn some lessons about how they can improve mental wellness efforts – an emphasis on coaching will be crucial, Puckett and other experts said.
“We're kind of in this terrifying space that could either paralyze us or it could be seen as an opportunity,” Puckett said. “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.”
And that space, Puckett said, could easily be the workplace.
Designing the Right Culture – and Addressing Racial Tensions
But such a vision only works in the right culture, which is missing at far too many organizations. A 2019 report by Mind Share Partners found that 60 percent of respondents had not spoken to anyone at work about their mental health in the previous year and that they were least comfortable talking about it with HR or senior leaders. Meanwhile, 86 percent said a company’s culture should support its employees’ mental health.
Any rethinking of workplace wellness needs to address that disconnect – and consider the experiences and needs of diverse employees, especially in the wake of the racial reckoning sparked by the killing of George Floyd in Minneapolis. Unfortunately, some business leaders have fumbled the initial attempts to address this malignant problem.
“Stop making black people or people of color tell you their story so you know their pain,” said Tanarra Schneider, managing director, design at Accenture Interactive/Fjord. “The tough thing about that is the listening sessions are meant with the best of intentions. But you know what those experiences are, so stop asking us to repeat them.”
Showing that kind of sensitivity – along with taking diversity initiatives out of silos and ensuring third-party wellness partners include diverse faces – will go a long way toward creating cultures where company mental wellness efforts are embraced by employees. But it’s just as important that leaders embrace these efforts and make it known that they’re participating in mental wellness sessions while making it mandatory for employees to do so, too, Schneider said.
“You are not going to incentivize or disincentivize people to change behaviors without implementing structural changes that may cost something and go beyond performative measures,” she said. “Otherwise, the onus continues to lie with the individual.”
Conflict Identification and the Immediate Frontier
Starting with this chapter, Work, Wellness & Space will articulate pressing social conflicts that emerged through our conversations with experts. Our goal is to prime the pump for relevant stakeholders to come together to innovate solutions to these conflicts designed around measurable structural change.
Specifically, regarding mental wellness, we’ve identified the following conflicts:
● Mental Wellness — from Benefit to Necessity: Growing demand – and corporate prioritization – of mental health comes just as budgets tighten. How can employees get what they need, and can mental wellness be viewed as a necessity, not a benefit? This is harder given the likely (and important) focus on health and safety. But will mental health become an afterthought?
● The Difficulty with Metrics: Offering mental health services seems humanistic, but data and metrics still must apply. If it's not measurable, no one is served. What will those metrics involve? How can organizations incorporate them into any new wellness initiatives? How can employee feedback and increased engagement inform high-level decision-making?
● The Importance of Cultural Sensitivity: We must address mental wellness in a culturally sensitive way, particularly in light of racial tensions. How do companies design programs and change their cultures? Further, can corporate leaders who have historically focused on providing a broader vision and managing people act as coaches who help employees navigate an increasingly crazy world?
Coming Next Week in Work, Wellness & Space: What Will the Office Look Like? Think elevators that you activate with your toes, fewer communal areas and new ways to hold meetings.