A 32-year-old male presents for evaluation of fever and mild dry cough. His vital signs are stable and within normal limits, he is in no respiratory distress, and he looks otherwise comfortable. He is a physician at a nearby emergency department and he notifies you that he just learned that he was just exposed to a Coronavirus positive patient. He had not been wearing personal protective equipment at that time. Your diagnosis? High risk for coronavirus-19 (COVID-19) Your management? If looking well, home quarantine. If possible, he’ll be doing remote work.

Some of us and many of our coworkers, family, and friends are currently working remotely. How do we make this sustainable, productive, and efficient? To answer these timely questions, we turned to our resident digital expert, Dr Shuhan He. Shuhan is the Chief Growth Officer at ALiEM, Associate Director of Digital Growth Strategy for Strategic Alliance Initiative, Center for Innovation in Digital HealthCare, and the founder of ConductScience.com, a scientific methods company which just happens to be entirely remote.

Some definitions

remote work

What outcomes do we use to evaluate employees?

  • Primary outcomes: pure productivity, such as programs implemented, grants received, papers published, patients seen.
  • Secondary outcomes: time spent in meetings, number of phone calls, face time.

What are the levels of remote work?

  • On site: Like most academic hospitals as it currently stands. Meetings are a key factor in moving projects forward.
  • Remote: There still is a central HQ, but some employees work remotely. This can often lead to inequities in evaluation of employees, as secondary outcomes are prioritized above primary outcomes.
  • Distributed: This is the more ideal states as everyone is on equal footing, and the only possible method to judge performance is primary outcomes of productivity. Secondary outcomes like face time are not possible.
  • Synchronous work: Doing work together at the same time.
  • Asynchronous work:Doing work at your own pace and time

Remote work is highly correlated with asynchronous work, and synchronous work is highly correlated with on site work, but they’re not the same. I am going to use remote work and asynchronous work interchangeably, but this isn’t always the case.

What are the benefits of remote work?

For employers

Remote work allows you to hire the best people.

Let’s say I’m looking for a designer. Let’s compare the talent pool for a local designer versus a designer living anywhere in the world. In my town of Cambridge, MA, there is a total population of 113,630 in 2018. If I am hiring a top 1% designer, assuming the entire town had the appropriate skill set, only 500 people or so would be even considered. Of those 500, I have to find not only a person with the right skill set, but also someone unemployed and with the  right cultural and personality fit. What if they’re a mother who is taking care of a child and doesn’t want to return to the workforce? Or has a significant other who wants to move to Chicago? Well I’m out of luck. But if you take the top 1% in the world? Well that pool is 37 million.

 Town (Cambridge)BostonStateCountryWorld
Population total113,630685,0946,900,000350,000,0007,500,000,000
50% Eligible56,815342,5473,450,000175,000,0003,750,000,000

For Employees

When: Remote work is incredibly family friendly. Because of the emphasis on asynchronous work, I get to see my loved ones basically any time I want, run chores during the day, go to the bank and get my laundry done. Remote work promotes inclusion and equity in the workforce.

What: Remote and asynchronous collaboration means more productive work. Productivity can decrease in the office because of interruptions and distractions. It’s so easy to ask your office mate a quick question–but fairly disruptive to workflow. Using asynchronous collaboration your “office mate” can answer your question during a normal break in their work, minimizing distractions and allowing communication at everyone’s own pace. We already do this in the hospital when we consult a service. They see the patient, formulate a plan, and get back to us, all while triaging other more emergent (or less emergent) questions. This is asynchronous collaboration.

Where: Remote work means no commute. This is significant for even the shortest of door-to-doors. If you spend 30 minutes per day commuting to work, you lose 250 hours per year.

Why: We work really hard in medicine and already spend a significant amount, if not all, of our clinical time in the workplace. Distributed workforces have freedom and the ability to live a life that they want. Having the freedom to waste less nonclinical time means a more meaningful work experience, and less physician burnout.

What are your tips for working remotely?

We are used to functioning via “time and place,” leading to a mentality where we value secondary outcomes like “how much time did you spend” more than primary outcomes like “how productive were you.” These deeply ingrained biases permeate society and I challenge you to find them in your own thinking; adjusting this mentality will improve our ability to work in a digital and distributed organization. 

  • Remember Parkinson’s Law: Work expands so as to fill the time available for its completion.” The more time you allow, the more time it takes up and the less efficient you are. Create an agenda within a limited time on a daily basis. Just because you’re at home does not mean you have unlimited time.
  • Measure yourself properly: What I recommend is that you should learn how to judge your own productivity with your ability to run your own to-do list. How often were you able to get the 3 most important things on your agenda done in any given day?
  • Measure others properly: One of the things that is magical about remote work is that petty measures are impossible to measure. Was a colleague on time? Did John take too many breaks today? Why is John always on Facebook? These things are impossible for me to know, and frankly, I don’t care. As long as my team members get work done, then I’m happy. One amazing thing about remote work is that you’ll only be able to measure others by their productivity. What are people doing? How much are they doing? What is their contribution.
  • Keep doing high yield things: One thing you’ll quickly need to do is find more projects, because you’ll be much more efficient. Once you realize that you can’t just waste time in meetings, you’ll start feeling like you’re not getting anything done. Its a paradoxical effect, but be patient! Take on new projects that excite you. Spend time getting dinner with family, and see a movie. This is new found time, but it won’t be there forever. As you find new higher-yield ways to build your time and be more effective, you’ll start to feel busy again.
  • Leave the house: Leave the house periodically with structure. I exercise in the afternoons on alternative days, or sit in a coffee shop for a quick bite during lunch. Its important to remember that the world still occurs. Avoid cabin fever.
  • Digital Hangouts: Alternatively, instead of leaving the house, do a digital hangout. I think the most important part of working from home is the social isolation. My friends and I who work remotely all work together on google hangouts, and we just work in parallel without interruption or agendas. It gives me the sensation of being with someone. We are socially inclined creatures, after all.
  • Creativity still happens: One of the most common things I hear is that you just don’t get that magical “aha” moment when you’re sitting in a room by yourself. This is a bogus assertion. I’d argue that having the ability to concetrate and socialize on individual time spurs the feeling of freedom and thus creativity. Besides, how much of on site work is actually just remote work anyways? How often have you actually met the person from IRB that keeps emailing you about a protocol? If they were in Mexico, would I really know that? Keep in mind you can still in parallel synchronously work with people on a screen as well, and there never is any limitation on just hanging out on screen together.

What are your tools for working remotely?

  • Slack: This, or Microsoft teams, is at the core of most remote organizations. They allow people to chat about specific projects and chat on teams virtually as if you were in the same room
  • Asana: a great tool for to do lists and action items, which Slack is weak at.
  • Google Hangouts: I really think the function of meetings is actually separate from just seeing people socially. I will actually just Gchat hangouts with collaborators so that I feel like I have social links with people, without any agenda or to do list in the discussion. Alternatively, Discord or Twitch works in a similar way.
  • Google Drive: To help our organization share files
  • Zoom (Paid), UberConference (Free) to set up formal meetings and discussions. 

What does your workstation look like?

[amazon link=”B01LXCDPPK” title=”Webcam” /]For web conferencing, a high quality camera can really make a difference
Jarvis Bamboo Standing DeskTo alternate standing and sitting for those particularly long days
Bamboo Office Chair MatKeeps the hardwood below the chair sturdy
[amazon link=”B0786TJC33″ title=”Mini fridge”/] (not pictured)For the instant coke zero in the morning
[amazon link=”B073177QS8″ title=”LIFX Smart lights”/]For working nights (red light optimization)
[amazon link=”B003VAGXWK” title=”Backlit keyboard” /]A backlit keyboard is amazing when working in the dark or at nights

Computer Setup

[amazon link=”B07NBM6KYH” title=”Main screen” /] [amazon link=”B07HZ499J4″ title=”Two falcon wing screens” /]For three extra screens, and the ability to read long pieces of content or code
[amazon link=”B00SYVE3CI” title=”Monitor Stand” /]To keep the monitors afloat and adjustable
[amazon link=”B07CQG2K5K” title=”External GPU Case” /]Helps my smaller laptop handle the large GPU needs of supporting so many monitors
[amazon link=”B0779K9DG2″ title=”USB Hub” /]Connects my Laptop to the multi screen setup
[amazon link=”B07VDB92RK” title=”Extra Tablet” /]

with a

[amazon link=”B00N1VDCGO” title=”Tablet stand” /]
I use this to hang out. One thing that is really nice about remote work is just hanging out remotely with people while you work. Makes me feel like I’m not alone, but also that I can be productive.
[amazon link=”B07CWPX43H” title=”Lenovo Yoga 2 Computer” /]My main computer that I can disconnect and take with me on the go
[amazon link=”B00J0NZYOK” title=”Cooling Pad” /]Prevents my laptop from overheating while powering so many external monitors
[amazon link=”B00J0NZYOK” title=”Speakers” /]For the computer setup
[amazon link=”B07NC8X2Z6″ title=”fourth monitor” /]For a separate computer, really handy when I need something in the background like a tutorial

Where can I learn more?

ALiEM is a remote organization of people all over the world. I’d strongly recommend listening to Teresa Chan and Michelle Lin’s Podcast about it. Remote learning? Try ALIEMU. I also highly recommend the book [amazon link=”0804137501″ title=”Remote” /] by the Signals 37 group, a company that has really led the way in rethinking about how we run organizations in the digital age.

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Shuhan He, MD