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Category Archives: Health Performance-The missing link to better returns on health investments

The posts in this category lay the scientific and conceptual foundation of my corporate consulting services. As an Internist and a Psycho-pharmacologist, I bring a unique perspective to employee health, especially in the setting of a service organization. By analyzing and codifying what I have been doing for my patients for nearly a quarter century, I have developed a proprietary application that allows me to accurately diagnose employees health problems based upon analysis of their work performance issues. This application can interface with any organization to materially enhance the returns on their health investments.


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.

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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

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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

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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.
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  • 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.
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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.

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Mitchell R. Weisberg, MD, MP