Now that everyone’s situation is a little different, how can you be sure your staff’s rights are protected, and that business continues as normally as possible?
Kerin Stackpole leads the Employment + Labor Law Group at Paul Frank + Collins, based in Burlington, Vermont. She is also a frequent speaker and teacher. While Stackpole’s colleagues have been accustomed to working remotely for some time, she acknowledges that communication between remote employees, especially during current stay-at-home measures, can take some extra effort.
While in the office, her assistant Mary and she are “joined at the hip,” when working remotely, the two keep in close contact over the phone: “We both prefer Facetime, because we get to see one another also.” Remote work has also presented her with a career first when she met via video conference with witnesses and lawyers for an arbitration. “We essentially did a trial over video chat. That was the first time I’ve ever done that!”
By far the most important resource pediatricians have to maintain morale, productivity, and efficiency is communication. In an article for Fortune, Gina M. Weatherup, founder of Chantilly Mediation and Facilitation, in Virginia recommends over-communicating messages rather than the opposite. “You can never really be 100% certain that whoever you’re communicating with understands fully unless you ask them what you said or what they think you’re asking for,” she explains.
Practices may have some staff working remotely while other teams are more present in the office. Daily huddles, team meetings, or management communication workflows can help everyone set clear goals, receive updates and feedback, and report hurdles and achievements. In some practices, you may even benefit from selecting a point person to communicate from office to remote staff -- the U.S. government requires federal teleworkers to have a “Telework Managing Officer” to keep teleworkers up to date.
Infrastructure for Remote Work
Stackpole knows that for many pediatric practices, remote work may be a new and intimidating experience for both management and employees. She says that the two most important factors a practice should strive for to make the shift successful are infrastructure and imagination. Infrastructure, she says, includes both processes and tools to get the job done.
“A basic laptop today comes loaded with things to do telemedicine. Regulations on telemedicine have been changing, and HIPAA regulations have been relaxed some during the pandemic. This makes telehealth a bit easier. But you need to have the structural capability to work remotely. That involves enough licenses for doctors and staff to access billing, electronic health records, video conferencing services and other programs remotely. You should also have really good cyber security programs on devices you use, and make sure you regularly update those protections. I can do just about anything with a basic Thinkpad. But the idea is, we’ve invested in licenses and programs that allow us to do that. Our firm imagined lawyers working remotely, and we created the infrastructure to support those activities.”
Tracking Employee’s Work, Time, and Maintaining Privacy
Ensuring time is effectively spent at work by nonexempt employees is an obligation of any employer. Stackpole says it’s important to have policies around where and when an employee can expect to have their time and productivity tracked by the employer.
“I’m not watching you walk in the door, but remotely, I need to check in to be sure you’re there. Figuring out the best way to do that can be as simple as my assistant sending an email when he or she comes and goes. You could have a time clock system. There's tons of HR systems that have exactly that, and you don’t even have to work remotely for those systems to work.”
Safety of Remote Workers
Safety in the workplace is dictated by OSHA laws, but Stackpole says that these laws don’t always apply, though state regulations vary. For legal advice on safety in your state, always consult an attorney. “When working from home, I can put some parameters around the employee’s use of their space, and say ‘You need to certify (put in writing) that your set up is healthy and safe.’ But generally, most states’ OSHA requirements do not go into detail about what is required in a person’s home, with some exceptions.”
FMLA, FFCRA Rights and Employer Responsibility
The Families First Coronavirus Response Act (FFCRA) requires employers to allow employees up to 12 weeks paid leave in order for them to care for family members or themselves in case of illness, or in cases where schools and daycares are closed, requiring parents to care for children.
“But they can take it intermittently,” Stackpole says, with reasonable notice and with agreement of the employer. She gives an example: “If I’m sharing duties with my spouse, perhaps, I can work Monday, Wednesday, and Friday but not Tuesday and Thursdays. Or, I can work every day from 7am to noon and 5pm to 7pm, but not between.”
What is reasonable notice? That’s a good reason to have documented and signed policies for your practice. “For smaller practices, they may not have those or have bought them from someone else. Remember: these policies need to be customized for you. Some policies around absences and notice are advisable -- think about “reasonableness” as your basic standard.”
Healthcare workers are essential to navigate the current crisis, so they may be exempt from FFCRA regulations. Employers can and should explore options for parents and employees caring for loved ones at home -- for example, an employee can take on different responsibilities while working from home, or commit to less frequent shifts in the office.
For more information on FMLA leave, you can consult the pandemic-specific resources here.
A Note On Leadership
Healthcare team management requires a unique type of leadership, and at this time it can help your practice thrive. Good leaders delegate responsibly, outline clear expectations, and are flexible enough so that employees feel they can communicate their needs. Experts at the Harvard Business School advise employers to lead by example. While admittedly it’s a hard task for employers to resist responding to emails at midnight or texting an update to your office manager, if management has instructed staff to respect office hours, managing pediatricians and office managers should set the standard.
The professors at HBS also recognize that employers will need to be more flexible to support their staff, as everyone acclimates to stress, schedules, kids at home, economic fears, and constantly-shifting news, and physical safety. What flexibility means for your practice will be individual, but some examples include adjusted schedules for billers, shift changes for parents of children at home, and trading telemedicine for time in the office, with precautions.
The onus for remote work is not completely on the employer. The employee too has duties they are obligated to fulfill. Stackpole says that self-governance is the responsibility and challenge for many remote workers.
“Every employee has a common-law duty of loyalty to his or her employer,” she explains. “What that means is, it’s my job to not harm the interests of my employer, but act in a way that is loyal to those interests. If I’m getting paid for 8 hours a day but working for 4, I may be breaching that common-law duty. That’s a situation I’m not living up to my obligations.”
Stackpole says that an employee’s top responsibility is to first “meet obligations the employer has set, and recognize that may be a challenge. So be efficient as you can be, and if you’re struggling, reach out and ask for help or think through it together.”
Remote workers may struggle silently before reaching out. Here’s advice from the Harvard Business Review on helping remote workers avoid loneliness and burnout.
Managing Remote Humans
Physicians and office managers may find it difficult to check in on remote employees, and this can eventually result in late work, mismanaged projects, and a resentful environment. To prevent communication misfires, Stackpole recommends a strategy of over-communicating. Huddles and daily meetings, clarifying questions, and regular, honest feedback can help too.
“Generally speaking, the more productive way to manage humans is to have good communication with them. I should be able to give you certain expectations, a certain time frame, I should support you with materials and information. And then, if you don’t get them done in a timely or appropriate fashion, I can address that. That cycle of expectations, meeting them, or if not, addressing consequences, it’s all about being clear.”
Stackpole recommends managers cover the following when assigning projects to remote workers: “Do you have any questions? If you need help, here’s when I’m available. I should receive a call before the due date if you can’t get it done.”
Michelle Richards, BSHA, CPC, CPCO, CPMA, SHRM-SCP is the owner of Coding and Compliance Experts, LLC, and an HR and compliance expert. She provides clients in the healthcare industry with HIPAA and compliance training and human resource management.
Richards recommends that all practices with remote staff make a brief return to basics. “So one of the first things I recommended to my providers was to have a good HIPAA training, showing them again how, when you're working from home, it's the same HIPAA expectations as when you're working from the office. You know, you have to make sure that patient confidentiality is your top priority and making sure that your computer system has the appropriate firewall, and just making sure that you have some kind of encrypted storage space.” She emphasizes that work should only be completed on company devices and not from personal ones, as personal devices are likely not set up to be HIPAA-compliant, and an employee’s time and work cannot be as easily reviewed unless the employees have a VPN access into a remote working application, which is the ideal remote worker set up.
Richards makes it clear that PHI should never be communicated insecurely -- “So if they're talking, even if they have to put initials, they should never put a medical record number in a text message. Healthcare workers should never give any kind of identifying information. An example would be if someone was to text the doctor and say, ‘JR needs you to call them at’, and give the phone number, that's not appropriate because that phone number is identifying patient information.”
So how can remote workers handling PHI communicate it securely? One option is via a secure chat feature, such as one within your EHR. After refreshing HIPAA guidelines, Richards suggests employees signing an acknowledgement agreement stating that they understand HIPAA regulations and their responsibilities. Richards also suggests that productivity tracking, such as on an Excel spreadsheet, can be useful for keeping employees accountable.
Keeping In-House Staff Safe (What are my OSHA responsibilities?)
As Ms. Stackpole mentioned above, OSHA laws do not usually extend to a person’s home in the same way they do regular office settings. (Here, you can find some clarifying questions on remote OSHA safety.) However, that doesn’t mean that precautions shouldn’t be taken to verify staff is healthy and safe at home. Richards says,
“Anyone in healthcare should always work with the universal precautions in the back of their mind. Nothing should have changed when it comes to healthcare workers. There's so much anxiety amongst healthcare workers right now. Like, ‘Oh my gosh, I can't believe I have to treat so many people and they could have the virus!.’ But they should have been working like that all the time. Healthcare workers should always act as if the person you're treating has some kind of illness and you should always wash your hands.” In addition to standard best practices, healthcare providers should also be wearing the personal protective equipment recommended by the CDC.
At-Risk Family Members of Healthcare Providers
Healthcare providers who test positive for COVID-19, who have traveled recently, or who have family members who are ill should quarantine for the CDC’s currently recommended 14 days before returning to work. In addition, providers who have children at home may be entitled to 12 weeks’ paid leave under FFCRA, but special conditions apply for healthcare workers.
Richards recommends that a healthcare worker with high risk family members at home should take appropriate precautions, such as changing clothes and showering after they return home. She also recommends that the high-risk person wear a mask, even at home. “It can also give peace of mind to the healthcare worker. You know, give yourself that peace of mind by cleansing your body, the person can take off the mask and then they can eat and have a nice evening.”
While employers are not required to outline these precautions to their employees, they may choose to do so as a courtesy. “As an employer,” says Richards, “You should always care about your employees' well-being. So absolutely. You want to make sure, ‘Hey, you know what, sometimes we just don't think about this stuff. But you know, if you do have a high-risk person at home, take a shower, make sure that you do clean up.’ And no hugs, unfortunately.”
FMLA for Healthcare Workers
Richards advises that as essential workers, healthcare workers may not be eligible for the FFCRA stipulation that parents of children whose daycares and schools have closed may opt for FMLA paid leave. Of course, she says, “There are other ways of taking care of this situation, you could maybe allow the person to work from home two days a week or something, and then the other days, you know, just have a flexible schedule.”
Final Advice: Keep up Morale
Richards says that communication is key to keeping remote and in-house staff healthy, safe, and productive during this turbulent time. But she also has advice on keeping up morale, which she does by example: “Oh, and by the way, if I have to wear a mask, which I do, I got one in style. Purple's my favorite color, so I got me a purple glittery mask! So, you know, you just gotta make do with what you have. You know, make lemonade out of lemons.” Those around you will still sense your smile hidden behind the mask.
Pediatric offices are in a unique position when it comes to keeping up morale, as working with children often keeps adults on their toes and ready for fun. Your practice may have found ways to keep patients safe, maintain communication with parents and staff, and continue to perform duties via telemedicine or remote work, but it’s still vital to make sure your in-office and remote staff are supported.
Some practices find silly ways to keep up spirits. Bloom Pediatrics in Michigan dressed hot dogs as Disney princesses, while other pediatricians wear costumes or use props during telemedicine visits.
Pearland Pediatrics in Pearland, Texas, holds daily huddles and allows employees to indicate when they’d like a manager to check in with them. They’ve also been active on Facebook, publishing fun videos to encourage patients to visit their drive-thru clinic and holding raffles for books and toys.
For more resources on keeping your staff, patients, and business healthy and safe during the pandemic, please visit PCC’s COVID-19 resource page.