Skip navigation

Category Archives: Employee Health


Part 1 of a several part post

Introduction-What is the structure of Human Performance?

The definition of Human Performance: the part of human functioning that accomplishes tasks according to measurable standards of efficiency, completeness and accuracy. In other words, performance is that part of our function that literally represents the purpose of our lives. Forming a coherent and rational understanding of human performance seemed obligatory to me as a practicing clinician; I began this pursuit two years ago. As in all scientific and philosophic inquiries, I knew that I needed to find the right question to answer which, as always, meant going back to basics. Recalling that nothing can function without possessing structure my inquiry into the nature of human performance began with my asking myself the following question, “If our performance is a part of our function, what then is the structure of our performance?”

The structure/function relationship is the basis of all rational scientific thought. In essence, structure and function is the same thing.  Take a simple sheet of paper; when you place it on a flat surface it functions as something upon which you can write; fold it in a specific way, and it can fly like an airplane; crumple it tightly into a ball and you can toss it into a trash can ten feet away. Regardless of how many ways you may change the same sheet of paper, the relationship of its structure and function remains constant and immutable. While the proof of the existence of sub-atomic particles long ago disproved Plato’s conception of the atom as the smallest and indivisible form of matter, the concept that the structure of any physical object in the universe is inseparable from its function continues to hold firm and regardless of scale, whether sub-atomic, microscopic or astronomical. A single proton in its core, or nucleus, is all that separates the 112 individual elements on the periodic table from those to its right or left. The element, Hydrogen with a single proton in its nucleus functions perfectly as a trigger of an atomic reaction; inhale the next element to the right on the periodic table, Helium, which has two protons in its nucleus and you will speak with the voice of a Munchkin from the land of Oz; skip the next four elements and we come to the Carbon atom with its 6 protons, that functions as the exclusive template upon which all life on our planet was manufactured for 3.5 billion years and counting. Finally, on the astronomical scale, with a structure more than 1300 times the volume of Earth, Jupiter functions as a gravitational shield, protecting our relatively tiny world from catastrophic collisions with the orbiting debris left over from our solar system’s creation some 5 billion years ago. In essence, Jupiter’s structure provided the Carbon atom the opportunity to function as the designated element for all life on Earth. What’s more than its sublime, ubiquitous even poetic nature is the relevance of the structure-function relationship to our understanding human performance. What follows is the answer to the question that I asked my self two years ago, “just what is the structure of human performance?”

Human Performance; a window to Human Health

Human performance is an aggregate of actions or behaviors that take place exclusively in the physical world and it is executed entirely by the human body; its skeleton, muscles, joints and connective tissues. Examples of human performance include speech, driving a car and making love; separately or all at the same time. In turn, each of these constituent behaviors or actions is a direct reflection of an ever-changing or plastic structure of the human central nervous system (CNS). At the core of the brain’s plasticity is a process called, neurotransmission which is the communication via chemical-electrical signals between one brain cell, or neuron and another. In all there are one hundred billion such neurons originating in the human brain, each having as their final destination a muscle fiber somewhere in the human body. At the molecular level of this inter-neuron communication process are chemical-electrical messengers, or neurotransmitters each of which has a unique chemical structure limiting its interactions to only with, structurally compatible, molecules located on the surface of the neuron known as receptors There are trillions of these chemical-electrical signals communicated in the human brain every second, thus giving the brain a nearly fluid, or plastic molecular structure which over time actually change the visible, or macroscopic structure of the brain. Hence the recent addition of the term, neuro-plasticity to the vernacular of neuro-science.

Within this neuro-plasticity framework, we can conceptualize human health as the sum of all forces, internal and external, which affect the plastic molecular structure of an individual’s central nervous system. Examples include exposure to a stressor such as Hurricane Katrina or a medical illness such as an infection. The extent to which any such force, whether external or internal, will impact an individual’s performance is limited by, or is to the same exact extent to which this force impacts, or molds the plastic structure of the individual’s brain. Conversely, only if a given force, whether internal or external, impacts the plastic structure of an individual’s brain will it have any impact on an individual’s performance. Within this framework, which represents the consensus scientific view, health and performance are the structure and function, respectively of  any individual human being. Thus, an individuals’ health and performance are indivisible and direct reflections of each other.

My health-performance proof shows that an individuals performance is a surrogate for their health and vice a verse. The clinical implications of this relationship are profound and far reaching. My understanding of this fundamental relationship between our health and our performance has served as my main cognitive tool for providing medical care to my patients that is far above the prevailing standard of care in our healthcare system. In my next post I will show how this tool is easily scalable and can be applies potential to fundamentally  change our healthcare system for the better and enhance its real value.

End  Post

Mitchell R. Weisberg, MD, MP


Introduction

A person is what a person does. What defines us is not what we believe, it is what we do. In life, the only thing that we truly own is our actions, everything else is on a temporary loan. While our homes, our cars and all of our material possessions add joy to our lives, only what we do affects the world during our lives and long after we are gone. What we do determines if we are important, irrelevant, famous, infamous, or eternal. What we do is the essence of who we are and a sign of our vitality; but is it a vital sign? I say that our performance, what we do and how we do it, is the most vital of all of our vital signs and here’s why.

The relationship between our Health and our Performance

Just as nothing in the physical universe has structure without also having function; our health and our performance are inseparable, linked by these same fundamental physical laws. Performance is defined as that part of our function that accomplishes tasks according to measurable standards which raises the question, what is the structure of our performance?

Our performance is an aggregate of behaviors and is executed exclusively by our bodies; our skeletons, muscles, joints and ligaments. Each of these behaviors, in turn, directly reflects the state of our ever-changing, plastic central nervous system (CNS). When viewed from this perspective, our health is defined as the sum of the forces, internal and external, that mold our plastic central nervous systems. The extent that any given facet of our health contributes to this molding process, is the extent that it will affect our performance; and only if it contributes to this molding process will any given facet of our health affect our performance. Our health and performance is our structure and function, respectively. Metaphorically, our health is the roadway to our performance  with our central nervous system being the final stop on the journey.

What our Performance (function) says about our Health (structure)

While we may not find and fix the problem, we all know that when our car stalls while we are driving (mal-functions) there is something wrong with our cars’ engine (a corresponding structural defect) and if you are like myself, you will call an auto-mechanic. The first thing an experienced mechanic will do before popping the hood is take our car for a test drive to see how it performs so that he can visualize what structural defects may be causing the malfunction. While I can’t take my patients out for a test drive, I can get a heck of a lot more information regarding their health from asking them how they are doing at school, work or home than by weighing them, taking their blood pressure, running a battery of laboratory tests or, dare I say, even looking at an MRI scan. Regardless of how thoroughly a pediatrician may examine a child during a checkup,  if she does not look at their report card she has no idea whether or not her patient is healthy. The same is true for the child’s mother and father when they go for their annual checkups and they are not asked about their work performance.

Our performance is, indeed, the most vital of all our vital signs. For more on this topic, please see my previous post,

A Tale of Mental Health in Two Settings

End Post

Mitchell R. Weisberg, MD, MP



Introduction

This is an update of our nation’s mental health crisis  from my perspective. I define the crisis and look at at its causes and  impact on the American people. In addition, I explore the perspectives of this crisis in the American healthcare system, the American workplace, and the American employer. Following this update I will propose my solution to the American mental health crisis. 

Setting 1

Mental Health in the American Healthcare System

This is the worst of times for people with mental health problems in the American healthcare system. One in four (58 million) American adults suffers from a diagnosable mental health problem, preventing a normal and productive life. (1)

In general, people with undiagnosed and untreated mental health problems use the healthcare system more often than people of the same age group who are unaffected. The services most often used in the healthcare system include Emergency Room visits, non-psychiatric hospitalizations, and primary care visits. (2)

For American adults with any form of chronic medical condition, the likelihood of also having a diagnosable mental health problem is higher than for adults in the same age group who do not have chronic medical conditions.  Furthermore, those people with both a chronic medical condition and a mental health problem who have their mental health problem diagnosed and properly treated will show more improvement in their chronic medical conditions than those who do not receive treatment for their mental health problems. (3)  Between 70% and 90% of those with mental health problems experience a significant reduction of their symptoms and an improved quality of life with a combination of medications, talk therapy, and other support mechanisms. (4)

So why is it the worst of times in the American healthcare system for people with mental health problems? In spite of using the healthcare system more often, less than one in three of the 58 million American adults with mental health problems have their problem diagnosed and one in ten receives the treatment they need to get well and lead a normal, productive, and fulfilling life. (5)

Why does our healthcare system, which has highly effective remedies for mental health disorders, fail to recognize them most of the time? The explanation leads to the solution to the American mental health crisis.

To begin, take a full minute look at this optical illusion. When you first look at this picture, you may see either a young woman or an old hag. But the longer you look at it, eventually the one that you did not see initially will appear. This demonstrates the limits of our human senses. We may not see, hear, smell, or feel what we are not looking for, even when it is right in front of us. Similarly, our healthcare system fails to recognize mental health disorders in most cases. While all health problems impact a person both structurally and functionally, our health care system tends to focus exclusively on the structural part of health problems.

For example, a 50-year-old man sees his doctor because he is feeling severe pain in his left lower abdomen. The doctor’s evaluation reveals that the man experiences discomfort, especially when the doctor gently pushes on his left lower abdomen. A CAT scan shows severe inflammation in the left side of his colon (a condition called diverticulitis). After 5 days in the hospital with nothing to eat or drink, and a regimen of intravenous fluids and antibiotics, the man recovers completely. This man’s inability to work or take part in family or community activities is an expected functional byproduct of his structural health problem (diverticulitis). Thus, information about this man’s functional status was not required to successfully diagnose and treat his medical problem.

Now let’s imagine that this same 50-year-old man sees his doctor for the same complaints.  The doctor’s evaluation is the same as in the first scenario, except the CAT scan shows that all structures, including the colon, are perfectly normal. The physician tells this man that he likely has something called Irritable Bowel Syndrome (aka, functional bowel syndrome) and in spite of the man’s bowel being structurally normal, the doctor advises him to increase the fiber in his diet and prescribes a medication to cut the bowel spasm when the abdominal pain occurs. While these remedies may or may not help, one thing is certain: this man’s problem has not yet been identified or resolved. Therefore, he will suffer more and  go back to his doctor or the emergency room.

Had this man’s physician looked at him just a little longer after his extensive and costly evaluation, much like we looked a little longer at the picture of the young woman and the old hag, he would have been able to do more for his patient than simply assure him what disorders he didn’t have. Had he looked at his patient from a functional perspective using a sophisticated diagnostic tool such as asking him, “How are you doing?”  the doctor may have discovered that his patient had not been performing too well at work and had not engaged in family and community activities for the past six months. This information could have uncovered the primary diagnosis and lead to the proper course of treatment, reducing this patient’s suffering and prevented him from continuing to return to the healthcare system again and again. In this man’s case, his abdominal pain was a physical manifestation of an Anxiety Disorder and had this been recognized and treated appropriately, not only would his abdominal symptoms have subsided he would have been able to function a lot better at work and at home, as well.

When functional impairments, such as poor work performance or lack of participation in family or community activities, do not accompany an identifiable structural process, neither the person nor his physician necessarily recognizes this as a medical problem. Unfortunately, this is the exact scenario experienced by of one in three of all disabled adults on our planet all of whom have a diagnosable and treatable medical problem called mental illness.

Our healthcare system fails to recognize and treat our mental health because it is purely a structure driven system. Our system is more adept at telling us what structural health problems we do not have, than at actually identifying those health problems that most impact our ability to function fully. For instance, a person suffering from severe headaches may see a Neurologist and have a normal neurological examination and a normal MRI of his brain. The Neurologist will tell him that his headaches are not caused by a brain tumor or an aneurysm. While the reassurance may offer a temporary sigh of relief, it does not resolve the man’s health problem; the system fails.

I assure you that the next time any of us see our primary care physician or go to the emergency room, we will be looked at structurally, regardless of the reason for our visit. The nurse will measure our height, weight, blood pressure, temperature, pulse, and respiratory rate. Then,  a physician will ask us to point to where our problem is. The doctor will look at, touch, listen, probe, and possibly scan the area in 3D. With almost equal certainty, neither the nurse nor the physician will ask us how we are doing at work or in school, or if we take part in activities with family or friends, or in our communities.  Not looking for or seeing a person’s functionality or performance is the deficiency of our nation’s healthcare system that makes this the worst of times for Americans with any degree of mental health problems.

Setting 2

Mental Health in the American Workplace

For American employers and employees, with mental health problems, this is also the worst of times to deal with mental health problems. Employers’ indirect costs arising from their employees’ mental health problems–in the form of short- and long-term disability, absenteeism, and presenteeism–is four times greater than  a company’s direct costs for employee healthcare. (5)

Why do these employees with mental health issues contribute more to healthcare costs? In a service-based economy such as ours, an employee’s productivity is most dependent on her cognitive abilities, such as deductive reasoning, task management, effective communication, and creativity. Health issues of all types will likely impact a service workers’ performance. Workers with mild or even “sub-threshold” mental health problems have measurable productivity problems early on, well before they experience more serious health effects. (5) And these employees tend to use the healthcare system more often than people of the same age group who do not experience mental health issues. In essence, American employers are paying for their employees’ mental health problems twice–once for the direct costs of frequent use of healthcare services, and again for the indirect costs for the diminished productivity of the affected employees.

Two facts emerge from employers’ data on the impact of mental health on the productivity of a workforce. First, based on the current numbers, it is clear that employers have not yet found a remedy for an extremely costly problem in both financial and human terms. Second, based upon the numbers, employers prove capable of measuring its workforces’ performance in a way that accurately identifies a health problem that eludes identification in the healthcare system; our healthcare system has proven remedies for the problem but fails to recognize it. When employers demand their money’s worth from a healthcare system for which they are paying, it will be the best of times.

For a detailed plan of how employers can get what they and their employees need and deserve from the healthcare system, contact me @ drweisberg@wmchealth.com

End Post

Mitchell R. Weisberg, MD, MP

Weisberg Medical Consulting

Weisberg Medical Consulting adds a clinical perspective to an Organizations Balanced Scorecard, aligning the health of their workforce with the health of their enterprise.


to an

Organizations Balanced Scorecard

by

Mitchell R. Weisberg, MD, MP

  • Employers’ indirect costs (absenteeism, presenteeism, employee turnover, diminished talent attraction-retention and successorship) resulting from Employee Mental Illness is 4 fold greater than their direct costs for Employee healthcare. (1)
  • Arguably, at least some part (in this physicians informed opinion, the majority) of this burden is due to the ever-increasing cognitive demands on the American Workforce that was the result of a continuous servicization of the American Economy that began with the dawn of the information age just under 6 decades ago. It was within this time period that our national economy transformed (I say, evolved) from one highly dependent on its workforces’ brawn to one almost entirely dependent on its brains. *
  • In spite of the fact that people with mental illness use the healthcare system much more often than does the general population, most (2/3) of Mental Illness is never recognized (diagnosed) or treated. (2)
  • Once diagnosed, Mental Illness is highly treatable with between 70 and 90 percent of people having significant reduction of symptoms and improved quality of life with a combination of medication, talk therapy and other supports. (2)
  • A major obstacle to recognizing mental health disorders is their lack of symptoms in the traditional sense of the word thus making mental illness the invisible epidemic. (3)
  • Identifying mental illness is dependent upon an awareness of a person’s functional status such as their social-interpersonal functioning and workplace (vocational) performance.
  • People with any form of chronic medical (physical) condition such as Diabetes or COPD, experience minor mental health or cognitive impairments as well as full-blown mental illnesses much more often than their healthy counterparts.
  • Not uncommonly chronic medical conditions may initially manifest with mental health impairments including full-blown mental illnesses.
  • The recognition and effective treatment of mental illness in people with other chronic medical conditions results in better overall outcomes than those in whom their mental illness remains unrecognized and untreated.
  • The early recognition and effective treatment of mental illness has a profoundly positive impact on human health in general.
  • Since there is evidence that even workers with mild or “sub-threshold” problems begin to show productivity problems early on – perhaps long before they experience other health consequences – employers are in a unique position to effect significant change in the way services are delivered. (1)
  • Over the past two decades The Balanced Scorecard has been widely employed as the Business Management tool of choice by most major employers worldwide. (4)
  • The Balanced Score Card aligns the goals of an Organization with the personal goals of its Employees for the purpose of achieving optimal performance at the Organizational level.  (5)
  • Periodic measurements of Employee Performance in terms of achieving their personal goals (employee performance metrics) are an essential part of an effective Balanced Scorecard. (5)
  • Contained within the core of Employee Performance Data is vital information about Employee Health in general as well as the most essential and most overlooked information required for the early recognition of Employee Mental Health in particular. (1)
  • Since there is evidence that even workers with mild or “sub-threshold” problems begin to show productivity problems early on – perhaps long before they experience other health consequences – employers are in a unique position to effect significant change in the way services are delivered. With more than 2 decades of clinical experience as both a Primary Care Physician and a Mental Health Care Provider and a career commitment to optimizing the health and performance of his patients, this physician is in a unique position to aid employers in getting healthy returns on their health and human capital investments. (1)
  • This physician can show the stakeholders of any Organization that there indeed is a tremendous value in adding a clinical perspective to their Balanced Scorecard.
End Post       


  • Enterprise Performance is a direct result of the collective performance of its employees.
  • Employee Performance is a sensitive indicator of Employee Health; performance is literally a vital sign.
  • Thus, Enterprise Performance and Employee Health are in alignment.
  • Therefore, unless participation in an Employer Based Health Initiative is performance driven the outcomes will be suboptimal. 

The time has come to add a clinical perspective to your Organizations Balanced Scorecard.

Mitchell R. Weisberg, MD. MP



  • Employers’ indirect costs resulting from Employee Mental Illness is 4 fold greater than their direct costs for Employee healthcare. (1)
  • In spite of the fact that people with mental illness use the healthcare system much more often than does the general population, most (2/3) of Mental Illness is never recognized (diagnosed) or treated. (2)
  • Once diagnosed, Mental Illness is highly treatable with between 70 and 90 percent of people having significant reduction of symptoms and improved quality of life with a combination of medication, talk therapy and other supports. (2)
  • A major obstacle to recognizing mental health disorders is their lack of symptoms in the traditional sense of the word. (3)
  • Recognizing mental illness depends on an awareness of an individual’s functional status such as their social functioning or work performance.
  • Since there is evidence that even workers with mild or “sub-threshold” problems begin to show productivity problems early on – perhaps long before they experience other health consequences – employers are in a unique position to effect significant change in the way services are delivered. (1)
  • Over the past two decades The Balanced Scorecard has been widely employed as the Business Management tool of choice by most major employers worldwide. (4)
  • The Balanced Score Card aligns the goals of an Organization with the personal goals of its Employees for the purpose of achieving optimal performance at the Organizational level.  (5)
  • Systematic  measurements of performance against the Organization’s stated goals is an essential part of an effective Balanced Scorecard. (5)
  • Information contained within employee performance data, if viewed from a clinical perspective, will facilitate the early recognition and treatment of mental illness in a workforce. (1)
  • The early recognition and treatment of mental illness in a workforce yields a significant Return on Investment for Employers. (6)
  • Since there is evidence that even workers with mild or “sub-threshold” problems begin to show productivity problems early on – perhaps long before they experience other health consequences – employers are in a unique position to effect significant change in the way services are delivered.
  • With more than 2 decades of clinical experience as both a Primary Care Physician and a Mental Health Care Provider and a career commitment to optimizing the health and performance of his patients, this physician is in a unique position to help employers effect this change. (1)
  • This physician can show the stakeholders of any Organization how to realize the value of adding a clinical perspective to their Balanced Scorecard.
End Post

It should come as no surprise that when the term human capital first appeared in the annals of economic theory some 60 years ago it was a fungible resource similar to the machinery of what was, at that time, a manufacturing based economy. (1) This characterization literally changed at the speed of light with the United States response to the Soviet’s launching of Sputnik in 1957 and the advent of  what is now commonly called the World Wide Web(2) As a direct result of this development, there has been a continual servicization of the US economy ever since with 77% of US GDP in 2010 being derived from the service sector. (3) In this same 60 year time span, the US labor market had to transition from one based almost entirely on its brawn to one that is now based almost entirely on its brains. The implications of this transition we are only now beginning to collectively witness. For instance, it is the cognitive evolution of our nations economy that resolves the seemingly paradoxical coexistence of Depression level unemployment with the critical low mass in attraction and retention of talent and successorship in Corporate America(4) When viewed from this cognitive” perspective it also should come as no surprise that absencedisability and unrealized productivity related to issues of employee mental health cost employers more than four times the cost of current employer-based medical treatment. (5) Leadership, both public and private, continues to fixate on spiraling health care costs while perilously neglecting the value of the most important asset in our national portfolio; our Human Capital.

Mental illness is the single largest contributor to disability on the globe accounting for 33% of the total and the single largest cause of impaired work performance in the United States. (6) While 70 to 90% of people with a mental illness improve appreciably with treatment only 1 in 3 workers with mental illness are ever even diagnosed much less effectively treated. (7) What is more is that always preceding a person’s first or repeated episode of a full-blown mental illness, there is a sub-threshold form of the illness where functional impairment is the only harbinger of the malady that is to follow. (8) Organizations that effectively watch and appraise their employees work performance and align this with their Balanced Scorecard are in a unique position to leverage these performance metrics in a way that will have an order of magnitude impact on both the health of their workforce and their bottom lines.

Organizational Health in the 21st Century:

Work Performance; a New Vital Sign for a New Economy

Providers of a cognitively complex service with a global reach need only experience an episode of jet lag to understand how functioning at anything less than their optimal mental state can negatively impact their work performance, much less should they experience a full-blown mental illness. One in four members of the American workforce is impaired by a treatable mental illness; arguably, those employees providing the most cognitively complex services will be most susceptible to performance impairment. While Cognitive Behavioral Therapy (CBT), psychotropic medication or both is effective in 70 to 90% of people with mental illness, only one in three workers with mental illness actually seeks the attention that they need and only one in ten actually receives adequate treatment. (8) In addition to the burden of human suffering, there is the unrealized value of the most critical asset in an Enterprises portfolio, its human capital.

If we are to fix this problem, we first must understand why we are failing to recognize mental illness. The perceived stigma of being diagnosed with a mental illness continues to play a significant role in the under-recognition of mental illness. However, the fact that persons with non-diagnosed mental illness, on a per capita basis, utilize significantly more non-psychiatric healthcare services including non-psychiatric hospitalizations, Emergency Department visits as well as visits to Primary Care Physician that the general population points to the main culprit, and that is the  failure to recognize mental illness.

Two factors contribute to the invisibility of  mental illness.  First is lack of recognition on the part of patients that their flailing work performance may be due to a mental health condition, and thus they don’t seek the care of a professional for diagnosis and treatment.  The second is the medical school and post-graduate training physicians receive, which focuses on diagnosing and treating illnesses that are three-dimensional; that have a color, a texture or a mass that can be pointed at with a finger. In contrast, mental illness is invisible to every clinical tool that the modern healthcare provider has at their disposal.  Two clinical vignettes can best demonstrate this contrast:

–      In the first post season playoff game on the opening pitch all 50,000 fans in the stadium hear the loud popping noise that comes from the pitcher’s mound and witness him fall to the ground grabbing his right shoulder in utter agony. Neither the team’s trainer nor a single spectator need to see him throw a second pitch to diagnose the fact that something terrible has happened to the shoulder of their beloved star’s pitching arm.

–      Another pitcher has a 10 year career ERA of 1.8 until this season, in which his ERA has fallen to 4.1.  Needless to say his team did not reach the post-season. Neither his trainer nor a single fan in the stadium ever considered that this once high achieving superstar had recently begun to have depressive episodes due to an undiagnosed mental condition known as Attention Deficit Disorder. In spite of the fact that his performance on the mound is meticulously and accurately measured, none of these metrics gave any sign that his decline in performance was a direct manifestation of his underlying mental illness.  Failing to receive treatment widely recognized as highly effective in restoring function and performance, this pitcher was sent back to the Minor Leagues and was never seen in the Majors again.

In the case of the first pitcher the definitive diagnostic tool for recognizing a torn rotator cuff is the MRI.  But what most organizations, including baseball teams and companies of all types don’t realize is there is an equivalent to the MRI for detecting a range of mental health conditions.  Inherent in the Human Resource organization’s rigorous employee processes and performance tracking resides the essential information to assure that a workforce’s health is maintained at an optimal level, and to detect instances where a treatable mental health condition is  likely present.

The Human Resources professional of the 21st century, wittingly or not, is at the front line in this nation’s battle to break with its myopic cost oriented health care system and lead us to one that is value based  with a return on investment; and who better qualified for this position than an person who actually has the term human capital in mind with every action she executes. Like a principle of an elementary school, she spends 90% of her professional life with 10% of the human capital whose professional lives are within her charge; but this is not where the similarity ends. The 21st century Enterprise comes equipped with performance metrics or, highly advanced versions of report cards that, when executed well, hold invaluable information germane to the future continual success of the employee, manager or executive to whom it is applied.

End Post

Please stay tuned for the following posts coming soon:

  • Performance-Health: The missing link in the evolution of Employee and Organizational Wellness
  • What the quality of an Employee’s performance saying about the quality of their health and why it is important to know?
  • Anticipating the unintended consequences of Performance as a Vital Sign
Thank you for sharing your comments and insights!

It should come as no surprise that when the term human capital first appeared in the annals of economic theory some 60 years ago it was characterized as a fungible resource similar to the machinery of what was, after all, a manufacturing based economy. (1) This characterization of human capital changed at the speed of light in the aftermath of the Soviet’s launching of Sputnik in 1957 and President Eisenhower’s determination that the United States to never again lose to another nation in the race for information, and the  Advanced Research Projects Agency (ARPA) and soon thereafter, the internet was born. (2) Prior to Sputnik, approximately 40% of the US GDP was derived from the manufacturing sector. (3)  From the dawn of the Information Age however, a virtual servicization of the US economy has occurred with 80% of US GDP in 2011 being derived from the service sector. (3) With this transition from a manufacturing to a service economy, the US workforce evolved from one dependent on its brawn to one that is based almost entirely dependent on its brains; consequently the employee health issues that are most likely to impair their work performance hav  (5) Mental illness is the single largest contributor to disability on the globe accounting for 33% of the total and the single largest cause of impaired work performance in the United States. (6) While 70 to 90% of people with a mental illness improve significantly with treatment only 1 in 3 workers with mental illness are ever even diagnosed much less effectively treated. (7) What is more is that always preceding a persons first or repeated episode of a full blown mental illness, there is a sub-threshold form of the illness in which functional impairment is the only harbinger of the malady that will soon follow. (8) Organizations that effectively monitor and appraise the performance of their employees as a component of their Balanced Scorecard are in a unique position to leverage these performance metrics in a way that will have an order of magnitude impact on both the health of their workforce and their bottom lines.

Please stay tuned for my upcoming post,

Organizational Health in the 21st Century:

Employee Performance; the New Vital Sign in the New Economy

Until then remain healthy and remain effective.

End

Mitchell R. Weisberg, MD, MP


The current Prognosis for U.S. Business:

Footing for at least 1/3 of this nation’s healthcare expenditures, the continually rising costs in this sector is a cancer that threatens the life of U.S. Business. In the past 2 decades healthcare expenditures have increased 300%; a rate that is 5 times that of inflation for this same time period.  This represents 16.2 % of GDP (gross domestic product), giving our nation the unflattering distinction as the leader of the industrialized world in this category.(1)  Based on the current spending trajectory, by this nation’s tricentennial nearly one half of its collective productivity will be consumed by healthcare expenditures. (2) Characterizing this issue as a terminal illness is not simply a convenient medical metaphor; absent an unprecedented fundamental change in how healthcare is provided in the near future, the long-term prognosis for U.S. Business is certainly a grim one.  

The Diagnosis: US Business became so fixated on cost they have completely forgot about value

For the past 3 decades Corporate Americas’ prevailing healthcare strategy has been to outsource to third-party payers. While initially cost-effective, based upon the statistics just cited, this is clearly no longer the case. In its effort to survive spiraling health care costs, US Business has adjusted its strategy to cost shifting to its employees.This has only served to deepen the crisis by disenfranchising the workforce during an economic climate in which US business can ill afford to do this. While US unemployment is at its highest post Depression rates, recruitment and retention of talent and successorship are also at a critical mass in our nation; at the same time, global competition has never been more intense. Most importantly, cost shifting is only postponing the inevitable need to grapple with what, after all, is the elephant sitting on the sofa; an overvalued healthcare system. By conservative estimates 1 dollar of every $3 spent on healthcare in this country is wasted outright.(3)

This physician’s proposed course of Treatment

Sound business principles dictate that curing the malignant growth in health care spending be derived from novel combinations of proven remedies already in existence. In house strategies, such as on site wellness programs is one such proven remedy. Such programs have consistently demonstrated healthy returns on investment of $3 to $6 return on every $1 invested. While still an emerging trend, on site health services have higher employee participation and employer satisfaction rates than most other health programs. (4) In contrast to the negative PR generated by cost shifting, companies offer on site programs to stay competitive in the marketplace and use such programs as a recruitment and retention benefit. While clearly a breath of fresh air, in-house strategies have inherent limitations that keep them from making any more than a small dent in our current healthcare crisis. However, with some creativity these limitations may be easily overcome. When organizations have  invested in on site wellness programs they typically realized returns quickly. Unfortunately, due to the inherent selection bias of such programs, these returns seem to plateau just as quickly. Selection bias would predict that those employees most likely to participate  in an on site wellness program will be those already wellness minded. As a result if this phenomenon, these programs will tend to help those employees that least need it while leaving those employees that have the most to gain, behind. Overcoming this limitation would require a method to easily identify those employees that would derive the greatest benefit from an on site wellness program and provide them with the incentives to take part in it. Such methods of employee selection will appropriately raise the ethical and legal concerns regarding an employees privacy and a multitude of other such issues. However, with what this physician has in mind, such issues will be of no concern. Before addressing this issue, it is necessary to provide the clinical background information upon whicn this authors solution for healthcare is founded. Please stay tuned for my next post, The Neuroscience of a Service Based Economy

 

End

Mitchell R. Weisberg, MP, MD

(1) http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358 http://www.measuringworth.com/ppowerus/.

(2)  http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf

(3) http://thomsonreuters.com/content/press_room/tsh/waste_US_healthcare_system

(4)  http://www.hewittassociates.com/_MetaBasicCMAssetCache_/Assets/Articles/2010/Hewitt_Survey_Findings_TheRoadAhead_2010.pdf


While I applaud the Obama Administration’s passing into law of The Mental Health Parity and Addiction Equality Act in January of this year, its achievement is more symbolic than practical. Mandating that Employers provide equal coverage for the treatment of mental health disorders, it does nothing to address the issue that costs four times as much in terms of dollars and infinitiely more in terms of human suffering; the lack of recognition of mental health disorders. Of the 10% of the work force that suffers with Depression annually in the U.S., most of these individuals are being treated inadequately or not being treated at all; and this is not simply due to the perceived stigma surounding mental health diorders disuading individuals to seek treatment. 50% of patients with depression do not seek medical help; 50 % of those who turn to their doctors are not diagnosed, and only one-half of those who are correctly diagnosed receive appropriate medical treatment.(1)

Employers did not need Mental Health Parity Legislation to have a bottom line motivation to invest in the mental health of its workforce. Absence, disability and lost productivity related to mental illness cost employers more than four times the cost of employee medical treatment.(2)

It appears that mental health disorders are not only difficult to identify clinically, their exorbitant cost has no designated column on a balance sheet, either.

This physician’s diagnosis is that we have a Societal Disability to rationally confront the issue of mental health. If we do not raise our standards  from simply shooting an even par, I am afraid that our prognosis is grim.

End

Mitchell R. Weisberg, MD, MP

(1) Ann Intern Med April 20, 2010 152:JC4-13;

(2) Partnership for Workplace Mental Health, A Mentally Healthy Workforce—It’s Good for Business , (2006), www.workplacementalhealth.org.