Dr. Laura Esserman leans forward and speaks with conviction, making broad gestures with her hands. "Over the past couple of decades, I've watched industries be transformed by the use of information systems and incredible visual displays," she says. "What we could do is to completely change the way we work — just by changing the way we collect and share information."
Sounds familiar, right? But Esserman isn't championing yet another overzealous Silicon Valley startup — she's envisioning how cancer patients will interact with their doctors. If Esserman, a Stanford-trained surgeon and MBA, has her way, patients won't sit passively on an exam table, listening to impenetrable diagnoses and memorizing treatment instructions. Instead, they'll have access to a multimedia treasure chest of real-time diagnosis, treatment, and success-rate data from thousands of cases like their own. Better still, they won't meet with just one doctor. There will be other doctors on the case — some from the other side of the hospital and some, perhaps, from the other side of the world.
Esserman and her colleagues at the University of California San Francisco's Carol Franc Buck Breast Care Center are pioneers in the new world of virtual teams and virtual tools, a world in which there will be real change in the way highly trained people whose work depends on intense collaboration get things done. After years of grand promises about the power of high-quality videoconferencing, high-speed Internet connections, and well-designed collaboration software, it may finally be time for virtual work to become a business reality.
Part of the good news is, of course, rooted in bad news: In a period of war and recession, fewer people relish a life of nonstop travel, and fewer companies want to pay for it. But there's more to it than that: The tools are better than they used to be. "The technology has really evolved," says Leon Navickas, chairman and CEO of Centra Software, based in suburban Boston, whose Web-enabled collaboration and e-learning platform is used by more than 1.7 million people. "We're capable of a high degree of interactivity, of developing a very rich media environment through an ordinary computer, even with those who are connected to the Internet at low speeds. And we're able to get through proxy servers and firewalls without compromising the security of the Internet or a corporate intranet."
Meanwhile, companies are beginning to understand the uses (and limitations) of the technology. Accenture is a classic power user. The giant consulting firm, long famous for its fanatical commitment to training and development, uses Centra software, along with all kinds of other virtual tools, as part of its strategy to help people collaborate more and travel less. The company's online-learning portal, myLearning.com, has become a major piece of its knowledge infrastructure. (The firm expects that up to 70% of all of its courses will be offered via e-learning rather than in person.) But the goal, says Reinhard Zeigler, global lead partner for Accenture's eLearning and Knowledge Management group, is "blended learning — a careful mix of virtual and physical learning experiences. We'll never go completely virtual."
What follows, then, is a real-world guide to the promise and perils of electronic collaboration. To answer the most basic questions about virtual work, Fast Company spoke to a broad group of technology suppliers and leading-edge users, from doctors and developers to consultants and engineers. Their conclusion: When it comes to delivering on the real promise of electronic work, we are virtually there.
Doctors: Not Just Cheaper, Smarter
Be honest. Most companies look to virtual technologies to work cheaper — to save money on airfare and hotels. But that cost-cutting mind-set underestimates the real potential of the tools available. Electronic collaboration can help people work smarter; it can bring more brains to bear more quickly on more-important problems.
That's why Laura Esserman is so passionate about fully collaborative health care. Her goal at the Buck Breast Care Center is to use virtual tools to bring more useful information (and more doctors) into the exam room. Why? Because two heads really are better than one. She explains that when patients see their doctors after a breast-cancer diagnosis, for example, they are handed a recommended course of treatment that involves serious choices and trade-offs. Of course, most patients don't know enough about the merits of, say, a lumpectomy versus a mastectomy to make an informed choice, so they trust their doctors to tell them what to do.
But a single doctor isn't always equipped to make the best decision, especially since different procedures can have very different long-term physical and emotional impacts — but may not be all that different in their short-term medical outcomes. "Very often," Esserman says, "doctors recommend a particular treatment because they're more familiar with it. But we should be advocates for our patients, rather than our specialties."
Although her full-blown program is a long way off, Esserman has run a pilot project with 24 patients. She worked with both Oracle, the Silicon Valley database giant, and MAYA Viz, a Pittsburgh company that develops "decision community" software, to allow doctors across the country to collaborate virtually. Through Esserman's approach, when a patient arrives at the doctor's office to receive treatment instructions, instead of listening to a physician's monologue, she's handed a printout. On the top left side of the page is the diagnosis, followed by patient-specific data: the size and spread of the tumor, when it was discovered, and the name of the treating doctor. Below that is statistical information generated from clinical-research databases, such as the number of similar cases treated each year and details about survival rates.
A set of arrows point to treatment options. Next, the patient reads the risks and benefits associated with each treatment. She can follow along as the doctor explains the chances that the cancer will recur after each option and the likelihood that a particular treatment will require follow-up procedures, as well as a comparison of survival rates for each one.
At this point, the patient has an opportunity to voice concerns about treatment options, and the physician can explain her experiences with each one. "When you share this kind of information, patients and doctors can make decisions together according to the patient's values," Esserman says. This is where the network tools come into play. Drawing from stored databases of both clinical trials and patient-treatment histories local to the hospital, the physician can compare courses of action and results far beyond her own personal experience. "A medical opinion is really just one physician's synthesis of the information," notes Esserman. "So you need a way to calibrate yourself — a way to continually ask, Are there variations among the group of doctors that I work with? Am I subjecting people to procedures that turn out not to be useful?"
With a real-time, shared-data network, these questions can be answered at the touch of a button instead of after hours, weeks, or months of research. But that's just the beginning. A real-time network also presents the possibility of seeking help from other specialists on puzzling cases, even if those specialists are on the other side of the world.
Ultimately, says Esserman, the questions that might be answered by this new way of practicing medicine are fundamental to the field. "Who's doing something different, and how do we learn? With tools like these, we have the opportunity to bring learning back in real time to the practice of medicine," she explains. And patients have the opportunity to get a second — and even a third and a fourth — opinion while their primary doctor stands by.
Developers: Even Better Than the Real Thing?
Most people who consider using virtual-collaboration tools assume that, even at their best, they are a second-best solution. If companies had unlimited travel budgets and if teams had endless amounts of time, then face-to-face meetings would be the best way to work, right? Not so fast. A team of product developers at Texas Instruments has discovered that virtual meetings work better than their face-to-face alternative.
A case in point: TI's efforts to develop the next generation of wireless communications devices. The company's Dallas-based mobility and collaboration team recently delivered a crucial strategy presentation to employees and business partners in Europe, Japan, and the United States. The format was pretty standard: 45 minutes of PowerPoint slides followed by an extended Q&A. Not so long ago, TI would have flown in participants from all over the globe. This time, managers conducted the meeting over WebEx, the Internet-based virtual-meeting platform. Participants followed the slides using their laptops and instant-messaged their questions and comments throughout the presentation.
The virtual meeting reduced travel costs and saved time. But over the course of the session, the team discovered that the virtual presentation was also more effective at soliciting feedback from attendees than any of the face-to-face meetings that they had conducted with international participants. "So many of our international partners are not comfortable with English," says Evan Miller, team manager. "On a conference call, or even in person, accents can be tricky — especially when you gather a group from Europe, Japan, and the United States. With WebEx's chat feature, we found that many people could type English better than they could speak it. It made everything so much smoother."
Smoother, even, for meeting participants who were already in Dallas. During the same presentation, Miller's colleague Lisa Maestas was connected via WebEx from TI's South Campus, about five miles across the traffic-choked city. Says Maestas: "I got to stay at my desk, listen in, and participate, but I could still keep an eye on my other projects."
In fact, local group interaction is quickly becoming one of the most valuable uses of WebEx for this TI team — even among people who are sitting in the same room. Portions of both of the company's Dallas facilities are outfitted for wireless network connectivity. So these days, when Miller, Maestas, and other local members of the mobility team gather for a meeting, they bring their laptops, make their wireless connections, power up WebEx, and take a personal view of the document under discussion. "It's usually so hard to crowd around a screen to see what people are talking about," says Maestas. "With four laptops, everyone can see the screen. We can share control of the screen and annotate as we go along. At the end of the meeting, everyone has the same version of what we worked on. There's no more confusion."
Consultants: New Behaviors for New Technologies
Some of the the most advanced users of learning and collaboration tools are at the top consulting firms. At Accenture, for example, employees have become virtual maestros of virtual work. They use Centra along with videoconferencing, eRoom online work-flow software, the company's corporate intranet, and their myLearning.com portal. The technology is impressive, but what's most impressive is the way that Accenture's power users have devised small social cues to make sure that virtual work goes as smoothly as face-to-face sessions. They've figured out what it takes to smile, to interrupt, even to yawn online — which is why the technology works as well as it does.
Joanne McMorrow is someone who has had to think about how she works in order to make technology work. Three years ago, she transitioned from consulting with clients to working on internal knowledge-management projects. "I went from being 100% face-to-face on the consulting side to being 100% virtual in the knowledge-management practice," McMorrow says. Accustomed to jumping on a plane every Sunday night to be at client sites by Monday morning, she had to adjust her habits to join a new team that was spread across multiple cities; face-to-face meetings were a rarity. "It was a drastic change," she says. "You have to be more explicit with colleagues about certain things when you're working virtually."
Now, after changing roles a second time to become a marketing manager in Accenture's human-performance group, McMorrow says she has the virtual routine down pat. She uses Accenture's Knowledge eXchange to share documents and track progress of her group projects, NetMeetings and her telephone to participate in team meetings, and myLearning.com to take courses and track her personal-learning budget. Throughout her workday, McMorrow makes sure to verbalize to colleagues when she's shifting mental gears, when she's stepping away from her desk during a long virtual meeting, and when she needs more feedback. Once a quarter, McMorrow attends an in-person meeting of the entire "people enablement" practice in order to solidify personal connections.
McMorrow's work-style transition is a good illustration of what's involved in successful long-distance collaboration, says Accenture's Zeigler. "There are two important questions," he says. "Who's going to collaborate and for what purpose? And how does the collaborative environment fit into the way people do their work?" According to Zeigler, these are the same issues that companies face when they roll out a virtual strategy enterprisewide. "Take our e-learning strategy," he explains. "MyLearning.com allows employees to sign up for, track, and take courses online. They can also sign up for in-person courses at various locations around the world. Which one they choose depends on the business purpose of the course."
When Accenture consultants search the portal for a course, they can search by service line to view recommendations for the industries in which they consult or by career level to see what courses other consultants are taking. If consultants choose a service-line course, they're likely looking for content-specific knowledge — which means that they're likely to take the course online. But if they choose a course according to career level, perhaps they are searching for tools that their peers find most useful in their own jobs or for the types of assignments that have been most enriching to their careers — which would be best translated face-to-face. "In this particular case, the teaming and interpersonal skills learned by taking the course in person are as important as the content gained," explains Zeigler.
Bankers: Less Paper Means More Backers
Any new technology has its share of skeptics. And when that technology shapes how people work, resistance can be intense. With virtual work, one way to overcome resistance is to focus on everyone's favorite enemy: paperwork. More electronic collaboration means less paper documentation.
At Fleet Securities Inc., for example, the loan-syndications team has embraced Web-based tools for some of its most sensitive operations. New England bankers aren't famous for their digital enthusiasms. But in this case, virtual work has meant dramatic reductions in paperwork and improved service to corporate investors — which means that the bankers are on board.
Jeff McLane, a senior associate in Fleet's loan-syndications team, remembers what it was like before his group started using a secure online service to post materials for investors. "The worst was the time we went to the printer and discovered that someone had accidentally shredded our deal books. We ended up sending people to five different printers to make the deadline. But today, when you finish compiling material on a deal, you post them directly to the Web. You've eliminated the entire printing process."
McLane and his Fleet colleagues use a service called IntraLinks. Common to the banking and legal industries, IntraLinks allows companies to create secure Web sites for each deal. Team leaders determine which individuals can view which materials, and each time new material is posted, notifications go to the people who need to read or respond to it. Lawyers can even post due-diligence materials.
"Once the site is up, you can see who looked at which document," says McLane. "I can call up John Smith and say, 'You downloaded the book this morning. Do you have any questions or problems with it?' " Never mind that these virtual features save time and money — they also buy peace of mind. No more worries about whether a FedEx package reached an investor who's on vacation. "It takes out the guesswork," says McLane.
William Maag, managing director of Fleet Securities, reports that virtual tools are figuring prominently in the final stage of the deal-making process: the close. Maag says that more and more investors — sometimes up to 60% — are participating via conference call, rather than making a trip. "We'll do a PowerPoint presentation, but the nice thing is that now, if you are on the phone, we can post the presentation to the IntraLinks site and people can follow along," says Maag. It's just one more piece of evidence that such tools for virtual collaboration are becoming reliable enough for businesspeople to bank on.
Alison Overholt (firstname.lastname@example.org) is a Fast Company staff writer based in San Francisco.
Sidebar: A (Virtually) Perfect Close
Talk to almost any sales manager in almost any company, and you'll hear the same refrain: To close a big deal, you've got to meet your customer face-to-face. Michael Nelson, cofounder and CEO of emWare Inc., sings a different tune. He manages to close business without the hassles of long-distance travel. In part, that's because Nelson's company, which provides software and services that add remote-management capabilities to electronic devices, is ideally suited to doing business over the Web. But in large part, it's because emWare has been clever about making the virtual-sales process attractive to its customers.
Before the economic downturn, Nelson's company maintained a large sales force that was always on the road. Now, however, with his team scaled down to an eight-member sales-and-business-development team, virtual sales calls have become a necessity. And they've turned out to be enormously successful.
Previously, for example, a favorite sales technique was to bring a potential corporate customer to Salt Lake City, where emWare is based, for a technology demo. The signature gambit: Let the customer drop a Coke from a soda machine using the Web-based controls on a computer across the room. Today, using emWare's technology, the same demo can be performed from anywhere. EmWare's remote-device-management technology allows customers to take control of the soda machine and drop the Coke from Boston or Boise. A Webcam and a telephone audio hookup allow the customer to see and hear when it happens.
We tried the demo ourselves, and the next day, a can of Coke appeared at Fast Company's San Francisco offices. "It sounds hokey, I know," says Nelson. "But you'd be shocked to know how often that soda on the desk seals the deal." And there you have it — a virtually perfect close.
Sidebar: 4 Real Tools for Virtual Work
The fast-growing world of electronic collaboration is filled with helpful tools — as well stuff that promises more than it delivers. These are a few of our favorite things.
1. PlaceWare's "Question Manager" feature (www.placeware.com): Most online-meeting programs allow you to "raise your hand" by clicking an icon, signifying a question for the entire online group. Most software also allows you to instant-message a question or comment directly to the meeting host. But only PlaceWare has the panel-of-experts feature — a direct instant-messaging capability that allows users to ask spontaneous questions of a designated group of experts throughout a meeting session. By directing on-the-spot queries to the panel, meeting attendees don't have to confess ignorance to the whole group. Nor do they bother everyone else in the middle of a presentation. The panel can also keep a record of issues raised throughout the session — and the questioners actually learn what they need to know when they need to know it.
2. WebEx's desktop control-sharing capability (www.webex.com): This feature is the reason why WebEx isn't just an online meeting facilitator — it's the way teams work together across vast distances. By allowing someone other than the meeting host to take control of the desktop and annotate a document, this feature makes it possible for engineers, designers, or anyone else to virtually grab the document at hand and say, "No, wait! I've got it! What if we tried it this way?"
3. Centra's flexible configurations (www.centra.com): Big group conference? Individual workspace? Centra is remarkably flexible. Unlike many collaboration tools that have a single mode of operation (presentation mode), Centra's service allows users to customize their views for group meetings, for one-on-one work sessions — even for individual learning environments. Quick links to the different views mean that users can even change modes midsession. During a CEO presentation to the entire company, for example, a Centra user can switch over midsession for a quick breakout meeting with her department and still rejoin the larger session with her group's questions and ideas before the presentation ends.
4. The Tandberg 1000 wireless videoconferencing unit (www.tandberg.net): In a field of high-tech gadgetry sexy enough to make any geek swoon, this device is in a class by itself (and not just because of its $5,490 price tag). The Tandberg 1000 is the first videoconferencing product capable of running on a wireless LAN, which means that the executive boardroom is no longer the only place equipped for a videoconference. Wherever you are is where your next videoconference will be. No wires. No permanent hardware installations. No hassle. Unless, of course, your colleagues grab it first.
A version of this article appeared in the March 2002 issue of Fast Company magazine.