Bring Back the Water Cooler

December 2022

Remember when we started to label sitting as “the new smoking;” bad for our health? The next public health crisis may well be loneliness from social isolation. Bryce Ward’s recent opinion piece in the Washington Post captures the essence of the crisis.[1] As Ward notes, “Our social lives were withering dramatically before covid-19.”?According to Ward, “Social media, political polarization and new technologies” all played a role in this decline. And we are only just beginning to recognize the startling impact of the Pandemic on this and other considerations. Social isolation as an issue will no doubt continue for many years to come. And it matters not weather the Pandemic is the cause, only that it is a contributing factor. Other indicators point to an even bigger problem.

That this should not be a new consideration is borne out by some alarming statistics. According to US Census data, 37 million?adults aged 18 and over lived alone in early 2021, up from 33 million?ten years earlier.?Single-person households represented only 13 percent of all households in 1960. Fully 1 in 4 households today are occupied by one person. And marriage has changed too. 34 percent of all Americans over the age of 15 have never been married, up from 23 percent in 1950. The percentage of adults living with a spouse decreased from 52% to 50% over the past decade, according to newly released estimates from the?U.S. Census Bureau’s annual America’s Families and Living Arrangements [2] . Children living in two-parent households has dropped since 1968, while the percentage living with their mother only has doubled. While 85% of children under 18 lived with two parents in 1968, this had declined to 70% by 2020[3] . A majority of Millennials are not currently married, marking a significant change from past generations. Only 44% of Millennials were married in 2019, compared with 53% of Gen Xers, 61% of Boomers and 81% of Silents at a comparable age. Overall, marriage rates have declined since 1970, and the sharpest declines have been amongst the least educated adults[4] .Today, the median age for a man when he first gets married is 30.4 years old, while the median woman is 28.6 years old.

Most frightening perhaps is the realization that, at least with respect to isolation, it is no longer merely an affliction of old age and is now permeating virtually all generations. Especially in western society, people who can afford it are choosing to live alone. While living alone does not necessarily lead to loneliness, it can be a contributing factor. Loneliness and solitude are not the same, but there is a correlation. Our kids have suffered immeasurably from the isolation of lockdowns. One complexity that arises from this intergenerational issue is that addressing these concerns will require a broad array of approaches over an extended period of time. This brings us to what I would like to call the water cooler effect.

Many of the water coolers in office settings were replaced long ago by something “organic,” more in keeping with the new generations. But the metaphor is still relevant. In this post-Covid world (are we allowed to say that yet?), it is time to try to sort out key differences between remote versus in-person working. No doubt, healthcare has benefited as much as any industry from the remote experience. This is especially true for Virtual Health (Telehealth) that by at least one estimate has been accelerated by 5 years from waiving various barriers to adoption during Covid[5] . Some of these waivers are about to be lifted however and we continue to sort out the relative value of in-person office time.

Just as public health completely missed the negative impact of school lockdowns on kids when initially weighing approaches to controlling the spread of Covid, I think companies may be under-estimating lost productivity and innovation due to remote working during the Covid shutdown. In contrast to remote learning, the key to in-person working may be found in two areas: proximity, and interpersonal skills. These are related to be sure, but each is worth covering in some detail.

Proximity is nothing more than people gathering and/or, with respect to services, being closely located together. Note: it is possible to be lonely even when surrounded by other people or in a relationship for that matter. For now, I am focusing more on the recent phenomenon of being alone during a large and growing part of the workweek.

I have long been enamored with the benefits of teams versus individuals.?Healthcare is a team sport after all. This gives rise to one of my favorite topics: multifunctional teams. In my opinion, this is part of the secret sauce of the best consulting firms[6] . Bringing experts together to conquer complex problems is one of the most invigorating intellectual pursuits and it enjoys a long track record. I first came to appreciate this most acutely years ago when I was made aware of so-called cancer committees. There was an age- old debate regarding the primacy of medicine versus surgery when it came to cancer in terms of diagnosis and treatment. Of course, the real answer is that you needed both in addition to imaging and sophisticated lab work (think genetics). What these cancer committees gave us was the stark reality that you really could not diagnose or treat cancer with any rigor without the various disciplines present for every case. There were nuances to be raised that were specific to each lens that these experts brought to the table. Many lives have been saved as a result. As much as any technology, I have been told by many clinicians that this simple step of sitting experts around a table together proved to be a remarkable clinical breakthrough.

I believe innovation is indelibly tied to proximity.?How much innovation is the result of a chance encounter? As I look back, even in consulting, there have been numerous examples for me of running into someone that resulted in a new idea or a new way of looking at things. This may be the real opportunity cost of no longer gathering around the water cooler (i.e., working remotely). As Cat Von Maydell recently noted: Isolation is a barrier to innovation. Innovation result[s] from collaboration. Collaboration is an antidote to isolation.[7]

The benefit of casual conversation is easy to overlook. But it is far more difficult to emulate through Zoom or some other technology. Man is a social animal after all. While this loss may be challenging to measure, to deny this basic need for human interaction has all kinds of negative consequences, as we are just beginning to find out. In drawing attention to this, it is not my intent to disparage remote working; only to underscore that there can be a downside as well if taken to excess.

As the next generations are moving up in society (and Millennials are now more numerous than Boomers), there are always a number of noticeable differences from prior generations. The newer generations are supposed to be all about collaboration (participation trophies is an oft criticized outgrowth from this). Among other things, this was starting to be reflected in innovative office space designs (e.g., whiteboard walls, upgraded meeting rooms) that encouraged interaction and open exchange. However, none of these designs anticipated a scenario where nobody comes to the office. Education of future leaders has long stressed team attributes and the importance of a diversity of ideas. That such exchanges can dry up precipitously was not really contemplated as this was taking hold in business schools. Yes, there has been emphasis on how technology can help with this, but perhaps not enough attention has been paid to the necessity of in-person meetings. At this time of the year, office holiday parties were once ubiquitous. I remember well shelling out considerable dollars around the holidays so our employee colleagues could enjoy a casual time with spouses around conversation other than office issues. Hopefully, this is something you will be enjoying in some capacity this month. ?Certainly, remote work has been all the rage for quite some time, but the counterweight has yet to be fully put in place. We are just starting to witness some initial backlash from a few employers (e.g., Tesla) who are insisting on some level of office attendance. I have yet to see any team sport that can be played remotely. Team is a critical factor to what is considered culture in most businesses with which I am familiar.

Interpersonal skills. In the age of device screens there is legitimate concern about the loss of interpersonal skills. What parents haven’t worried about screen time of their kids? How many times have we had to point out to our kids that the iPhone is actually a phone and not just a computer screen (note over 50% of cell phones are now smart phones)? I can see the look on their faces now. “Kids don’t do phones.” We are just starting to measure the tragic deficits related to loss of school time. How do you measure loss of interpersonal skills? Use it or lose it as they say. Social isolation represents many health concerns, according to the CDC. More than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated[8] . This is tragic with enormous implications. Working remotely won’t help. It is time that we give equal time to those of us who think that a physical office, while expensive for employers (yes, I had my own firm for 17 years), is worth it. The collaboration that is possible in an office setting is hard to replicate using other technologies.

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As a consultant, I have relied upon off-site retreats for many years. I am captivated by the energy generated from such gatherings and have participated in many where true breakthroughs were accomplished. On many occasions, it appeared to me that the only way a few of these breakthroughs could occur was because of the presence of each and every person at these gatherings; everyone had a contribution to make. Which reminds me of one of my favorite stories. A respected physician who was in one of these retreats kept complaining about a specific decision that was made by the hospital. The complaint was that there had been no input in making the decision. Most people get immune to this criticism and essentially ignore it as noise, typical during such gatherings. But the doctor persisted on numerous occasions. Finally, the Chairman who was facilitating a few of the group sessions couldn’t take it anymore and challenged the good doctor, “Phil why do you keep saying that there was no input? We formed a Task Force to study it. And weren’t you a member of that Task Force that made this recommendation? To which the good doctor replied, “Yes, but I disagreed with that recommendation. You see, there was no input.” He had a bit of a devilish look on his face as the rest in attendance had a good laugh. Absent this retreat, I am convinced that the controversy could have persisted instead of being put to bed.

Strategists can become fixated on the merits of a shared vision. Emphasis on sharing. What we have learned over time is that having a CEO share what is in their head, while helpful, is insufficient to achieve buy-in. To be truly shared, people need the opportunity to examine the alternatives and become convinced of the merits of the vision on their own terms. With respect to a future vision, I liken this to “being able to see yourself in the picture.” But it is the group interaction during the process that is most important. A vision becomes shared when the many dimensions of the vision gain expression from other members of the team sharing how they relate to it.

The future vision for healthcare must reinforce the essence of human interaction and pay homage to such influences as social determinants of health (SDoH). Clearly, SDoH must include issues of loneliness and isolation. Being healthy demands being around people and having the ability to interact (skill). The broader mission in healthcare acknowledges its key role in promoting healthy lifestyles. This includes modeling healthy behaviors. As we attempt to innovate with such things as hospitals at home and meeting consumers where they are, we must be careful to still gather the teams together for the bonding and relationship building that is so essential to the human experience. The return of the water cooler is essential to maintaining a vibrant corporate culture. We need to bring back the water cooler, especially in difficult times like what is currently being experienced in the healthcare industry.

[1] Opinion | Americans are spending more time alone. Let's reverse that. - The Washington Post

[2] www.census.gov/newsroom/press-releases/2021/families-and-living-arrangements.html

[3] Census Bureau’s?Current Population Survey (CPS)

[4] www.pewresearch.org/social-trends/2020/05/27/as-millennials-near-40-theyre-approaching-family-life-differently-than-previous-generations/

[5] Virtual health accelerated | Deloitte Insights

[6] See Chapter 8 in my recent book Executive Turned Consultant: Transitioning from Experienced Executive to Trusted Advisor in Healthcare, (Chicago: Health Administration Press, 2022).

[7] https://www.dhirubhai.net/posts/catarinavonmaydell_leadership-strategy-innovation-activity-7003711073614786560-ZlK8?utm_source=share&utm_medium=member_desktop

[8] https://doi.org/10.17226/25663external icon