Naveen Madhavan PhD MBCS, Senior Product Specialist (Pathology) at the NHS Wales Informatics Service, assesses how COVID-19 has changed our perceptions of the workplace and explores the likely lasting influence for the virus on digital transformation.

With the first death of a UK care home patient on 5 March 2020, COVID-19 had arrived at our doorstep, bringing rapid change to daily life from the Government’s evolving definitions of normal. The world watched as the contagion’s epicentre shifted from China to Iran, Italy, then to the USA, with Canada and South America next in its orbit.

In our virtually connected world, online updates from John Hopkins University and Medicine and Worldometer, among others, fuelled public behaviour and reaction to the pandemic’s advance. Just as 9/11 changed airport security forever, the decision to lockdown suddenly shattered the inseparable bond between work and the physical office, opening speculation about its lasting effects on working practices, business interaction and socialisation in the post-pandemic economy.

A digital pandemic?

In 1918, H1N1 (or the Spanish Flu) caused 50 million deaths worldwide, followed by H1N2 (or the Asian Flu) first identified in Singapore in 1957, which then spread to Hong Kong - eventually costing a further 1.1 million lives worldwide. A decade later, H3N2 (or the Avian Flu) in 1968 resulted in 1 million more deaths globally.

Each of these pandemics initiated a series of lasting changes within medicine involving quarantine, oxygenation, protective equipment and vaccines. However, technology is now harmonising with medical countermeasures, such as in mapping the human genome to analytically understand the anatomy, mutation, sequencing and dispersion of a virus at a molecular level.

In contrast to more recent pandemics like SARS in 2002, which cost 774 lives and A/H1N1pdm09 (or Swine Flu) in 2009, which claimed 550,000 lives and counting, COVID-19 is unlike any other viral event. Globally, governments have incorporated digital technology into policy to enhance its detection, testing, analysis, contact-tracing, intervention and mitigation.

IT service provision

In the first few weeks of March 2020, laptops flew off the shelves as service providers, anticipating a lockdown, exploited technology and online connectivity within days to translate the physical office into virtual workspaces for service continuity. Healthcare providers like the NHS Wales Informatics Service aligned themselves with the Welsh Government to initiate a series of organisational process-changes that prioritised clinically critical IT services for urgent development and delivery.

Resources were optimised within NHS Wales to deploy new lab analysers to accelerate pathology testing, facilitate virtual GP consultations, route results between national Welsh systems and systems in the rest of the UK, extend the Welsh Clinical Portal from secondary to primary care, deploy the Welsh Clinical Portal mobile app, increase online-processing bandwidth and apply security patches across the estate.

The origins of the office

The start of the office and related working practice can be traced back to the industrial revolution, where people migrated to cities for work as factories took advantage of automation and the efficiencies from the division of labour.

When production increased, so did administrative tasks. As workers on the factory floor were overseen by a supervisor, likewise clerks took seat at rows of desks in an open space to perform administrative tasks overseen by a manager. With the expansion of technology and automation during the 1980s and 1990s, a product-driven economy made way for an emerging service paradigm demanding more knowledge- and skill-based resources.

The idea that staff should clock-in and clock-out is from the industrial revolution, prior to which pay was based on output or production. If organisations were to revert to the productivity model, it would make the 9-to-5 routine less meaningful and productivity a more reliable measure for management decision and planning.

Yet 200 years later, even with the expansion of technology, the internet, connectivity and devices, the format of the physical office persisted. Many sectors such as construction, manufacturing, cleaning / maintenance, hospitality, healthcare, couriers / logistics, retail and customer-facing businesses require staff presence to function. But, for service providers, a dominant blind-spot prevailed: the realisation that in a virtually connected world, most staff did not need to travel into the office to get work done.

Attitude and behaviour

Psychologist Daryl Bem conceptualised Self-Perception Theory in 1972 to posit that people understand their attitudes and preferences from observations of their own emergent behaviour in various situations. Likewise, where budgetary allocation for staff-training has been sparse, often from a lack of faith in its benefit, staff were left to formulate their own behaviour influenced by prevalent culture and peer pressure.

Although one wouldn’t chance to visit a GP who hasn’t had formal medical training, budgetary constraints mean that technical and clinical staff are often left to resolve complex issues through trial-and-error or intuition to deliver patchy fixes that seldom reach any proficiency.

Similarly, technical staff who move towards management without adequate preparatory training struggle to engage staff, delegate work, share knowledge, document procedures and manage a team. Experienced people-managers will equally face their trials to retain knowledge on technical detail, interoperability and outcomes.

Management Professor Douglas McGregor conceptualised two fundamental management approaches in 1960, the key factor being motivation. Theory X identifies the manager as a pessimist-authoritarian who assumes his staff lack responsibility, direction, control and initiative. In contrast, theory Y describes a collaborative-participatory manager who believes his staff have focus, responsibility, initiative and reliability.

Both approaches are driven by personality, attitude, and preference which have their own drawbacks. Theory X can demotivate, limit personal development and increase staff turnover, while theory Y has to contend with staff distraction, lethargy and unproductivity.

Although managers tend to lean more towards one theory, it’s often a bit of an amalgam. Research indicates that managers tend to naturally veer towards theory X and those who initially advocated theory Y but then noticed their leniency being exploited by staff when out of sight, then regressed more towards theory X. In either case, remote working has created a stigma forcing home-working staff to overcompensate by working longer hours through self-imposed pressure to reinforce their commitment and trustworthiness.

With the necessary infrastructure in place for the virtual office, the pandemic provided the final tipping point. Theory X managers suddenly found themselves in the lurch, initially enforcing accountability with regular catchups but later reducing staff-engagement from evidence that over-scrutiny adversely affected staff motivation, accuracy and productivity. In time, the lines between work and home life blurred as employees balanced their commitments to a preferred pattern and their performance started to surpass the levels of the pre-pandemic office.

Lasting effects

1. The expanding virtual office

Remote working is poised to increase as more organisations begin to deconstruct and reconstruct their services to draw on its benefits. Recent surveys indicate that a majority of staff feel more productive from the flexibility of apportioning their time between work and home life. The physical limitations of meeting room availability and the need to travel are now replaced with wider accessibility and unrestricted virtual capacity.

2. Cultural adjustments

The complexity of IT services has created individual technical experts within various organisational departments, whose technical knowledge isn’t always documented, to benefit lesser skilled team members. This trend has forced corporate hierarchy structures to flatten as senior managers engage junior staff directly and more frequently to understand technical and service issues. In other words, this pandemic has further encouraged management attitude and behaviour towards theory Y.

3. Reduction in staff absences

As more staff work remotely, staff sickness is expected to reduce. Those who may have previously called in sick having considered the onerous commute into work, are now more likely to feel well enough to login from home to engage in less intensive tasks, where previously, the requirement for their physical presence in the office would have resulted in them not choosing to work at all.

4. Extended IT support

The convenience and flexibility of the remote office presents opportunities for organisations to extend their service support hours from 9-to-5 to longer support arrangements, should service demand ever require it for critical technical and clinical services.

5. Recruitment and retention

Virtually hosted organisations can now extend their geographical recruitment-reach beyond the immediate commutable area to source a wider pool of technical talent. As much as remote working is highly convenient for existing employees, it also removes the burden for new starters to relocate or commute.

6. Digitisation, interoperability and resilience

The historical electronic-versus-paper debate has been tipped further in favour of the digital record. As the benefits of digitisation and interoperability are realised, project efforts will increase towards digitisation, easier accessibility, wider connectivity and resilience.

7. Information sharing and self-service

Just as non-emergency patients were re-directed from hospital A&E units to phone and video consultations, service users will increasingly rely more on self-help guides and local advice to overcome service issues as service providers compensate by focusing more on standardisation, functional-optimisation and training guides to facilitate this.

The first wave of the pandemic brought society’s tolerances to virtual scrutiny, sparking feelings of unity, acts of kindness and the need for social equality. As the technological landscape continues to alter to what is now known, communities will have to brace themselves for further change from a virus that hasn’t yet lost its momentum.