The future of healthcareLearn More

Work with employers to improve health

719229070_d47589476e_z

Annual profits confirm whether the staff of a company performed well. Profit margins, and the rate of innovation, closely reflect the health of the people who deliver that success. Employers are, and perhaps always have been, a key partner in the drive to improve the health of the nation. What has become a greater imperative to forge a partnership is the threat to profit margins from the looming spectre of chronic illness in epidemic proportions. Work is a vitally important aspect in most of our lives:

The average working American spends the majority of his or her waking hours on the job. Some of us live and breathe our work. Others of us work to pay our mortgages. Either way, the workplace has become an important source of social capital for millions of Americans – a center of meaning, membership, and mutual support. More than ever, we find our close friends and life partners on the job, we serve our communities through work-organized programs, and we use the office as a forum for democratic deliberation with people different from ourselves. Countless studies show that a workplace with strong social capital enhances workers’ lives and improves the employer’s bottom line.The workplace and social capital.

Similarly in Australia people spend most of their waking time at work. On average 34 hours a week . Sixteen percent of us work more than 50 hours per week. In contrast we spend 6-9 hours  per week doing house work and 6 hours and twenty seven minutes per day asleep. The impact of the working environment on health ranges from physical to psychological and can be both harmful and beneficial. Employers in most developed countries are therefore legally obliged to provide:

  • safe premises
  • safe machinery and materials
  • safe systems of work
  • information, instruction, training and supervision
  • a suitable working environment and facilities.

However there is much more that can be done to optimise the health of employees. The economic argument for this is clear and closely related to the rising incidence of chronic and complex illness among the working population. In 2002 approximately 59 per cent of global death was attributable to chronic, non-communicable diseases and the toll is projected to increase to 66 per cent by 2030.  The other outcomes that should worry employers is the prospect of premature retirement from the workforce.

It was found that individuals who had retired early due to other reasons were significantly less likely to be in income poverty than those retired due to ill health (OR 0.43 95% CI 0.33 to 0.51), and there was no significant difference in the likelihood of being in income poverty between these individuals and those unemployed. Being in the same family as someone who is retired due to illness also significantly increases an individual’s chance of being in income poverty. Schofield et al

A report by the Australian Institute of Health and Welfare in 2009 outlined the consequences of chronic illness and early retirement on the entire Australian economy. It concludes that:

  • People with chronic disease had, on average, 0.48 days off work in the previous fortnight due to their own illness, compared with 0.25 days for those without chronic disease.
  • The annual loss in workforce participation from chronic disease in Australia was around 537,000 person-years of participation in full-time employment, and approximately 47,000 person years of part-time employment.
  • For people participating full-time in the labour force, there was a loss of approximately 367,000 person-years associated with chronic disease, approximately 57,000 person-years in absenteeism associated with chronic disease and 113,000 person-years were lost due to death from chronic disease.
  •  Estimates of loss do not take into account lower performance while at work. Similarly, the effect of loss from participation in the unpaid labour force (carers, parents and volunteers) has not been accounted for. The estimates, therefore, underestimate the loss in workforce participation associated with chronic disease.

Therefore employers who wish to retain an effective workforce, and by corollary their profitability, need to invest in the well being of their workers. This responsibility extends beyond ensuring the physical safety of their workforce. A workforce that is under threat from an ageing population and an alarming incidence of retirement through ill health. If employees spend most of their waking hours at work then the following might concern the employer (click the links for the literature):

I believe health innovators who address these issues in their dealings with industry will discover an open door with massive potential for mutual benefit.

Picture by Vase Petrovski

Putting the patient first is not just good medicine, it’s good business

Primary healthcare is mostly organised as if all patients had the same needs. Patients who have a chronic illness who are repeat visitors and those with significant risk factors for future disease, are expected to fit into a system that is designed to meet the needs of someone with urgent and temporary illness. The current system is designed as if it doesn’t really matter which doctor consults them or what is known about their needs.

These are the facts:

1. Each week, there are 1,700 new cases of dementia in Australia; approx. one person every 6 minutes.

2. Cardiovascular disease affects one in six Australians

3. In 2011/12,4.6 million Australians(32%)aged 18years and over had high blood pressure (systolic or diastolic blood pressure is ≥140/90 mmHg or taking medication). Of these, more than two thirds (68%) had uncontrolled or unmanaged high blood pressure (not taking medication), representing 3.1 million adult Australians.

4. 1 in 2 Australian men and 1 in 3 Australian women will be diagnosed with cancer by the age of 85.

In some cases patients are expected to make appointments at a time and place that suits the practitioner. They might be seen for as little as 10 minutes and can feel that their questions and concerns have been addressed. The consequence is that both the doctor and the patient become frustrated.

The clinician complains about workload while the patient seeks alternative ways to meet their needs. There is published evidence that patients with chronic illnesses have significant unmet needs that impact on their quality of life.

The lean innovator knows that the future success of healthcare depends on serving the needs of those who are likely to need to consult a doctor many times in coming years. These patients need to live life despite pathology and to care for others even when they are not feeling their best. The person with enduring health problems also needs to believe that their doctor knows them, understands their perspective and has their best interests at heart.

In the business world such a loyal customer is prized. The business strives to make them feel valued. Great businesses constantly reinvent themselves and look for new ways to ensure that the customer is happy with the service on offer. It takes relatively little to satisfy the patient in a primary healthcare setting. We know, but sometimes forget, that what the patient craves most of all is their doctor’s undivided attention. Like a customer in any other business our patients want to feel that they matter.

We don’t need a department or a huge budget to innovate, because as both business owners and doctors we have the authority and insight to redesign how the patient feels from the moment they walk through the door and at every stage before and after their appointment.

If research has taught us anything it is that the fundamental need in healthcare is for their doctor to have good communication skills. Without that foundation nothing that technology can do for the patient will ever be good enough. Every touchpoint of the system needs to reflect the experience in the consulting room and should say to the patient—we know and care about you.

What is the most important thing you do for the people you serve? Do they get a sense of that from the moment they look for your help?