Near the end of the two-day Washington, DC conference, organized by the National Institute for Occupational Safety and Health (NIOSH), Joseph Fortuna, M.D., medical director for Delphi Corp., spoke with OH.com's senior editor about the value of the event and why U.S. companies need to pay attention to integrated health management. Fortuna supervises the medical and occupational health activities of more than 73 facilities worldwide for Delphi, a Fortune 100 company.
Integrated Health Management
OH: What do you mean by "integrated health management?"
Fortuna: For too long we've separated workplace safety and health from public health. We want to maintain our safety record in the workplace and also encourage our workers to have healthier behavior to prevent disease and accidents inside and outside the workplace. We also need to sustain and support these healthier lifestyles. It's in our best interest as companies to do that and I think it's in the best interest of employees. It's a win-win situation.
You're talking about holistic medicine, looking at the person, the environment, the machine all in a group. I think that's really a new trend.
OH: Do you believe it is urgent for U.S. companies to adopt this approach to their workers' health?
Fortuna: If we can't cut health care costs we're not going to survive. Controlling costs doesn't mean just shifting them to the federal government or some other party.
This is a global economy. We're competing against nations with different cost structures and to sustain our growth we've got to be able to move toward a more productive and competitive labor situation. Companies are now outsourcing even more experienced jobs. It's a whole different world.
The industrial environment is made up of man, machine and material. We've done a lot to improve material processing efficiency, and we've done a whole lot to make the machine part very, very efficient. We've done relatively little to improve the health and efficiency of our human capital.
So we're talking about reducing demand for health care, not just changing its price or who pays for it.
OH: Is this really new?
Fortuna: Some people say they've been doing it all along. That's probably true. There have been isolated efforts, but if it were wildly successfull we wouldn't have had this conference.
OH: How do you begin to do this?
Fortuna: First you need to know your organization extremely well. You need to know it culturally, where the biases are, where the skeletons are. You need to analyze where the problems are, in terms of the health status of your employees, by cost and by condition. Second, you need to be something of a politician and set in place cooperative intervention programs using existing resources to help people move into healthier lifestyles; the recognition and management of their disease processes. This includes both safe behaviors and health behaviors. There's really not that much difference between the two. And this has to be done everywhere: at work, at home, on the road - everywhere.
You've got a great way to get messages across, in the workplace. We do a lot to tell our employees about the health of the company, stock price. But not until recently have we begun to seen how effective good messaging techniques can be in changing behavior that not only helps employees but also helps us as companies be better, healthier and more productive places to work.
OH: Is this a cooperative effort?
Fortuna: It can't just be where you are losing the most money. You've got to work with unions and workers to come to a common understanding. For example, maybe you go to the unions and say, "We've got a lot of people in this company with diabetes or who are pre-diabetic. What are we going to do about them collectively? You guys in the union need to help us. It's not just for us, or even for them. It's for their families."
The 'Presenteeism' Problem
OH: What is "presenteeism" and how does that figure in here?
Fortuna: I personally think that one of the biggest effects of bad health, is presenteeism. That's when an employee shows up to work but isn't fully present, isn't productive, commits unsafe acts, and so on. We're not talking about the number of widgets per hour, but quality.
Let's say you have an individual who has a migraine headache, and hasn't been properly diagnosed for that condition. She's going to have a period from 24 to 48 hours after the onset where she isn't going to be able to function very well. The products put out by that person aren't going to be so good.
If we put out a batch of bad product, our customers may have to shut down their production line. Well that's a disaster. We've got to do everything we possibly can to avoid this.
Absence is another huge problem. Who comes in to do the job? Someone less qualified, not as experienced, not trained as well. We'll have more accidents. So there are safety, quality and productivity consequences to absenteeism and presenteeism.
OH: Are these hidden costs?
Fortuna: The health status of workers involves a whole bunch of costs. Part of it is direct costs. Health care costs are going through the roof. But that's not the majority of the problem. Indirect costs are far more important.
It's one thing to know what you pay out of pocket for managed care. It's another thing completely to know what you're really paying for, the lost quality, the absence rate, presenteeism. It's increasingly clear that for every dollar we're losing in direct costs we're losing 4 to 10 in indirect costs.
OH: Is this about individual change or organizational change?
Fortuna: There are three different levels: individual, organizational, and societal. It involves all three.
The Birth of a New Community?
OH: What's fired your interest in this?
Fortuna: My interest is there's so much opportunity. It's a great place to be and a great time to be there. We've got a nation that's bleeding at the seams economically because of the ravages of our bad collective health. There are other things involved too, but this is a very major part of it. And it's an opportunity.
It's a culture change. It's not going to happen over night. The closest I think of if is the environmental situation back in the 60's.
OH: What was the value of the NIOSH conference in advancing the movement toward integrated health management?
Fortuna: I think you witnessed the birth of a community. This was embodied the first day when someone asked, "What is ROI (return on investment)?" We brought together diverse cultures of people here. Some have a great background in health, but don't know jack about economics and the economics of health. That's really what it's going to take. To be successful we've to have a collaborative multi-disciplinary approach.
OH: What barriers do you see to success?
Fortuna: Companies in this country have a fundamental problem: we manage from quarter to quarter, and not for the long haul. Other countries look at things from a longer-term perspective. We've got to keep that in mind, otherwise we won't have a workforce in the future. Or we'll have an unskilled workforce.
Second, this movement has got to be able to communicate effectively with senior management and make the business case. We need to know how to sell it, the right words to use. And we need to learn how to motivate people to do it.