Organizational culture and remote work: case study in a high complexity hospitalABSTRACT
Purpose the general objective of the study presented in this article was to describe and analyze how a highly complex hospital institution implemented the practice of home office in its operations during the pandemic.
Methodology a qualitative and exploratory approach was adopted. Data collection was carried out through semi-structured interviews conducted with six managers of Hospital Gama and a questionnaire with multiple-choice and essay questions completed online by employees of these managers’ teams.
Findings the results indicated that: (1) facilitating elements provided by the hospital, managers, and employees were applied to the migration of the work modality; (2) several challenges were identified to the new modality, the overcoming of which could foster the transformation of the hospital’s culture in the medium and long term; (3) the hospital was not prepared in terms of technology and human resources for the transition process, but a set of quick actions were taken to make the migration from in-person work to home office possible; (4) the advantages indicated by the interviewees about the new modality corroborate the literature that served as the theoretical basis for this research; and (5) the level of employee engagement during the change process appears to have remained the same or increased, according to the perceptions of the research participants.
Originality presents a single case study that describes and analyzes the process of migration from in-person work to telework as a consequence of the COVID-19 pandemic in a reference hospital for complex operations in the city of São Paulo.
Organizational culture; Cultural change; Telework; Home office; Remote work
RESUMO
Finalidade o objetivo geral do estudo apresentado neste artigo foi descrever e analisar como uma instituição hospitalar de alta complexidade implementou a prática do home office em sua operação em meio à pandemia.
Metodologia adotou-se uma abordagem qualitativa e de natureza exploratória. A coleta dos dados ocorreu por meio de entrevistas semiestruturadas realizadas com seis gestores do Hospital Gama e aplicação de questionário com questões de múltipla escolha e dissertativas preenchidos de forma online por colaboradores das esquipes desses gestores.
Constatações os resultados apontaram que: (1) para a migração de modalidade de trabalho houve a aplicação de elementos facilitadores proporcionados pelo hospital, gestores e colaboradores; (2) identificaram-se vários desafios à nova modalidade, cuja superação, poderá fomentar a transformação da cultura do hospital em médio e longo prazo; (3) o hospital não estava preparado quanto à tecnologia e aos recursos humanos para o processo de transição, mas houve um conjunto de rápidas ações para tornar possível a migração do trabalho presencial para o home office; (4) as vantagens indicadas pelos Interviewee s sobre a nova modalidade corrobora a literatura que serviu como fundamento teórico para esta pesquisa; e (5) o nível de engajamento dos colaboradores durante o processo de mudança parece ter se mantido igual ou aumentado, de acordo com as percepções dos participantes da pesquisa.
Originalidade apresenta um estudo de caso único que descreve e analisa o processo de migração do trabalho presencial para o teletrabalho, como consequência da pandemia da COVID-19, em um hospital de referência em operações complexas do município de São Paulo.
Cultura organizacional; Mudança cultural; Teletrabalho; Home office; Trabalho remoto
1 INTRODUCTION
The year 2020 began with a crisis that will go down in the history of the contemporary world: the coronavirus (COVID-19) pandemic. That year, notions of health and safety were transformed, and the way we interact was profoundly affected. The primary strategy adopted for prevention was social distancing, which impacted human life in all its aspects, including the work model practiced by organizations, with a significant highlight being the widespread adoption of telework or remote work.
The COVID-19 pandemic shook the foundations of modern society. In this context, the individual-work relationship could not remain unaffected, and many aspects of this crisis influenced this relationship and the very meaning of work (Losekann & Mourão, 2020). While the adaptation of the individual to work was already an increasingly pressing requirement, expressed through the highly regarded corporate concept of resilience, during the pandemic, it became even more essential for individuals to adapt to new conditions, however unprecedented they might be.
Research conducted during that period by renowned consultancies such as McKinsey and KPMG, as well as articles published in prestigious corporate journals (HBR, MIT Sloan, World Economic Forum), revealed various forecasts about the post-COVID-19 world of work (InfoMoney, 2020). Remote work, or home office, which had been a practice in some companies, became an urgent necessity, affecting many workers worldwide. What was once an exception became the rule (Granato, 2020).
In the face of the urgent need to implement alternative work models like remote work or home office, employees and managers were challenged to find the right balance for setting and achieving goals and deadlines. This was particularly complex as work hours competed with time for family, household tasks, school activities, and rest (Granato, 2020).
The COVID-19 pandemic accelerated trends that had been gradually taking hold in the world of work, such as remote work (Kaled, 2020). According to a McKinsey report released in 2021, remote work during social restrictions was particularly concentrated among highly skilled professionals with high levels of education and from various industries, occupations, and geographic locations. It was believed that about 20% to 25% of the workforce in advanced economies could be highly effective working remotely three to five days a week, as effectively as if working from an office. In the following years, the same report suggested that this shift to remote work might slow down or even reverse the historical trend of jobs and people being concentrated in the largest and most dynamic cities, potentially leading to a population shift from large urban centers to smaller cities.
The main objective of the study presented in this article was to describe and analyze how a high-complexity hospital implemented the practice of remote work during the pandemic.
This general objective was broken down into the following specific objectives: (1) to describe how the practice of remote work was implemented by the hospital, analyzing the challenges and opportunities of the implementation, (2) to identify and analyze how leaders and employees adapted to the new remote work modality and maintained their level of engagement, and (3) to identify, from the perspective of employees and leaders, which initiatives and practices most contributed to this process.
In addition to this introduction, the article is structured into four other sections. The next section presents the theoretical framework, followed by a detailed account of the research methodology. Then, the results and their analysis are presented, and finally, the authors provide their concluding remarks.
2 THEORETICAL FRAMEWORK
This section aims to discuss the theoretical foundation that supported the research described in this article and is structured around two important concepts: organizational culture and remote work.
2.1 Organizational Culture: Its Formation and Change
The concept of culture has been a subject of relentless academic debate for the past 25 years, with various approaches to its understanding (Pettigrew, 1979; Wilkins & Ouchi, 1983; Schein, 2009). In particular, researchers studying organizational culture agree that culture is formed and transformed within organizational segments and units themselves. Culture is a construct influenced by numerous variables, both external and internal to the organization. One of the most relevant proponents of this concept is Schein (1986, 20, 2009), a highly regarded author for structuring this research.
Culture formation occurs when a particular group of people, who interact over time, experiment with strategies and reinforce what works through intense socialization. Schein (1986, 2009) defines organizational culture as the set of basic assumptions that a group has invented, discovered, or developed while learning to cope with external adaptation and internal integration problems.
The primary influencers in the formation of organizational culture are generally the founders and leaders of the company. These actors define the organization’s management model, typically guiding the organization to act in a way that mirrors the values of the leader or founder (Schein, 1996). Thus, socialization and leadership are fundamental elements for the success of this process (Motta, 2019).
To understand the formation of an organization’s culture, Schein (2009) identifies several distinct methods and proposes a dynamic model that considers the investigation of essential elements such as the institution’s mission, the objectives derived from that mission, and the sense of achievement arising from processes and structures. The author emphasizes that a successful researcher will include an understanding of the organization’s mission in their study of its culture, as the mission is one of the most important elements of any culture and pertains to the company’s reason for being and its identity.
Once the formation of organizational culture is addressed, it is also important to understand its changes. Organizational culture change occurs when there is a real need to transform the way things are done. This change can happen, for example, when there are fundamental shifts in the environment; when the market is competitive and dynamic; when the company is experiencing average or deteriorating results; when the organization is becoming a large corporation; or when the company is growing rapidly and new employees are being hired (Deal & Kennedy, 1983).
Finally, for a change in an organization’s culture to occur, according to Deal and Kennedy (1983), executives must reach a consensus and all agree on the change. It is also important for leadership to emphasize trust in the change and understand that this process will involve the development of new skills through training and a constant learning environment. Additionally, it is crucial to respect the time employees need to accept and adapt to the new situation, and to encourage all staff to adjust to the new conditions, recognizing that these changes are necessary.
2.2 Remote Work / Telecommuting / Home Office
Remote work, telecommuting, and home office are terms used interchangeably in the literature to describe the practice of paid work facilitated by information and communication technologies (ICTs) and carried out outside of the company’s premises. In this article, these terms are used synonymously to refer to salaried remote work performed regularly from home (Messenger & Gschwind, 2016; Brant & Mourão, 2020).
High technology, combined with space and transportation challenges in large metropolitan areas, has driven the advancement of telecommuting, initially within large companies in telecommunications, information technology, consulting, auditing, and advertising sectors. Gradually, these practices have expanded to various sectors and organizational sizes. (Castells, 2004).
This work model began to be consistently documented and became a topic of academic analysis starting from the 1990s/2000s (Barbosa, 2010). To study the influence of remote work where employees perform their duties from their residences (home office) on the transformation of corporate culture, several relevant authors were considered. They conceptualized both remote work and the capabilities that managers need to develop or enhance to handle the implementation of these practices. Among the authors who provided the theoretical foundation for these concepts are Mello (1999), Brant and Mourão (2020), Losekann and Mourão (2020), and Eikenberry and Turmel (2018).
A lot of research into teleworking has been carried out in recent times, some of which has shown that teleworking has brought several advantages to the companies that adopt it, such as: (1) reduction of indirect costs, determined by lower infrastructure costs compared to face-to-face work; (2) fewer problems of coexistence between employees; (3) elimination of time controls; (4) improvement of delivery times; (5) elimination of absenteeism; (6) ease of geographical expansion in the search for talent; (7) possibility of growth without structural changes; (8) possibility of hiring cheaper labor from areas with a low supply of jobs; and (9) ease of geographical expansion. (Granato, 2020).
For the worker, some beneficial attributes are also highlighted in the literature, such as: (1) a higher quality of life; (2) proximity to family; (3) flexible working hours; (4) less stress and greater job satisfaction, provided by the feeling of self-sufficiency (Brant & Mourão, 2020). Employees value this type of work (Fursman, 2009), which can be considered an attractive factor in the process of hiring new employees (Atkinson & Hall, 2009).
Despite its potential to be a valued practice among employees, remote work has some disadvantages that can impact individual psychological aspects. Although flexible hours allow employees to adjust their working hours and location according to their needs, working exclusively from home can increase the likelihood of stress crises. This happens because, even when at home and during leisure time, the worker may feel obligated to continue working (Shockley & Allen, 2007; Kaled, 2020).
According to Eikenberry and Turmel (2018) and Costa (2007), remote management requires an in-depth discussion about the type of organization the manager wants to create. It is important to question the following: Does the current culture support remote management? What are the expectations of leaders and employees working remotely? What organizational capability gaps need to be addressed? What is the plan for training, evaluating, recognizing, and rewarding remote teams? How will the manager prepare the organization to work with remote teams? Addressing these questions helps management better understand the emerging hybrid work environment.
Thus, the first major challenge of home office is related to leadership, which will need to relearn how to manage the workforce in this context, creating engagement, motivation, and monitoring work being carried out in a dispersed manner (Granato, 2020).
3 METHODOLOGY
This section will present the methodological procedures through which the research objectives were investigated and the propositions formulated were submitted and understood in the empirical field, enabling reflections and discussions based on available references in the literature (Nielsen et al., 2018).
The research presented in this article is exploratory in nature (Zanella et al., 2013) and adopted a qualitative perspective, utilizing a single case study approach (Yin, 2015) to understand the process of implementing the remote work model in a high-complexity hospital in São Paulo during the COVID-19 pandemic.
To ensure the confidentiality of the participating hospital, it was designated as Hospital Gama. Its selection was made based on convenience, as the researchers had easy access to the hospital’s employees and documentation.
Data collection was carried out using three distinct and complementary instruments: (1) bibliographic and documentary research; (2) semi-structured interviews with the managers of the teams that migrated from the face-to-face work model to the remote model (Stake, 2011 and Yin, 2015); and (3) a questionnaire sent to the professionals belonging to these teams, previously indicated by their managers.
The interview guide for managers was developed with pre-formulated questions related to online work, the transition of work modalities, company culture, engagement, benefits, and challenges faced during the transition process. To capture information not covered by the interview guide, managers were advised that they could speak spontaneously at any time, in addition to answering the questions from the guide.
Between April 25, 2022, and May 10, 2022, the six managers from various hierarchical levels who had their teams mobilized by the shift from on-site to remote work were interviewed. This included a director, superintendents, managers, and a coordinator. Chart 1 displays the profile of the interviewed managers.
These interviews lasted an average of 45 minutes and were conducted either in person or virtually using Microsoft Teams. They were recorded, transcribed, and analyzed using Bardin’s (2011) content analysis approach, which involved decomposing and recomposing the content, classified by categories generated based on a preliminary literature review.
During the same period as the interviews with the managers, a questionnaire was sent to a sample of employees to gather their perceptions on the studied topics. The questionnaire included direct and multiple-choice questions covering the same dimensions as the interview guide used for the managers: online work, transition to remote work, company culture, engagement, benefits, and challenges faced in the transition process. To ensure semantic clarity of the data collection instrument, a pre-test was conducted with a sample that was excluded from the final analysis. The average time to complete the questionnaire was 30 minutes.
This questionnaire was created using Google Forms and sent electronically to 35 professionals from the studied teams, selected by their managers. Out of the 35 questionnaires sent, 28 were completed and deemed valid for analysis. The purpose of this questionnaire was not to perform statistical analysis of the data, so there was no concern about the sample size. However, these responses provided descriptive statistical analysis that contributed to the qualitative understanding of the studied phenomenon (Yin, 2015). Chart 2 summarizes the profile of the valid respondents’ sample.
Following the guidelines for the stages of a case study, propositions were developed to be either confirmed or refuted based on the results obtained from the empirical stage of this study (Yin, 2015). The propositions were based on an in-depth review of the literature that constituted the theoretical framework of this study. Thus, the propositions are as follows:
Proposition 1: The shift from on-site to remote work, driven by the needs brought about by the COVID-19 pandemic, has introduced initiatives and practices that have contributed to transforming the organizational culture of the studied hospital.
Proposition 2: The transition from on-site to remote work in a hospital presents challenges in implementing practices for both managers and their teams, requiring leaders to provide the necessary resources for the changes.
Proposition 3: The shift from on-site to remote work brings more benefits than drawbacks for most teams and their managers, potentially maintaining engagement with the company.
4 RESULTS AND ANALYSIS
Next, the results derived from the data collection conducted through semi-structured interviews with six managers from Hospital Gama and the online questionnaires completed by employees from these managers’ teams will be presented and analyzed.
The content analysis of the responses revealed that managers perceived maintaining the hospital’s organizational culture and efficient communication as a challenge for those who transitioned to remote work. The following transcribed interview excerpts reinforce this perception.
Interviewee 1: “The biggest challenges were how to maintain connection and integration of the team I led and the team with the entire company. Initially, we moved to remote work in a somewhat unstructured manner. Additionally, how to keep in touch with internal clients, who were previously so present? We, as administrative staff, were required to work from home to free up space for those who needed to stay here, but we had a face-to-face culture that didn’t allow this to happen 100%.
Interviewee 2: “Yes, I believe remote work changed the way we communicate. We empowered the staff at the front line more. If we think about other companies or sectors, we were able to break significant paradigms. We encouraged teamwork and worked in a more transversal way. We had to do remote work because we needed to work but couldn’t be physically present. We had to break very strong barriers, including the notion that working from home wasn’t seen as legitimate because work was traditionally seen as being done only in the office. We had to learn to listen to the teams more.”
Furthermore, information security has been identified as a central element of the new organizational communication culture, as indicated by interviewee 2’s transcribed response.
Interviewee 2 – “Information security needed to be significantly strengthened, and technology equipment was reviewed because our technological infrastructure was entirely designed for on-site work. Ergonomic aspects were prioritized; the hospital provided chairs, foot supports, and manuals.”
Additionally, according to the responses from other interviewees, before the pandemic, telecommuting was seen as an alternative but inefficient means of work. There was a perception that this modality would not be suitable for the teams, necessitating a shift in mindset from everyone. The initial resistance to addressing the difficulties arising from the urgency of home office during the pandemic was also pointed out by Granato (2020) and Losekann and Mourão (2020), and is illustrated in the following transcripts.
Interviewee 5 – “People’s insecurity regarding performance, the team I lead worked with remote work tools, such as Teams, and shared the tasks they had to complete. Another challenging point was the physical and technological structure, as some people did not have space at home or the necessary equipment to perform the work.”
Interviewee 6 – “The greatest challenges were in how to maintain the connection and integration of the team I led, the team with the HR department, and beyond that, HR with the rest of the company. We moved to home office in a poorly structured manner.”
On the other hand, some interviewees believed that with the home office, new work and communication bonds were established, which could become simpler and more productive over time (Kaled, 2020). When asked if the new format influenced the hospital’s culture, interviewees 4, 6, and 2 answered affirmatively:
Interviewee 4 – “Yes. We became closer. There was unity among teams; we gained time that we used to spend commuting and now we gain with just a click. Today, when we have a problem, we quickly bring people together to solve it. Teamwork has strengthened a lot. The number of medical leave has decreased significantly, in my perception.”
Interviewee 6 – “What seemed impossible here today is a fact. People learned to use tools and systems to enable remote work, and there was a special rapprochement with our Brasília unit and doctors with more critical schedules. We implemented remote systems, webinars happened remotely. This was inconceivable before the pandemic. We broke many barriers. ”
Interviewee 2 – “Faster communication, with more people connected in a meeting. More cross-functional interaction. We formed a committee with over 50 people from different areas who met remotely and had great agility.”
There was unanimous agreement among the responses regarding the organization’s lack of preparedness for the transition to remote work. The main issues highlighted were the lack of technological resources (tangible resources) and adequate staff training for the moment (intangible resources), as noted in Sułkowski’s (2020) research. However, the responding managers pointed out the adaptations that were made to implement the work.
Interviewee 3 – “During the pandemic, we started to truly address diversity: we paused to think: how can I have an employee work from home if they don’t have the necessary equipment? How is their home set up for this? [...] Challenges of inclusion, less hierarchy, more planning and alignment, managing anxiety.”
Interviewee 6 – “For me, there were more disadvantages than advantages. We had our desks, knew our workspace, and went to work with a clear focus. Going home was a big adjustment. Mixing personal and professional life. I had to adapt many things at home. [...] I don’t disconnect from work, and work invades my personal life.”
Interviewee 2 – “We had to change the mindset towards self-direction. The mental shift to thinking that managing remotely is possible. [...] The call center can be a very good example: operational area, we initially moved everyone home and provided technological, physical, and ergonomic resources so they could perform their work.”
Interviewee 1 – “Organization. I had to organize and plan for this work, adapt my home, upgrade the internet, learn to focus, set up an exclusive workspace. [...] Senior leadership still doesn’t know how to handle the hybrid environment, so when we have meetings where most people are present in person, those remote are not involved/heard as they should be.”
New moments of adjustment were described due to the return of some to in-person or hybrid work, indicating a path still to be traveled and a new culture yet to be established within the teams.
Interviewee 1 – “Our business is in-person, with a culture of being together, walking in the hallway, and seeing up close what is happening. Transversality happens when I am present, so if I am working remotely from home, it feels like I am not engaged. There is a belief that if a person is not present, they are not engaged. I try not to encourage this thinking with my team. The only time I believe presence is necessary is during feedback sessions; other than that, I strongly encourage the remote model.”
The interviewees were invited to reflect on their initiatives and practices that most contributed to understanding and establishing the company culture (Schein, 2009; Pettigrew, 1979). As team leaders, these managers, during the migration to telework, needed to adapt themselves and their teams so that work continued, deliveries were made, and employees adjusted to the new experience (Wilkins & Ouchi, 1983).
Interviewee 1 – “We provided a subsidy for internet. We didn’t have training, and it was done on the fly. At first, we thought the remote work would last 2 weeks, then we believed it would be 2 months, and eventually, we realized it would be over 2 years. [...] VPN for everyone, laptops, internet subsidies, monitors, chairs, and access systems for remote work.”
Interviewee 3 – “Internet subsidies, chairs, equipment such as laptops or desktops, meal allowances. Incentives to stay at home. [...] Support from HR, IT, and agility for departments to adapt to the new model. Encouragement from top leadership for people to stay at home. Resources were provided to ensure operations. Creation of a crisis committee focusing on health and necessary measures. The committee met every day”
Interviewee 4 – “Providing desktops, laptops, and all resources necessary for enabling work. What should have been avoided: access tool – initially, we chose a remote connection tool that was not well implemented; we could have used an easier and more effective tool as we encountered many issues with this.”
Interviewee 5 – “We implemented daily online meetings in addition to the practice of ‘daily meetings’. We had weekly virtual meetings – casual coffee breaks to talk about life and bring us closer. We provided equipment, including some that were deemed unsuitable, sought appropriate tools for work monitoring to avoid loss of productivity, had frequent conversations with the team, and implemented management rituals such as the daily meeting.”
The final question of the interview asked about the disadvantages identified by the managers regarding home office. The main disadvantages pointed out were: (1) professional life invading personal life, with the lack of boundaries in time and space at the beginning of the transition; (2) physical distancing in some situations where satisfactory resolutions cannot be achieved remotely; (3) limitations in fully understanding demands that can only be observed in an office setting; (4) invasion of rest time and difficulty in disconnecting; and (5) lack of interaction with people, leading to slower resolution of some issues. Some of these aspects were addressed by Barbosa (2010), who highlighted that legislation on remote work presents a challenge to be incorporated into both business and social culture, as new situations create solutions and generate the need for laws to address them.
Only one of the interviewees did not identify any disadvantages in the implementation of the home office:
Interviewee 4 – “I don’t see any disadvantages. We only had advantages. I had people who spent three hours commuting to work and three hours coming back; this greatly improved the quality of life for people, which increased their engagement. Being close to family, I was in a meeting recently and put my daughter to bed. Giving autonomy to the team, being close, and helping the team grow... these are such important premises for building trust within the team, and this is the foundation for managing a team remotely.”
Among the perceived advantages of adopting the new working model, the respondents highlighted (1) a reduction or elimination of time wasted in traffic (96.4%), (2) work is more productive, as there are no interruptions typical of the office (85.7%), and (3) time to spend with the family (75%).
However, the transition to remote work also brought disadvantages for 32.1% of the employees who answered the questionnaire. The isolation from other colleagues was listed as the main disadvantage.
Table 1 summarizes the main findings revealed from the analysis of the valid questionnaire responses.
5 FINAL CONSIDERATIONS
The aim of this article was to share the results of the research conducted by the researchers to analyze the impacts caused by the implementation of the home office practice in a high-complexity hospital environment, thus contributing to the expansion of knowledge on the topic.
The specific objectives of the research were achieved, and throughout the article, it was described how the home office practice was implemented by the organization, analyzing its challenges and opportunities. The article identified and analyzed how leaders and employees adapted to this new mode of work, maintained engagement, and identified the initiatives and facilitating elements that most contributed to this transition.
More specifically, Proposition 1—that the shift from in-person to home office work would bring initiatives and practices that contributed to transforming the organizational culture of the studied hospital—was confirmed by the perceptions of both managers and employees. Additionally, Proposition 2, which suggests that the transition from in-person to home office work in a hospital brought challenges in implementing practices for both managers and their teams, was also supported by the perceptions of both managers and employees. This transition required leaders to provide the necessary resources to facilitate these changes.
Regarding Proposition 3, the findings reinforce that the shift from in-person to home office work brought both benefits and drawbacks, according to the perceptions of the research participants. However, it was not possible to determine if the majority of teams and their managers felt that the advantages of this modality outweighed its disadvantages in terms of maintaining engagement with the company.
It is important to consider that the research was conducted during the pandemic, a phenomenon that heightened the need for a change in work modality due to social distancing requirements, which may be considered a potential limitation of this study. Another limitation is the possibility that a longer post-pandemic analysis period may be necessary to reach more robust conclusions about the achieved results. Finally, although the researcher’s choice of a single case study methodology does not allow for statistical generalization, which is also a limitation of this research, an analytical generalization based on existing theories is possible (Yin, 2001).
For future research, we suggest investigating (1) the extent to which the implementation of this new working model has intensified the differences between social classes; (2) which leadership model is best suited to dealing with the acculturation and development of remote teams; (3) issues related to the productivity of teams working remotely, and (4) which basic assumptions (Schein, 1986 and 2009) have been broken in order to effectively implement a remote working model.
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