Return to Office Success? It's the Culture
With the Covid crisis now largely in the rearview mirror, more and more employers, including hospitals and health systems, are invoking "return to office" (RTO) requirements.
The February 14, 2025 issue of the McKinsey Quarterly features an important article on RTO by Aaron De Smet, Brooke Weddle, and Bryan Hancock from McKinsey’s People & Organizational Performance Practice: "Focus more on practices and less on the policy".
The authors' examination of RTO and its effects lends unexpected support to what those of us in the clinician wellness and organizational resilience community have long been saying: when it comes to burnout, it's the work environment and organizational culture, not the worker or their setting, that matter most
The authors observe that leaders most frequently cite five reasons for adopting RTO policies:
collaboration,
connectivity,
innovation,
mentorship, and
skill development.
But a McKinsey survey of US companies found that employees say their organizations fall short in supporting these practices. The authors note that in-person, remote, and hybrid workers all report similar levels of intent to quit, burnout, effort, and satisfaction [emphasis added].
The authors conclude: “The policy mandate itself is far less important than the work environment organizations create and the practices that accompany a policy’s implementation."
My colleague, Paul DeChant, MD, MBA and I note that during the height of the Covid pandemic many hospitals and health systems began experimenting with remote and/or hybrid work arrangements for some of their administrative personnel and even for some clinicians; for example, telehealth visits with physicians and APP's and remote patient monitoring and/or patient education by RN's.
Indeed, more and more healthcare organizations seem to be adopting these as permanent features of their job offerings. While there are good and valid reasons to consider embracing remote and/or hybrid staffing arrangements, hospital leaders should not conflate these as necessarily being effective countermeasures to clinician burnout. In the end, as McKinsey can attest, the work environment and management practices ultimately determine the incidence and severity of burnout, regardless of setting.
Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus for curing clinician burnout and staffing challenges runs through the C-suite. Here are examples of leadership-driven changes to the workplace that my colleague Paul DeChant, MD, MBA and I often recommend:
> Regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
> Consistently apply one or more of the improvement sciences (Lean, Six Sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
> Expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)
> Create and require leader standard work (LSW).
> Develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
> Judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
> Support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
> Get rid of superfluous or outdated policies, procedures, redundant approvals, and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
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