Ep. #32 Marianne Kreiner - Remote Jobs Are on the Rise: Can REI Clinics Follow Suit Successfully

Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field. 

Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of inside Reproductive Health, Griffin Jones.

GRIFFIN JONES: Today on Inside Reproductive Health, I'm joined by Marianne Kreiner. She's the Chief Human Resources Officer at Shady Grove Fertility. She helps them accelerate the overall growth of the practice through leadership in executing human resources strategy, recruiting talent, building the culture of engagement and innovation. She transforms organizational programs to support the practice’s goal in the areas of talent management, employee relations, organizational and performance management, compensation, and total reward strategy, some of which we will touch on today. She holds a Master of Science in Organizational Development and Strategic Human Resources from Johns Hopkins, and she's a Senior and Certified Professional through the Society for Human Resource Management. Marianne Kreiner, Welcome to Inside Reproductive Health. 

MARIANNE KREINER: Thank you. So glad to be here. 

JONES: I'm glad to have you on and to talk a bit about remote work. I want to talk about culture. I want to talk about human resources, especially culture something that we've hit on a lot. But one of the reasons why I really wanted to have you on is because I had a lot of people talk to me about remote work. Specifically, I have had people in the field that are trying to negotiate some sort of remote work terms with their employer and they might be at a standstill and I asked around and people felt that Shady Grove was more of a leader in having ART remote teams or people working remote at least part of the time. Luckily, I knew you. So I want to I would like to talk about why that became an impetus for Shady Grove in the first place. 

KREINER: So much like anything, there was a problem that needed to be solved for and that problem was within our business office. The group was certainly a small, but mighty team and they had an individual who was getting ready to move out of state. And of course, it was a great employee and it was 2008 and in addition to that problem with an individual moving out of state at the same time, they were having a difficult time attracting individuals who are familiar with our organization and how different parts worked and having some of that institutional knowledge want to transition into the business office as a next step in their career. And so it became a two-fold issue that we wanted to address. One being able to hang onto those great employees if they did have to move away, and number two finding a way to create a recruitment tool for that team as something, “Why I would want to go and try out something in another area. Maybe I've never worked there before.” Ultimately, we moved to looking at telecommuting as a way to address those two items and it has grown. We now have approximately a hundred individuals telecommuting on any given day and they're working in areas beyond our business office or administrative teams, where we have RNs who are working from home doing their fertility care or are coordinating work, as well as members of a number of different areas that you wouldn't traditionally think this is something where telecommuting could work or be a benefit that individuals be interested in.

JONES: You describe them as happening simultaneously--the retention of the employees that otherwise would have had to move and recruitment of employees to have access to a wider talent pool. Did they actually happen simultaneously or did, one, the retention happened before, two, recruitment. 

KREINER: Yeah, that's fair. I think that the first issue did come down to the recruitment, in fact because they were finding a hard time. If someone did move away, they needed to find a replacement for that individual and they wanted to find a way to attract internal candidates. That's a goal of ours internally to have 50% of our positions filled by internal candidates. But then subsequently, that great employee that you would never want to lose, that then happened and we needed to find a way I think, maybe, accelerated the investigation into piloting something like this and it started with one person. And I would recommend in looking at these situations, it's okay to try something and for it to fail and to make adjustments along the way, but if you don't try you'll never know if it's actually something that you can get to work. And it's been a huge benefit for us. 

JONES: I like that little nugget we pulled out--you had this need for recruitment and then there was someone within the organization who had that need that you could pilot it out. I think that's an important distinction because I worked in radio ad sales before I started my own company, before I ever came into the field. This is 10 years ago, we had one of the largest personalities in the market. He wanted to move to Florida to take care of his father and this is before Voiceover Internet Protocol as we learned trying to get on to this podcast sucks in 2019, and it was really rough in 2008, but they invested in some really great infrastructure to make it sound as though he was in the studio, but he had just moved to Florida. And that was kind of the idea because they didn't want to lose him. They didn't want to lose their ratings--that could have meant a lot of money to them. But I think it ended up having an adverse effect because it was not a pilot for something that the rest of the organization could do, it was special treatment for him. Then it just became this sort of thing of, “Here everybody else is doing all the work, this guy's in Florida, it's five degrees and three feet of snow in Buffalo.” And it was about special treatment for him, as opposed to a direction to the company was taking and availability for everyone. So for this for you was a direction that the company was taking. I imagine that not everyone can do remote work all of the time, so it's still not something necessary for everyone, I'm assuming. So who is remote work for in your company? 

KREINER: So there is a variety of applications where there are the individuals who never come into the office. An example would be in the new patient call center accepting the new patient appointment and scheduling those remotely from Indiana, from Georgia. Never needing to go into the office. Whereas there are others, I mentioned the Fertility RN Coordinators. I think a big part of being an RN is seeing your patients and you do miss out a little bit of that. Certainly having tools like Zoom and other remote work tools help to maintain those connections, but you know, just like you and I are able to chat using tools like the video tools, it's so much better when it's in person. I think that the patient's feel it and the nurses feel it as well. So having that ability to one day a week not have to commute, not have to deal with the traffic in the DC area or other geographic areas is nice. I think that there are definitely individuals who can benefit in this type of arrangement more than others and part of that is driven by who that individual is and what they thrive on. There are certainly remote work tools that help to facilitate those connections a little bit better, but ultimately, by taking the time to test and refine. It's a continuous process even today. We have found areas that we can do better when it comes to our remote work policy and how we're doing it. An example is when you have non-exempt or hourly employees, there are rules that the Department of Labor have set forth as far as how you must compensate individuals. Part of that being even if you did not know, meaning if you didn't give them permission to work between eight and five, anything beyond that, you must still compensate them for that. And if people are working at a time, because the system is open and allowing them to work or at that time, but they're not recording it for whatever reason, maybe they're an individual who hasn't been performing to standards and they don’t want to lose the benefit of telecommuting. Maybe by having access to the system at all times, they'll work off the clock so as to ensure their productivity looks better. So yes, it's great to have these flexibilities, but you have to still find a way that if the Department of Labor comes knocking, that you have taken the steps necessary to monitor, to audit, to, in some cases, close out the system at certain times because otherwise, you as the employer, this is me with my HR hat on, you as the employer are ultimately having to explain--defend really--why it is that it's not true and the burden of proof is super high. 

JONES: We just had this discussion as a team recently and I have not yet come to the perfect balance of the flexibility. I'm interested in if you have come closer then I have because the flexibility is, without question, it is the benefit of remote work in a prospective employees. Maybe even more so than save you time or other reasons why they might not want to come into the office, just having access to different companies, rather than just ones in their geographic area. But the flexibility, it might be number one. And it really is important to offer that, especially when we're talking about new parents, and parents-to-be, and young working moms, or just working parents of all kinds really. And to me, that means I do want them to be able to take off on a Friday to go to the event at the daycare. I want them to be able to go to a doctor's appointment, especially when we are also serving people. We also might be working with people who are also going through fertility treatments and really want to be understanding of that, but at the same time it's like, “Well, you can't just not work at a certain time and work at any given hour.” And we have continued to formalize that more. The way we formalize it now is these client meetings, these internal meetings, those you've got to be at. There are other times where there's a little bit more flexibility when you do your work. I don't want you doing work after a certain hour. I tell my team members, I don't want you doing any work after 9 p.m. And I feel like that's me being plenty flexible. I just don't want it messing with people's sleep. Tell them that you've got to have a home office in your home so that you're not in the bedroom doing work and then you can't sleep at night and it's affecting your relationship with your partner or your kids. So that's about as formalized is we've gotten. I still feel like we're lacking a little bit. Have you gotten any closer in buckling down and keeping the flexibility, but also have enough structure?

KREINER: I think that one of the things you are thinking is setting core hours of work. You don't have to have that be eight hours because they've agreed to work eight hours every day. You can have some buffer time built in there because you are able to allow for that. As long as you're able to audit for it and make sure that you and the individual are on the same page as far as expectations. It sounds a bit like that's how you have managed it. I think that setting the core hours is one of the ways that you can do that and then I think also within the policy, some of the things you mentioned: you need to have a home office having that space set aside, there are certain pieces of equipment that we will provide, that you will provide, sort of just laying out between us. It's an agreement between the two of us. Here's what the expectations are. That's wise. You want this to be something that you are rewarding individuals with because you're providing them with this additional flexibility. So a part of that is making sure they're reaching certain expectations. You’re meeting the milestones, performing at or above average. So they understand the expectation to unlock this level of flexibility is ‘X’ and that then is what you're expected to do moving forward. Having not only the policy, but then the agreement, and then having touch bases in the initial 90-day period when a person is first going into this type of arrangement, or whatever is the right time frame, really helps to make the adjustments and get things rolling in the right direction by the time you hit that 90 or whatever mark you've decided is the right time frame. With anything else, having those regular touchbases really help to avoid bigger problems down the pike.

JONES: Do those touch bases ever involve calls or particular times where they're touching base with a supervisor or someone else, you’d say? My company is much smaller, so this might actually be more applicable to some of the smaller fertility centers that aren't sure how to apply this, or some of the smaller companies that aren't quite sure how to apply this. But I say if nothing else, if you're still building out this policy and it just kind of figuring it out, a good rule of thumb is to touch base in the morning, or touch base and the afternoon at a scheduled time via video call. We use a project management tool called Asana, so we see the work that's going on. We track time with an app called Harvest, but even above that if you're still figuring out your onboarding process. We use Zoom calls and sometimes 15 minutes in the morning, 15 minutes in the afternoon. But if I’m onboarding a full-timer, it's probably a half hour in the morning, half hour in the afternoon for the first several weeks and that has helped tremendously. Then when we're done with that, we have, sometimes it's called a ‘scrum,’ other companies call it a ‘huddle,’ where we meet in the morning to tell, “What did you get done yesterday? What have you got to get done today?” And those are different from our weekly leadership meetings--our strategic planning meetings, but they’re frequent. Touch bases, I think you get back a lot of that face-to-face or a lot of what you would otherwise lose by losing face-to-face.

KREINER: I think, you know, if you're smaller and you're first trying this out, it is good to do it with one individual and it is easier, certainly, to work with an individual who is an exempt or salaried individual because it doesn't matter whether or not the work gets done between 8 and 5 and it doesn't matter whether they work 12 hours. It's all about as you know, getting the work done. And so it does allow you to get used to what telecommuting looks like and to set up those touch bases. And yes, it may on the outset need to be more frequent in having those morning and afternoon touch bases, but it also could be, depending on what the role is, that you're able to be more flexible. I would say certainly when you're thinking about the projects, like what you're doing--the type of things that you need to have done--you've layered in these tools. Asana is free, you can also get a paid version of it which we use it ourselves. There are technologies that do help to make deploying these types of arrangements a little bit easier and know that you have a good sense and they have a good sense of what's going on. I think there are certainly hesitations when you're trying something new, but if you go into it thinking, “What is ultimately my goal here?” For us when it started, it was retaining a great employee and, as you know, the cost of having to recruit and retrain is significant. It's two times that person's base salary when you look at the productivity time lost by the other members of the team, or projects that you're not able to take on, or patients that you really probably shouldn't be seeing, where you're going to be taking on yourself. So, it’s an investment of time, but it is an investment in that future state that ultimately provide you with something that makes you special because, as you said, not a lot of places are offering it when it comes to either a clinical position or a laboratory type of position, but there is definitely work that can be done at home. Even one day a week is viewed as a flexible benefit and can help you hang onto staff or attract staff into your positions. Two things that, no question, are essential to protecting your practice. I mean, your expenses when it comes to salaries and wages are your highest expenses. Protect that investment by allowing even if it is one day a week.

JONES: From my point of view, it's becoming non-negotiable. I think that remote work was just this nice idea before. Our company is entirely remote. There's no home office. I decided that in 2015 when I moved back to the United States this was only going to be remote work company. It was still kind of early to do that. There were other companies--there’s definitely more companies in software and services space doing that. In client services, though, not as much. Far more are doing it now, but I just knew, it felt like starting a traditional media company in 1999 if I were to open an office. It was like, I knew I was early, but I do that there would be diminishing returns if I opened up an office and I be at a competitive disadvantage of a sliding scale moving forward, and that remote work would only get easier and it has only gotten easier in the four plus years that we've been doing it. And what I'm seeing from people that are applying for positions is it is one of the biggest reasons why they are planning for it. Tt's one of the things that my employees like the most. They love not having to go into an office. They love not having to wait in traffic. They love being able to have more time with their family because even if you live in a city where you just have a 20-minute commute each way, that's 40 minutes of your day back! If you live in the DMV, even mile an hour and a half away, that's three hours of your day every single day and it's not just that commute time. It's also, “Well if I just wanted to leave for an appointment or to an event going on at the school.” That's harder to do from an office. It's much easier to do from home. And so I'm wondering if you're seeing this demand from prospective employees? You go to some really high level human resources events and you follow a lot of human resources experts, and just what's going on in the field across employee recruitment, not just in our field. Are you seeing more of this or do you feel like we're still in the baby stages where a lot of people aren't bringing it up yet?

KREINER: You know, when it comes to the medical field it is certainly less so. We started to see the telemedicine as something that has started to break through. But as much of the medical field that youths I'm sure have seen, as well as just in general, we are laggards when it comes to many things, when it comes to technology. And the same goes for trying new things as it relates to flexible work arrangements. Something you were talking about as it relates to people that are working from home all the time, you know, these are individuals that are performing jobs that don't necessarily require that face-to-face physical presence. An example, if I were in a smaller group would be, I would look at ways that you could utilize the financial team, right? Those are individuals working through counseling the patients that Zoom works just fine for those types of conversations. Heck, these days when you sign up for a mortgage, you're not going into some desk and having a conversation. You can do it all from the comfort of your own home and not even need to talk to somebody. But we feel that that's in the patient's best interest--it's not a mortgage and they should have that conversation. So again, the technology is available to provide that high patient experience. Then thinking about other ways in other areas, you know, whether it might be some of the clinical assisting type of rules, where it isn't patient care per se by drawing blood or turning over rooms, but perhaps some of the med off or the pre off that need to be performed, or following up and make sure that the patients are taking care of their homework, doing their day three tests and their HSG test and their SAs. Those are things that don't require an individual to be physically present. Sometimes with telecommuting and defying it into a workplace, it comes down to thinking about, “How can I reorganize the work?” By reorganizing the work, then you are creating a role that would allow it to be handled virtually. I think that being creative is important here. Yes, the field in general when it comes to human resources or when it comes to other Industries, it is definitely much more prevalent when you're talking about for example, the IT industry. My husband telecommutes. When he's looking for a job, if it means that he's going to have to work at a desk, it's not an option for him. He's looking for a job that will allow him to continue in the telecommuting world. There are a lot of individuals who are not going to even look at you as an employer if that's not something that's going to be offered for certain roles. Marketing is another great example. A lot of the marketing can be done in the office at home and some of it requires going out into the field, making the relationships with the referring physicians. So it allows for that hybrid-type of role where some of it’s at home and some of it is getting out in the field. It's true, some positions will more naturally fit within the telecommuting a hundred percent role. Whereas some others will need to be more of a hybrid, but there is that continued press from the candidates. And in this market where unemployment is low, it becomes a lot harder to find candidates, so that need to innovate and to try new things becomes even greater. 


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JONES: You talked about in a market where unemployment is low--it's really competitive. So you're expanding your talent pool. You're not just expanding the talent pool by geography and numbers, necessarily. You might also be expanding the talent pool of the quality of candidate you can attract. Because let's say you, for example, are in the DMV, DC, Maryland, Virginia area and some folks listening are on the coasts and they're in very high-cost markets. Perhaps, you might have a position that would put someone in the top 40 percent of wage earners maybe in your area, maybe just top 50 depending on what the position is. That same salary for someone in the interior of the country or a small market--in the Midwest and Upstate New York and different parts of the South or interior West--that same salary could be top 20% wage earner. And so you're not just adding to the number of candidates, but how attractive that same salary is without increasing your expense. You can attract a much higher quality candidate, I’ve found.

KREINER: I think that's a great point. Being able to have that bigger budget that can be used and, by the way, maybe it doesn't have to be used, maybe it's there's some happy medium where you're saving some money and that individual is being brought up. There are those benefits of accessing higher-quality individuals. And don't we want that? Don't we want to have the people working with us? I'm always looking for people who are better than me to come and join us and I think that we're doing the practice of disservice if we're not opening ourselves up and finding ways that we can attract those really great people, either in our field or outside of our field who are going to be game changers. 

JONES: I would not have been able to build Fertility Bridge the way it is ten years ago. If remote work was not an option, I could not build the culture of this company and then, consequently, not our quality of services, not our vision, not the way we have relationships with clients, because I would have to--even if I were to large, pretend I was in New York. Even if I were in New York, I would have to find a graphic designer who could do graphic design and has a passion for the infertility community. I would have to find a project manager in New York and that's good in project management and as a passion for the infertility community. Now I get to take that geographic restrictor off. It’s already hard enough finding the person that had the talent set and that knowledge and passion for the community. When I find that person, they are the right person for the company. When they're all about the infertility community and they're really good at their job, they’re right fit for our company and they really like it. And that I think that solves for us, a big part of the culture question because I do see how you could lose culture by losing face to face. The way we gain it back is we're so into this space that people are--the passion that they share for this field and then working in a way that they can use their marketing skills or client services skills all together that molds the culture together. But, do you find that objection of losing culture? Did you have to discuss that internally? Did you have to come up with a plan for it? Did you notice it happening? 

KREINER: If I think back to how we were able to roll it out, we are using known entities, meaning people who we know that they get it, who bleed the colors, and who are going to be able to continue acting in that same way. By rolling it out to individuals that were already within the organization and performing at a certain level, we had that reassurance. What you're speaking to is hiring people who you don't have that familiarity with, who you do need to have those additional touch bases with, and ensure that you take that time to assess them before they've ever started as to why is it that they want this job. And if they're connected to what were ultimately doing, then it is that much easier to know your culture can be protected and the way in which you can do that is asking the right questions. So let me ask you a question, as you go through that interview process, have you found there's one question that you like to ask of candidates that really helped you to understand that they're going to be a great bet for your group? Or is there a certain characteristic that you're trying to tease out? 

JONES: Yes, I can't say it comes in the form of a question. I essentially try to talk people out of working for me. I really try to talk them out of it and when they come back and they say, “No, I get it that sounds pretty good. I'm down. There are those people that are in effect. Very recently, I was interviewing someone who had a really impressive resume, she worked for some large agencies with really, really, large corporate clients. And I think wants to break into the field, and I'll help her do that because I think she's super sharp, but my concern was that I don't know if this culture is too scrappy for her. We’re a scrappy disparity, sort of resourceful when you're coming from larger clients with huge corporate budgets that have sort of this sexy corporate background that there might be other--the Silicon Valleys, the Madison Avenues--that's not us. It wasn't that I was talking or out of it because I didn't want her to work for me, of course I did! But I wanted to--I needed to be so over-the-top transparent that people can self-select. In her case, I think she came back and she was like, “Yeah, I don't know if it's a good fit right now.” I was secretly hoping that she would say, “No, I'm done, it sounds great!” But I really needed to tease out that she’s just going to be down for the cause. Anyone that’s with us gets that we’re a scrappy company. We don’t care about material things in so much as you know, in terms of material status. What we care about is having really great results. We care about having good relationships with each other, with our clients, and we care about innovating and that sort of substantive dialogue. But all of the other stuff is just not us. It's a long answer to your question. But I what I'm teasing out is are they really going to be inside. I try to talk them out to say, “Listen, we're not sexy, we're not corporate.” I'm a bad recruiter in that sense. But the people that go through, they get it. They're like, “Yes, this is what I want.” 

KREINER: Yeah, I think that finding a way that you are able to identify those traits and qualities in an individual can be as you had described, which is really helping to make sure you're very clear on the culture and the values of the organization and finding whether or not they have examples that can support that type of culture and values that you're looking for. So for me, one of my favorite questions is to talk about their personal values. When they share those personal values, what are some examples that they can provide because that is sometimes helpful. But, I would say even more so is asking those questions, “Talk to me about a time when you are faced with an angry patient,” or whatever it might be. There are there's another favorite question is, “When it comes to the--something that you're proud of an achievement, it doesn't have to be a workplace achievement. If you had to share one thing with me, what would that be?” It's interesting, sometimes you get to hear things from people about volunteer projects that they took on that you don't see on their resume, that you wouldn't necessarily hear from them. But, there are ways in which you can craft the questions, I guess is what I’m trying to get back to, that will help you to assess the cultural fit in order to help protect who you are as an organization and make sure that the actions that people are taking each day are going to be in alignment. Moving forward, there are ways in which you can infuse that. Regardless if you’re telecommuter or not, you still have to be held accountable through performance management, the policies, the framework in which you are setting up and allowing people to work within, and recognizing--the way that you recognize individuals, what you're recognizing them for--that doesn't change. So it goes back to the old saying: “What gets inspected gets respected.” Whether it be through knowing what it is that you care about, and what you're going to be following up on, making sure that you're checking in on the right things, and including that as being one of those, as well as ensuring that you're speaking to and recognizing people for those things that are important to you as an organization. Whether it be examples of being for you humble or being scrappy, these are things that are important and you need to make sure that you're reinforcing. And the same goes for any organization who's looking at this to be able to keep up that culture within a telecommuting environment. 

JONES: Those questions are really good. And one of the ones I asked sometimes is, “Talk to me about hard lesson you've had to learn professionally.” I like to say, “What was your favorite job? Why? When you were 18, what did you want to be when you grow up? How did you get here?” That's usually a little one I use to bring us out some insight. I like to have them describe the worst boss they've ever had because if they describe me, then you're probably not gonna like working here. I ask them to describe the best boss they've ever had and if I feel like I could destroy that then, “Just wait to start working for me!” But I think that even beyond questions there is an advantage to remote work for screening potential employees that is the best way to screen people, that is really hard to do if everything is physical location-dependent and that’s giving people test projects. Before we ever hire somebody full-time--we never hire someone full-time without having them just do some little independent contract work at an hourly rate. We'll give them a real small project, just to see where their heads at, and then scale up. Then once either of us get to a certain point, we can then hire them full-time and make the offer with the official agreement in the Department of Labor and all of that stuff, but it doesn't have to come first with remote work. For example, I'm hiring an additional project manager, so we have redundancy in project management. The first test project, Marianne, is just, “Here's our ebook. It was written three years ago. We've got to update it this year. Just build out those tasks in Asana. Just build out this ebook project we have to do in Asana.” It is just to see how they work, how they ask questions, where their heads at, and then, if they do a good job with that, we can say, “Ok. Well, here's some other project management things that we have to do,” and we can just give them the access of our project manager. They don't even need to be client-facing at this point--they do that and we just keep going until both of us get to a point where it's “I can't do this as a side job anymore” or we need to bring this role in full-time. But, it is a really amazing way to be able to fire quickly and hire slowly. Everybody always says, “Fire quickly, hire slowly.” With remote work, it's so much more actionable to do that because if they suck at that ebook project--gone and I wasted five to ten hours of whatever I paid in at that hourly rate. Big deal. Or if it just doesn't work out at any point--I'm hiring them slowly by default, because by the time I hired my creative director, by the time I hired my project manager, we have each been working with each other for months and we knew what each other's working style was like. They knew all of those things that I had tried to talk them out of, they knew what they were getting into. They still want it all in and I wanted them. I think that's an opportunity with remote work that is to the employer’s advantage. It might even be the biggest one. 

KREINER: Well, you know two things that you said that sort of stood out to me: one is it's almost like you're affording them the opportunity to be gig workers for you and we've heard that the gig economy is growing and these are individuals who--they're not looking for a full-time position or a part-time position. They're looking for short-term arrangements and short-term might be a year. Certainly to employers--back when I first started, when you were screaming resumes, you're looking for a solid five to seven years that that individual has been at a job and put in their time--does not exist anymore. You know, you are looking at individuals who they do not feel that they are growing and have upward movement mobility--and upward means different for different people--but they don't feel like they have that movement, they're gone after two years if you're lucky to get two years. To speak as well to that test project, there's nothing wrong with using that as a part of a screening tool for the appropriate positions. I would say that it also speaks to the great thing about trying this out. Try one day a week, try one day every other week, just to get it started to see what's working and what's not working, because as you said it may end up being a colossal disaster. And as long as you are setting it up with your employee with those great intentions to say, “Hey, we're going to give this a try and we're going to follow up on it regularly, once every two weeks or whatnot. At least then you've got the understanding of both parties that transparency that we're working towards this goal and here's what we're looking for as the outcome and if it doesn't work, that's fine. We'll go back to the traditional arrangement. Those are two of the things that sort of stood out to me in some of your comments. Love that you do the test projects. I think it's really appropriate for the type of work your people will be doing.

JONES: And I like your advice of just test it out. You can try it out for one day a week with someone. If it doesn't work, you can go back, but there are threats that you face if you don't try to incorporate into the way you operate the business. Eventually--we talked about the loss of attraction of talent pool--another catalyzing agent for someone to try is that if you’re going to lose the person, you mentioned that--the retention--you might just be losing someone no matter what. Either because they have to move to a different city or it just might be something they demand and they're not willing to go on if you’re not willing to extend it to them. So why not try if you're going to lose them anyway? And then another catalyzing agent that we haven't talked about yet is saving up facilities costs--expansion of facilities. If you're at that point where--”Oh gosh, I guess we should build another location because we're cramped here,” but you don't, in your heart of hearts, you don't feel that your growth trajectory justifies it. Then a great way just to cool off some of that capacity is, as you mentioned, bringing some financial folks, some of the coordination outside of the office, so that your physical office space becomes bigger, simply because its capacity isn't being used to its fullest or beyond its fullest. 

KREINER: Absolutely. I think that there are numerous benefits and really, it does come down to just give it a try and pick someone that you trust. I think that many times, we in the medical field can feel--we get into those safe places where we don't want to try new things. But in fact because we're afraid of the risk, very risk-averse population. However, this is not something that should be viewed as something that can't be done. Try it. Ease into it. Some of the examples you gave, some of the examples I gave, either one really helps on a variety of measures for attracting, retaining staff, driving down costs within your physical property of what you need to provide as far as cubicle space--all great benefits. 

JONES: We've identified five benefits, at least that I could think of, and maybe even break them out more finite. One is you've got the ability to hire more slowly and fire fast in the form of test projects. Retention--you can cool down to people that might otherwise have to leave. You have access to a wider talent pool, and I'm not sure if I would break that up. I might break that up to just remaining relevant to the talent pool that is the current workplace demographic and increasingly more so. I think I would break those two up. Being able to save on instead of expanding facilities. And then having more competitive wages because you're able to track from other markets and you might even be able to lower your wages and still have that be a higher wage for that quality of talent. So we've come up with at least six advantages. We've also talked about some disadvantages that need to be mitigated. Losing a face-to-face, which we mentioned can be done through video and frequent touch points--which could also be done by--we get our team together twice a year. Most companies that are client services and software as a service, get their cold teams together at least twice a year, if not quarterly. We do that, it's really great. But also that you can build around something that's more. You can select more by your values and not just values plus geographies. That does compensate for culture. What are some what are some other things that you lose with not having a face-to-face, everyone in the office, type of thing? I can think of one, but I'll see if you can think of any others and we'll talk about that one. 

KREINER: Well, there's definitely a lack of social interaction. If you're working at home, you may only be interrupted by a delivery person dropping off your Peapod or your Amazon delivery, and that's the extent of your real face-to-face or going to the grocery store. So I think that the social interaction piece is real and some people need more of it and some people need less of it. For the employer, I'd say that being able to monitor productivity can be a bit more challenging .That is something that sometimes people have a hard time of letting go of. You don't have to let go of it if you identify positions that have true deliverables such as project-based or a level of productivity that's easily audited and measured. But, you certainly can't be spending all of your time trying to measure that. I would say the other thing that I know, having a husband who telecommutes, he gets irritated because I don't think about the fact that he's working at home and I'm trying to get him to run a load of laundry or run something out to The UPS Store to be sent back. And so sometimes that can be an irritant of, “I'm trying to get work done here.” “Oh, yeah, that's right!” For the individual, that can be something that's challenging. I would say those are some of the things that I can think of right off the bat as far as some disadvantages to the employer. The biggest disadvantage to me is the additional need for, whether it be monitoring software or the ability to audit, and to know, for those non-exempt employees who are working, and to be able to maintain your compliance with the Department of Labor. That you have really zipped that up so that you don't get yourself into a pickle later on because you have no way of which to justify whether or not these individuals were in fact working or whether you had constructive knowledge--meaning you should have known. It doesn't take away your need to still pay attention to things. Doesn't mean become a micromanager. 

JONES: Yeah. I think those policies really help saying this is the time--you're not allowed to work beyond this time and also using time tracking. We use Harvest. There's probably more complex ones, but I don't know that you would need that. You can there's also TSheets is another app; they can integrate right with your payroll service. Use those! The lack of social interaction is a good point. I'll often tell my employees, go to a coffee shop every now and again just to be among humans. They will often tell me though that because we have so many video meetings--we got meetings with clients, meetings with each other, we’re communicating on Asana all day, but every time we meet with each other were on video-- they said they feel a lot less isolated than they thought they would and that make sense. But they'll also set routines, like making sure that I'm going out there walking the dog at a certain time to get out, I go to coffee shop on these days, or l got to a co-working space. I think those are really important and, probably, depend largely on the extroversion/introversion scale of of the person. That's really important to keep aware of. There is one challenge with remote work that I have not solved yet and we experience it today, which is freakin’ IT. Because when I worked in corporate America, I had an IT guy who is very similar to the IT guy that helped you as we were getting set up for this podcast and I can see this guy, I don’t know what your guys name is , but I'm going to call this guy, Greg. Company's offices have a Greg and Greg is the poor son of a gun that has to come and fix the darn thing and when it takes Greg 12 minutes to figure out, that means it's going to take me 45 minutes to figure out. When you have a home office, there's no Greg. There's sometimes when we're talking with clients and they might not be able to figure something, I can see their screen--we use Zoom--but sometimes they can't even figure out how to set up a Zoom, but I can help you there, we’re not physically there, but I can take you to rest the way. I can help you at least get it set up! And, you know, my printer sucks. I hate having to do anything with my printer because I got to like turn off my router and turn it back on. I say this all jokingly, but I do despise IT. It's probably my biggest frustration with being entirely remote because you don't have that person that you can have fix it--that A) can get it done much more quickly than you and B) can do it while you're working on something else.

KREINER: Well, I think that in the environment that we're working in here where we've got 32 offices from soon-to-be Manhattan down to Tampa, Florida, there are offices that have no IT presence. The way in which we've been able to work around that is to have contracts with local IT groups and, depending on the size of your organization or the size of the group that needs to be supported, that can help and be available. Plus, certainly in the advent of these remote tools where someone can actually log into your computer and remotely access what they need to access, they’re able to, a lot of times, avoid that need to leave their desk and to come and physically be at someone's office. Yes. I had that benefit because I'm working in a large office where there's 300 people, so they're able to have a physical presence. That's not the case everywhere. So again, the technology of being able to VPN into someone's computer is great, but having someone locally that you can turn to is also really helpful as well. So it sounds like we need to get you to the Genius Bar soon.

JONES: Yeah, probably just over have some you know, some subscription. We never found one that we really love. So if there is a subscription for smaller companies for IT support, VPN-based IT support, that’s quick. Please drop me a line. Let me know listeners! Clue in! Because that's still my biggest frustration with owning a paperless, entirely remote business right now.

Marianne, I’m really happy that we had you on because I don't know anyone that could have spoken this deeply on remote work in the field and I see it as a total inevitability is not shrinking, it's only growing. To what extent it grows, we don't know. But, all I'm seeing from pretty as it is, it’s a more and more important benefit. Then from a competitive standpoint, not having a facilities cost--it's like that allows us to one, be a profitable company and reinvest in our company. So don't have the second biggest expense that agencies do, which is facilities. We get to be a lot more experimental, which allows us to solve the problem that most marketing company faces. It's hard to be innovative because it's not profitable to be innovative. Profitability comes when you get the same thing over and over again. The problem is that you do the same thing over and over again and competition, like a company like Fertility Bridge, comes in out of nowhere and kicks your ass. So this allows us to be profitable and do new things and just from the recruitment standpoint. It's just that there is this talent pool that is above my pay grade to say, but when we talk about women in the workforce and women being able to have career abilities--I think it's also true for men and dads--but I can just say like the talent pool that we have access to as a remote company, because of women who want to have careers and also want to have enough of that family balance, has opened us up to an entire talent pool that most people aren't even accessing yet, or aren't accessing properly, aren’t serving properly. And so I'd see this not going away anywhere, I see it as a necessity more than a nicety. And I think that you have spoken to more deeply than any other fertility group in our field could. How would you want to conclude? Anything that I didn't ask you about remote work or how you see its prospects for the future?

KREINER: I think again I would just like to echo a little bit of what you said, which is thinking about the way of which work is going and opening up that talent pool. It may be opening up the talent pool within your own organization for them to try new areas and to do work that they may not have had the opportunity to do and do well for you previously, which is valuable in building that sense of growth and sense of mobility within a career that may not be available elsewhere unless, or certainly, within your organization without them leaving. So give it a try, take it one step at a time, go online--there are many templated plans as far as policies as well as agreements, and if it doesn't work make adjustments, there are ways that can make it work. 

JONES: Marianne Kreiner, Chief Human Resources Officer at Shady Grove Fertility, thank you for coming on Inside Reproductive Health. 

KREINER: Thank you, Griffin. 

You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.