What the 4-day workweek looks like in healthcare

When it comes to a four-day workweek, the arguments for and against such an approach are varied, and its use depends on the industry and role. However, one thing is clear: There is data pointing to a growing trend.

For example, in an Aug. 23 survey from Bankrate, 81% of the full-time respondents support a four-day workweek — and most of them would sacrifice something for it: longer hours on those "on" days, less pay, even more time on-site.

Data from the "Bentley-Gallup Business in Society Report" released last year, which was based on a Gallup Panel web survey, also found that 77% of respondents said a four-day, 40-hour workweek option for those who typically work 40 hours in a five-day workweek would have an extremely or somewhat positive effect on their well-being.

Additionally, Bill Gates has predicted an even shorter workweek of three days, due, in part, to the rise of artificial intelligence, and one company found success in a 4.5-day workweek.

This raises several questions: Is the four-day workweek possible for executives, clinician leaders and/or front-line staff in healthcare? If so, what would it look like? If not, why? What alternatives could be offered?

Becker's recently spoke with Greg Till, chief people officer of Renton, Wash.-based Providence, and Maxine Carrington, senior vice president and chief people officer for New Hyde Park, N.Y.-based Northwell Health, about related topics.

Flexibility is key

To start the conversation, it's important to discuss flexibility in scheduling, according to Mr. Till. This is something hospitals and health systems have increasingly embraced in recent years. 

"When I think about flexibility, I'm thinking about shifts and schedules for those who are on the floors," Mr. Till said. "I'm thinking about where they work."

He specifically pointed to Providence's work in terms of virtual care. The health system has brought virtual nursing to at least 10 sites across nine hospitals in four states. Within the model, virtual nurses work off-site to support bedside nurses and technicians by helping with administrative tasks like admissions, discharges, preprocedural checklists and medication reconciliation.

"The model is enabling our nurses to work some days on-site at a hospital, like most of them did three or four years ago, but also work a couple of their days in a virtual setting, supporting the on-site nursing team," Mr. Till said. "And we've seen incredible outcomes from this effort from everything to almost eradicating retention or turnover issues to a much higher level of engagement."

He acknowledged that flexibility may mean different things for different positions. At the beginning of the pandemic, 20,000 workers in administrative roles at Providence began working from home primarily, but clinicians weren't. 

"So, when I talked to our clinicians about flexibility, it really [revolves] around things like, are they able to make their own schedules?" Mr. Till said. "Can they work a four- or six-hour shift instead of three 12-hour shifts? And now, more recently, where can they work? And can they balance their time between an off-site support setting and a hospital setting?"

From an administrative perspective, Providence still has a flexible approach, he said, and many administrative staff still work flexible schedules, some fully from home and some hybrid.

"We already have the availability of flex schedules like a four-day workweek at the individual level where it makes sense," said Mr. Till.

Is a four-day workweek possible in healthcare?

As far as implementing a four-day workweek across an organization, health system leaders agree that may not be appropriate.  

Mr. Till said this is because doing so may create equity issues or availability issues "where we wouldn't be able to support our communities when really needed. But certainly at the individual or team level, that's something that we already permit and encourage leaders to think about how to expand those avenues for flexibility."

He gave the example of an administrative team supporting a call center.

In that case, "it probably doesn't really matter if you're in the office five days a week," Mr. Till said. "But it certainly would make a difference if you're a coordinator at the hospital level or a manager of several clinics. And we've broken out our administrative type roles and assigned the level of flexibility, at least in terms of where you work."

Mr. Till said Providence is also implementing a tool in several units across the system this year that uses artificial intelligence to predict workforce needs at a unit level.

"It's going to help us to build optimized schedules," he said. "And it's going to allow us to schedule four-hour shifts, six-hour shifts, eight-hour shifts and 12-hour shifts to get away from the silo thinking that a nurse needs to be on a shift 12 hours a day for three days."

Regarding executives, he said most work hybrid schedules, meaning schedules are based on business need and team connection. 

"We framed 2023 as 'the year of human connection.' This didn't mean everyone had to return to the office, but we did ask our leaders to be intentional about enhancing a sense of community, connection and belonging," Mr. Till said. 

"In clinical settings, leaders rounded more, conducted 'stay interviews' with caregivers, and were even more intentionally 'present.' Our administrative teams were encouraged to be more visible, spend time on campus reconnecting with their teams to enhance innovation, alignment and connection."

Overall, Mr. Till said he believes the concept of a four-day workweek in healthcare works best at the individual level.

"I think some executives and some leaders, all the way down to the manager level, may benefit from four-day workweeks because we're a 24/7 business," he added. "It'd be hard for me to imagine that being applicable across the board for everybody at the same time."

A four-day workweek playbook

Ms. Carrington agreed.  

Northwell offers flexible work arrangements where possible through models such as "summer" or "lighter" Fridays (e.g., no or limited meetings on Friday afternoons), alternating weekly hours, hybrid and remote models, and staggered shifts. Northwell's staffing agency also provides opportunities for internal and external employees interested in moonlighting and gig work — in clinical and administrative areas. One other option under consideration: Work for four days a week, typically 9.5 -10.5 hours, depending on role, instead of five days a week at 7.5 hours per day. 

While the four-day workweek may not be appropriate across the system, Northwell's HR team is working with operational leaders on developing guidance for leaders who may want to implement the option. The guidance is a playbook of sorts with chapters such as "Considerations for payroll and compensation."

"We're realizing more and more, rather than HR trying to own the end-to-end process, let's give our operations teams the resources and the tools," Ms. Carrington said. "They can then do the evaluation…as to whether [they] think a four-day workweek, for example, is going to work for their operations."

The efforts toward an official playbook for this option began last year when Northwell took a number of steps, including examining offerings in the labor market of which the four-day workweek has been a growing trend. The project team also held 13 focus group sessions last July and August to assess perspectives on expectations and preferences related to flexible work models. "We work very hard to always listen and ensure that stakeholder input informs the design of our initiatives and experiences."

Participants included leaders and employees across shared services and ambulatory areas, according to Northwell. Among the emerging themes was: "With various forms of flexibility offered, the question becomes less of 'Why should we do this?' and more 'Why wouldn't we offer this?'" According to Northwell, achieving a "work-life balance" also came up often, and flexibility was expressed in various ways. 

In addition to feedback from the focus group sessions, there were about 100 comments recommending that a four-day workweek be considered in the organization's annual team member experience survey.

Ms. Carrington said a four-day workweek, or a version of a shortened week, is used currently in some of Northwell's clinical and administrative operations. The playbook will provide formal guidance to ensure a smooth and thoughtful approach.

Once launched, a leader who wishes to implement a four-day workweek will be asked to confer with their senior leadership and local HR before proceeding with implementation.

"We're realizing more and more, for our size and scale, it's sometimes best to develop (with input) and provide the resource on how to implement, and then turn it over to the operators to make the decision and own the implementation. We'll be there to consult and partner with them," Ms. Carrington said.

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