Different - Johns Hopkins Bloomberg School of Public Health...Ask people who know nothing about your...

Different:

Reflections from an Occ Doc*

Novartis Business

Services

Robert Goldsmith, M.D., MPH, FACOEM

Mid-Atlantic Regional OEM Conference

October, 2018

*Not really

Novartis Business

Services

The goal of this session is to spark ongoing systematized

discussion about the future of occupational medicine, and the

role of MARCOEM in sustainability, growth, innovation and

excellence in the field.

The next hour is not intended to find all the answers. Rather,

it seeks to uncover the essential questions.

*Dr. Goldsmith is a FT employee of Novartis Services, Inc. There are

no conflicts to disclose.

Novartis Business ServicesBusiness Use Only3

A Mnemonic for Pulmonary Edema

Circa 1983

M

O

I

S

T

D

A

M

P

orphine

xygen

V diuretics

it ‘em up

ourniquets

igoxin or digitoxin

minophylline

ercurials

hlebotomy (or Paste)


The Secret’s Out


Nonfatal Occupational Injury and Illness Incidenc Rates by Case Type, Private Industry 2003-2016*

*Source: U.S. Bureau of Labor Statistics

Injury Rates are Down-Hooray!


So What’s the Problem?


An (old) Internist’s Perspective

• The pace of true innovation in OH is far behind every other medical

specialty. The law of process limits is largely ignored. OSHA is an

impediment to advancement in the field. NIOSH relies on industry and

academia for innovation. OEM has significantly ignored precision medicine,

in favor of population health.

• OH services are generally viewed by employers as a cost center. Medical

Directors have not developed a value-based approach to occupational

health. Without considering value, the practice of OH will always be under

pressure.

• New Occ Docs are training as generalists, rather than following their true

passions. Their career choices are handicapped by overwhelming student

debt.

• Employers claim to give a crap about health and safety, but very often, they

really don’t.

• OEM may have an identity crisis.


Identity: Some Existential Questions

1. Is OEM a better fit within HR or within HS&E?

2. Should OEM be more aligned with public health or medicine?

3. Does OEM appropriately consider both nature and nurture?

4. Do occupational health clinicians advocate for employees or employers?

5. Do OEM training programs adapt to the changing landscape?

6. Does the field aspire to achieve excellence or compliance?

Let’s start with innovation...


One of My Innovation Heroes

1. Japanese-American

2. Former world record holder

3. Now boycotts world championship

4. Lives to eat

5. He’s more than a hot dog.


As Long as We’re Having Fun...

1. Former American Olympic athlete

2. Track and field

3. Gold medal winner-1968

4. His innovation was a flop


What Drives Innovation in OEM?It ain’t the government

“OSHA recognizes that many of its permissible exposure limits

(PELs) are outdated and inadequate for ensuring protection of

worker health. Most of OSHA’s PEL’s were issued shortly after

adoption of the Occupational Safety and Health (OSH) Act in

1970”.


Meanwhile, in Medicine...

• BRCA1 Discovered in 1994

• Test commercialized in 1996.

• Current testing cost-$199 (23andMe)


The job isn’t to catch up to the status quo; the

job is to invent the status quo.-Scott Godin

And From Business...


Nonfatal Occupational Injury and Illness Incidenc Rates by Case Type, Private Industry 2003-2016*

*Source: U.S. Bureau of Labor Statistics

Is this Good Enough?


Process Limit

Innovation

opportunity

How Much “Better” Can We Get?Or do we need to “think different”?


A Standard Ergonomics Improvement PlanI/

I R

ate

Post-injury

assessments

New hire

trainingAnnual

retrainingImplement

controls

Early

intervention

0

Treating the job and the injury


Find the Personal Resiliency Factor(Hint: there is none)


“If I’d asked them what they wanted, they would have said, ‘faster horses’.”

-Henry Ford

There’s a Method to This Madness

“Sometimes you gotta’ throw out the baby with the bathwater

and start a new family”.

-Anonymous


There’s a Method to This Madness

1. Be inspired by the world around you.

2. Ask people who know nothing about your business.

3. Turn the existing process backwards, upside down, or inside out.

4. Think crazy thoughts. See if they still make sense the morning after.

5. Develop a tollgate system

An idea is born

24 hoursNuts?

Yes

No Develop

ConceptPoC Start programTG1 TGx

The UHC Garage System


Precision Medicine Meets OEM

Will OSHA respond? (Hint: no) Will employers?

Is there value in precision OEM?


Let’s Talk Value

“If I asked my boss for a million bucks, he’d

laugh my face!”

-Former big pharma medical director


The Curious Case of New HiresAre they 100% ready to go?

Day 1

• Young

• Healthy

• Energized

• Fully productive

Strain

I/I

Disability

Separation

Traditional OEM plays defense

Current state

Aspiration

100%

Healthy


The Curious Case of New HiresPlaying offense creates (+)value

Day 1

Strain

I/I

Disability

Stressed

? Healthy

? Fit

Not 100% productive

Stress

management

Behavior

modification

Chronic

disease care

Separation

Current state

Aspiration

<100%

Healthy


The Currency of Business

Marketing and sales

Product development

Productivity

Cost avoidance

Compliance

COPQ

EoC

Visibility

Community service

0

0

+++

+

++++

+

++

+

0

Form of Currency Estimated OEM Contribution


Creating Value Through OEM


It Must be Measured, Analyzed and Improved


The Next Generation of OEM CliniciansWhat the kids are thinking

“My passion is to help people and save lives. I also

like dance.”

-Not Yet Famous OEM Physician


OEM

PT

Sports Medicine Kinesiology

Orthopedics

OEM

Care for Professional Dancers-2018


PT


Orthopedics OEM

What’s Right with this picture?


PT


Orthopedics

OEM

Or this picture?


According to the Association of American Medical Colleges, the median four-year

cost to attend public medical school exceeds $240,000. A private medical school

degree can exceed $340,000. An institutional scholarship can ease this burden, but

the typical four-year award is only $18,000. Fewer than one medical student in

five receives $100,000 or more in financial assistance. Because few medical

students are wealthy enough to pay cash, most borrow heavily. The median

education debt of a new medical school graduate is $190,000. Fourteen percent

start their residency training owing $300,000 or more.

• How will debt impact the careers of next gen of occupational physicians?

• How will this debt burden impact the next gen of occupational medicine?

• What’s the plan?

Starting Deep in the Hole


Medical Degree

OEM Residency

Subspecialty Training

MBA/MHA

Corporate Medicine

Fellowship

OH Subspecialty

Pass the Boards

A Possible Strategic Shift

Expanded elective menu

OEM Generalist

Subspecialty dabbles

Financial planning assistance


Entrepreneurship, hmm...


A Couple of Final Ideas to Munch On

1. Consider building strategic planning into the MARCOEM OS.

2. Update the mission statement for OEM. Re-define the goals,

objectives, scope, business case, stakeholders, customers, and KPI’s.

3. Identify basic value streams and currencies. Build models based on

value to the employer.

4. Consider reviewing residency and fellowship curricula

• Financial planning and debt resolution

• Business, project management and leadership training

• Nurture curiosity

• Career decision support

• Full-time plus part-time work

• OM-PCP hybrid models

• Linking OH with personal passion

5. Reposition OM as a medical specialty, that innovates in step with other

specialties. Consider nature as an equivalent (or greater!) determinant

of human occupational health.

Novartis Business Services

“The secret to my managerial success is

keeping the people who hate me away from the

people who haven’t yet made up their mind!”

-Casey Stengel

Thank you!

37 Business Use Only

Different - Johns Hopkins Bloomberg School of Public Health...Ask people who know nothing about your...

Documents

Transcript of Different - Johns Hopkins Bloomberg School of Public Health...Ask people who know nothing about your...