The Medical Ramifications of Remote Work from an Organization Behavior Lens

In the early 2010s, working from home—otherwise, commonly referred to as “telework”—gained popularity likely from a convenience standpoint. In March 2020, due to the global COVID-19 pandemic an outpouring number of organizations (both private and public) that were traditionally dependent on face-to-face interaction adopted telework practices out of necessity for the health and safety of their employees and the community from the fatal COVID-19 virus. At the beginning of the COVID-19 pandemic, organizations prioritized the health and safety of their employees by implementing telework on a temporary basis until the threat of COVID-19 dissipated; however, when the global pandemic did not seem to subside and the return to in-person work seemed distant, telework became the norm, as did a new organizational socialization policy process.

Organizations are not only facing socialization issues but also mental and physical medical issues of their staff. A 2024 study surveyed 25 companies in Portugal and found that not only were there online socialization issues with colleagues, but also an increase in “smoking (5.5%), alcohol drinking (4.5%), and worse diet (10.1%)”.¹ Sierra Tuscon, a mental health treatment center in Arizona found that one out of five workers in the United States admitted to using alcohol or recreational drugs while working remotely in 2021.² All About Vision found that 68% of people who worked remotely since the pandemic had new vision problems.² The State of Remote Work in 2023 stated that 23% of remote workers struggled with loneliness due to the lack of energy they receive in the office.³ Finally, isolation and loneliness may become the new epidemic, as the U.S. Surgeon General came out with a report on how to heal effect of social connection and community.⁴

The change in the telework processes also alters the relationship of how organizations approach their socialization process for new employees. Some socialization plans may have been in place for decades. According to Robbins and Judge, new employees need to adapt to the culture of the organization, regardless of how effective the recruiting process was.⁵ To change organizational behavior, there is a four-step socialization process for new employees of organizations. The four steps of the socialization model are: 1) pre-arrival, 2) encounter, 3) metamorphosis, and 4) outcomes. In the pre-arrive stage, the employee brings their own values and attitudes from their last organization as well as new expectations. Next, during the encounter stage, the new employee’s expectations may differ from the reality taking place. If the expectations were similar, socialization is expedited, however, most of the time, expectations and reality are distanced. Employees may be resistant to change and sometimes quit within the first few months.

The third stage is the metamorphosis stage. This stage works out any problems that the new member may be resistant to change. During this stage, literature is used from the field of organizational behavior, which “the story of organizational behavior has its roots in the fields of industrial and social psychology”.⁶ Within an organization, the attitude, behavior, and performance of an individual are studied and focused on. Robert Denhardt (1968) is a well-known organizational behavioralist in the field of Public Administration who originally studied the bureaucratic socialization process of new entrants in the Appalachian anti-poverty program in the 1960s.⁷

Denhardt (1968) found that, during the metamorphosis stage, there are two perspectives of bureaucratic socialization. First, members of society who are introduced to bureaucracy for the first time may be required to make important changes to their beliefs.⁷ Denhardt used the work of Chester Barnard (1938) who was a Neoclassical Organization Theorist. Neoclassical Organization Theory refers to the 1930-1960, a time of transition where classical theory was expanded upon by sociology and psychology. Denhardt (1968) argued that Barnard’s (1938) zone of acceptance will help employees follow orders as long as they are within this zone.^7,8 Originally from Follett (1926), Barnard argued that in the zone of acceptance, employees accept authority from their supervisors and understand their directive to the organization’s goals.⁹ To expand this zone, organizational socialization becomes critical. By implementing French and Raven’s (1959) The Basis of Social Power and Weber’s (1978) bureaucratic model, he argued that “internalization of the concept of hierarchical authority must precede any exercise of bureaucratic power”.^10,11

Second, the organization may need to adapt to non-bureaucratic ways for socialization to occur. In some instances, the organization must accommodate the individual during the transition. Rather than bureaucratic or hierarchical ways of approaching socialization, Denhardt called for “transaction, a form positing administration by bargaining among relative equals through a series of transactions”.⁷ Essentially, the organization may need to accommodate the individual through the transition using nonbureaucratic methods.

According to Van Maanen (1978), organizational socialization can occur in seven ways. Socialization can occur formally through specific training programs or informally with no special attention depending on the type of employee.¹² Another option is to socialize them individually or through a group setting. Also, the socialization process can be sequential involving specific stages or nonsequential.¹³ Essentially, organizations have the flexibility to be as creative as possible to change new employee’s behavior. Recently, organizations had to be more flexible by implementing telework into their socialization process. Socialization mechanisms that worked a decade ago will most likely not work with this generation.

The fourth stage is outcomes. Schein (1968) argued that an individual’s response could be either 1) conformity, 2) rebellion, or 3) creative individualism.¹⁴ The first option for the individual is conformity. According to Robbins and Judge, after the metamorphosis stage, new employees have accepted the norms of the organization.⁵ Their productivity should have benefited, they are fully committed to the organization, and turnover should be relatively lowered. The second option is an open rejection of the socialization process. There was no notion of the “organizational man” or woman with this specific individual. They rejected change no matter how effective the socialization process would be.^10,11 The third option would be creative individualism in which the individual accepts the norms and values of the organization and is not a threat. However, the individual keeps peripheral norms and values of their own. As long as the individual is valued, managers allow for minor creative individualisms to occur.

The socialization process is also critical for organizational learning. According to Levitt and March (1988), organizational learning can be found in three behavioral studies. First, organizations’ behavior is based on routines. Second, organizations are dependent on history, and third, are outcome-oriented. They stated that “organizations are seen as learning by encoding inferences from history into routines that guide behavior”.¹⁵ Routines are the rules and procedures as well as beliefs and cultures. These routines are then transmitted through socialization. Essentially, they learn through direct experience and the experience of others. This information eventually becomes an organizational memory. When changing experiences occur, the memory could be altered and have “inconsistency factors.” Essentially, organizations can be viewed metaphorically as a brain.¹⁶

Thus, the COVID-19 pandemic has altered the memory of organizations. Socialization plans that worked three years ago do not work today. Organizations will have more rebellious and creative individualism responses than before. The definition of conformity has changed because new employees are not conforming to an organization’s pre-pandemic practices. In return, this creates new challenges for organizations to also include the medical community to their socialization plans due to psychological issues such as loneliness and isolation as well as Internal Medicine and potential surgery issues such as smoking, drinking, and diet.