Healthcare measures almost everything with real discipline. Then it evaluates a leader by whether their car is in the lot.
You Measure Everything Else
A health system can tell you its door-to-balloon time to the minute. It can report last quarter’s readmission rate and its denial rate by payer. The rigor is real, and it took years to build.
Then someone asks whether the director of managed care contracting can work from home two days a week, and the answer arrives as a feeling.
Organizations that track clinical performance with that discipline often have no comparable way to measure what a leader is supposed to produce. When output cannot be described, something stands in for it, and usually that is physical presence.
What We See
We see the demand side every week. When we contact an executive about an opportunity, one of the first questions is whether the role is remote or hybrid, often before compensation. Executives we never contacted inquire about remote opportunities. Open the geography on a role and the candidate list gets longer, and the top of that list gets stronger.
Some of This Work Belongs in the Building
This is not an argument that healthcare can be run remotely. Healthcare is a people-intensive business and care is delivered in person. A CNO who does not regularly walk a unit is not doing the job. Plant operations, surgical services, and anything that touches a patient belong onsite.
But that is not the hard part. The hard part is the roles where the work product is a decision, a plan, or a negotiation. Revenue cycle. Managed care contracting. Finance. For those roles, being in the building is a preference, and preferences should justify themselves the way a capital request does.
There is something underneath this that nobody says out loud. A bedside nurse cannot work from home. Neither can the tech running the scanner. Giving flexibility to the roles furthest from the bedside is a real morale question, and the answer is not to withhold it. It is to be able to say why a role qualifies, so the standard is the work, not the rank.
Presence Is a Metric. Just Not a Useful One.
Ask a leader why a role has to be onsite and the answer usually involves collaboration, culture, or mentoring. Those things are real. They are also not outputs. They are byproducts of people being together, offered as the reason people need to be together.
Ask what the collaboration is for, or how anyone would know if the mentoring stopped working. The answer thins out, and that is the tell. The problem was never location. Nobody wrote down what the role is supposed to produce, so nobody can tell whether it is being produced anywhere. Attendance becomes the measure because it is the only thing left to count.
Presence is the one measure a mediocre performer can satisfy perfectly, every single day.
None of this means the byproducts do not matter. It means producing them on purpose. Mentoring gets an assigned pair and a standing hour. Collaboration gets scheduled with the people it requires, wherever they sit. And culture in a hospital is carried by what leaders do in front of the people who have no remote option: a leader rounding on units builds more of it than one behind a closed door on video calls.
The Same Gap Shows Up Inside a Flexible Policy
Now consider the system that already permits remote work. If nobody can describe what good output looks like, promotions still run on impressions, and impressions are shaped partly by who is around.
So look. Pull the last two years of leadership promotions and ask what evidence each decision rested on. If the answers are impressions, you have learned how your organization evaluates people, and remote work was never the problem.
It Does Not Have to Be All or Nothing
Most of this gets argued as fully remote or fully onsite. Few people want either one. The room in between is wide and costs very little:
- Two days at home for the roles that can support it. Start where the work product is already a document, a model, or a contract.
- A start time set after rush hour. An executive who spends fifty minutes in traffic to arrive by eight has produced nothing in those fifty minutes.
- Anchor days when the leadership team is together. Put the collaboration on the calendar with the people it requires. Proximity is not a plan.
When two systems offer comparable roles for comparable money, the one that has thought about how the week is built becomes the easier yes.
Final Thought
Before the next debate about days in the office, take the role you argue about most and write down what that person should produce over a quarter. Not activities. Outputs. The contract renegotiated. The denial rate moved. The vacancy closed.
If you can write it down, distance stops being the question. If you cannot, the problem has nothing to do with remote work and will not be solved by ending it.
The next time someone asks, the answer will not have to arrive as a feeling.