Winter 1997, Vol. 6, No. 2

Disability-proofing the workplace

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

Top management is beginning to recognize that containing health care costs and managing disability in the workplace can only effectively be achieved when corporate culture supports and encourages the value and goal that healthy workers are productive workers. Essentially, corporate culture is the loom on which health and productivity are knit together. Corporations with cultures that both support and incentivize worker health and productivity tend to be productive and healthy corporations. On the other hand, corporations with productivity-oriented values and strategies that focus only on productivity may be highly productive in the short run, but at the price of increased disability and turnover in the long term. A change in culture is often the fundamental factor in the improvement of productivity, worker loyalty and well-being. Irrespective of whether the corporation is involved in manufacturing, service, or health care, corporate culture significantly affects worker health and productivity.

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 consultants have an important role to play in designing and implementing a coherent health and disability system that improves work productivity while maintaining or enhancing worker health and well-being. The function of managing health and health care involves developing an individualized health and disability strategy and system and implementing it within the corporation's basic strategy. The system would involve the entire spectrum of worker health from primary to tertiary prevention. Ideally, it would link the effective use of information 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.

Disability is best understood as a cumulative process involving a number of decisions on the part of the disabled worker as well as the corporation and managed care organization. This process includes the progression from risks to morbidity or disease, to disability. It also includes the integral link between risk management, disease management, and disability management. Risk management refers to policies and programs for the early identification of medical and behavioral health risks and timely intervention strategies that can prevent morbidity/disability and thereby reduce costs. It includes ongoing worker screening for health and disability risks. Effective risk management requires identification and intervention with both worker and organizational factors. Disease management refers to policies and programs to manage or treat medical and behavioral health morbidity and impairment. It involves disease-specific treatment protocols and guidelines. Finally, disability management refers to policies and programs aimed at reducing the impact of disability and costs associated with disability. It includes medical and psychiatric rehabilitation, work hardening, and job modification for early return-to-work.

A second focus, developing and managing a corporate culture of health, involves the translation of the health and disability system into operational terms such that it can be executed by staff and line managers. Worker health status would then be reflected in corporate financial health, as healthy, involved workers tend to be productive workers.

Case Example

ABX Corporation was facing increasing disability costs and employee turnover.

It was noted that nearly 90 percent of disability costs and 83 percent of turnover involved hourly workers who had been employed less than 18 months. Eighty percent of these disabilities involved cumulative trauma (low back, wrist, and shoulder). An organizational assessment of risk factors, morbidity and disease management data, and patterns of disability found that most disability costs were incurred by two of ten departments. Unique to these departments were entry level workers, extremely high productivity quotas, repetitive tasks, high job strain, and 12-hour work shifts. The organizational assessment also found that the prevailing norms in these two departments were: "run, don't walk," "never complain about pain," and "taking time off is a breach of department commitment." Furthermore, the core values of ABX for all departments were: "production is king" and "no holds barred quality." It should also be noted that two years prior to the consultation, a change was made in the profit sharing plan such that all managers were incentivized for exceeding production quotas. Needless to say, the managers of both these high risk departments had little tolerance for absenteeism, refused to permit workers to leave the line to receive medical treatment unless it was an absolute emergency, and were unsympathetic to requests for transfers.

Consultants recommended a few specific modifications of strategy and structure in the company which amounted to a subtle but significant shift in corporate culture. The first change involved a strategic modification: including "health" to the corporate values of productivity and quality. The second was a structural modification following from the strategic modification. Now, incentivization was to be based on both production and the costs of doing business in a department. In other words, besides direct costs and traditional overhead expenses, all employee health and disability costs were added. This meant that department managers who had high or increasing health and disability costs along with high productivity would get a smaller bonus—if any—than managers who had reasonably high productivity with low health and disability costs. The changes were adopted in the middle of the fiscal year. Statistics compiled in the ninth month after the changes were implemented demonstrated that a culture shift was occurring: productive workers were healthy workers.

Concluding Note

This case study illustrates a number of points discussed above. Probably the most important is the utility of conceptualizing disability in a larger perspective, i.e., in disability management system terms. Furthermore, it illustrates the necessity of changing corporate culture—as a result of modifying corporate strategy and structure—in the direction of health and productivity. Besides reducing disability costs and employee turnover, a disability management system can significantly attenuate risk factors for both morbidity and disability, as well as reduce direct and indirect costs associated with disease management.

References

Sperry, L. (1991), Enhancing corporate health, mental health and productivity. Individual Psychology, 47, 247-254.

Yandrick, R. (1997). Behavioral risk management: How to avoid preventable losses from mental health problems in the workplace. San Francisco: Jossey-Bass.

 
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