Winter 1996, Vol. 5, No. 2

Book Review Essay: Consulting on corporate health issues: Containing costs and disability-proofing the workplace

By Len Sperry, M.D., Ph.D.

While opportunities in the clinical practice of psychiatry are shrinking there seems to be ever increasing practice opportunities in the specialty of occupational and organizational psychiatry. One such area is corporate cost containment and disability-proofing. Top management is beginning to recognize that containing health care costs and managing disability in the workplace can effectively be achieved only when the corporate culture supports and encourages the value and goal that healthy workers are productive and satisfied workers. Corporate culture is the loom on which health and productivity are knit together. Corporations with cultures that convey shared values and emphasize active involvement of all workers tend to be more productive and healthy.

On the other hand, corporations with dysfunctional cultures such as Type A organizations, which focus on "numbers" i.e. producing more, faster, rather than on product quality and the value of workers are generally poor performers and exhibit the corporate precursors of worker illness and disability. A change in culture is often the fundamental factor in the improvement of productivity, worker loyalty and well-being (Farrier, 1993). Irrespective of whether the corporation is involved in manufacturing, service, or health care, corporate culture significantly affects worker health and productivity.

Previously, management has kept a low profile in health and disability matters, taking a passive oversight stance regarding employee, health provider, and insurer. Today's cost level and increasing complexity of health and disability issues now require a more pro-active stance and involvement. Management's best strategy for containing costs is to address the broader health system and the individualized needs of the covered population instead of merely contracting with providers and case systems (Barge & Carlson, 1993).

Farrier (1993) cites a study of rising health care costs threatening to eliminate all profits for the average Fortune 500 corporations if costs are not contained. He also cites a Washington Business Group on Health (WBGH) study that disability claims including rising stress disability claims are related to workplace factors. WBGH contends that management can control much of the disability linked to workplace conditions and that effective management can prevent much disability. Obviously, this is not happening at many corporations.

Because worker health and corporate productivity are so closely intertwined, and because the core culture of an organization influences both health and productivity, worker health and productivity will be enhanced when the corporate culture reflects the values of health rather than illness and disability. Occupational and organizational psychiatrists have an important role to play in designing and implementing a coherent health and disability strategy that could not only improve work productivity, but also worker health, well-being and job satisfaction. The function of managing health and health care involves developing an individualized health and disability strategy and implementing it within the corporation's health systems framework. The strategy would involve the entire spectrum of worker health from primary to tertiary prevention. It would link the effective use of information and systems for measuring and rewarding job performance as well as positive health behavior and improved health status. Furthermore, it would involve reducing the fragmentation of health services delivery and internal conflict within the health and disability systems.

A second focus, developing and managing a corporate culture of health, involves the translation of the health and disability strategy into operational terms such that it can be executed by staff and line managers. This would include formal programs including wellness, EAP, safety, and substance abuse, as well as informal management practices, such as worker involvement, supervisory behavior and management of change. Worker health status would then be reflected in corporate financial health, as healthy, involved workers tend to be productive workers (Barge & Carlson, 1993).

Occupational and organizational psychiatrists with an interest and some experience in the process of corporate culture change and in the dynamics of health and wellness should be able to quickly and easily establish a niche for themselves in this emerging area of consultation. The need for corporate cultures to change from an illness and disability perspective to one of health and productivity is great indeed. For those contemplating this type of consultation, the book The Executive's Guide to Controlling Health Care and Disability Costs by Bruce Barge and John Carlson is highly recommended. Several strategies for changing corporate culture to control health care costs, workers' compensation and disability costs, as well as increasing employee health and productivity are described.

References

Barge, B. and Carlson, J. (1993). The Executive's Guide to Controlling Health Care and Disability Costs: Strategy-based Solutions. New York: Wiley.

Farrier, M. (1993). Perspectives on intervening to improve employee health. In Golembrewski, R. (ed.) Handbook of organizational consultation. New York: Marcel Dekker.

 
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