When I was growing up, I cannot recall my father doing anything which resembled his actual "work" when he was away from his work site. It was not that his work days were filled with manual tasks. He was a PhD trained scientist and I suspect that he did many of the same technical and administrative tasks which I do today. It is possible he did some reading in the evenings when I was very young and I was not aware of this since they herded us off to bed very early. However, at this point in time, it was very clear when he was working and when he was not and it tracked very closely to where he was physically located.
In the intervening 50 years monumental changes have taken place in the work place. What is remarkable is not only the actual technical advances (although some may question the use of the term advances), but also the lag of the recognition of how technology has changed how we work. I have previously blogged about the resident duty hours regulation, which has been crafted completely discounting the how technology has altered how medical house officers do their work. It should be noted that these observations apply to increasing numbers of people in the work force.
Why should any of this really matter? There are huge costs associated with bringing people together to do work and we need to ask the question, why do we need to do this? Historically, we brought people together physically because it was required for them to do their jobs and I believe we continue to use this model because we have not given it much thought. As I have written about before, we bring patients to our offices for face to face encounters and this is driven by the payment system as much as anything else. We bring our employees to work in a building in an academic medical center where we pay a premium for space. This requires that the taxpayers pay large sums of money to support a road system that can handle peak traffic where everyone needs to get to work about the same hours and needs to leave about the same hours. We need to find places for them to park their cars. This is very expensive.
I read a story about a traffic jam in Beijing which extended 60 miles. It is obvious the Chinese are trying to play catch up with road building in order to support economic growth which entails people traveling form one place to another to do their jobs. I have my doubts they can actually build fast enough to make a dent in this.
You might be wondering where this blog is going? My point is we are at a cross roads where we need to ask the question, is it really necessary for us to continue doing business this way? I asked one of the people who works for me how much of the work she does could be done from home. Her answer was 85%. I did a mental checklist of other people who work for me, tallying was they do and the "product" they produce and realized, many need not come to physically work.
I think the implications of this observation are quite striking. I do not have the data but I can speculate that even moving modest numbers of people of virtual employees will have huge impacts on the resources needed to build roads, parking structures, and offices where they historically traveled, parked, and worked. Anyone familiar with economics realizes that where the action is is at the margins where small changes are leveraged to have huge effects.
Obviously there are big barriers to widespread deployment of a virtual employment model. There are cultural issues, the most notable being a combination of lack of trust that those who are working will actually be working. This lack of trust is not completely unwarranted since a not insignificant portion of the workforce will game whatever system they operate in. However, robust information systems also allow us to define what we need done and have the potential to transform how we define work accomplished. Physical presence and the ability to define whether people are physically at work has been the standard. You can have workers punch in and punch out. This still leaves us with the common scenario employees are physically present but accomplish nothing. It is vastly preferable that you can define what needs to be done, track this, and not need to worry about how long it takes them to accomplish this or where they accomplish it from.
Within the realm of health care, this has tremendous ramifications. Obviously we are a ways off from doing surgery remotely. There are circumstances where we need to be in a position where we can examine patients directly to derive particular pieces of information and use intuition to make critical decisions. As far as I know how much of medical decisions making which occurs in this context has not been studied. However, I suspect it represents only a modest fraction of overall encounters. I believe that most of medical decisions are much more pedestrian and assuming the information systems can be built which allow for collection of relevant data, we can move health care encounters into the virtual realm with little or no loss of quality. I suspect that quality and value will improve.Anything which allows for effectively dealing with patient needs without requiring them to travel and consume their time is almost certainly a winner.
The cost savings will be staggering. My own home institution was considering completely rebuilding our health care campus until the economy turned south. One of the major elements were road improvements and parking enhancements. Simply to create sufficient parking for peak demand required an investment of hundreds of millions of dollars. Eliminate the need for a modest 15% of the visits which can be dealt with in virtual as opposed to real (and expensive) spaces and viola! - you can deploy those funds to build something which really brings value to patients and the health system.
All of this will require that we redefine what work is. It will likely require that we redefine the relationship between employer and employee, how we pay for services, and how we track quality and quantity of work done. It may ultimately blur the distinction between working and leisure, business and consumer, as well as management and labor. Perhaps in the future we will be having our long weekend marking the end of the summer celebrating Management and Labor Day.