Ability to apply a business model will play part in future
(Editor’s note: This is the second of a two-part series on the state of the occupational health profession. In last month’s installment, we examined some of the forces that led the profession to its current state. In this article, we explore the trends that today’s professionals cite as their greatest challenges, and what is being done to overcome them.)
If you want to know what’s happening in any profession, ask the people on the front line. "Generally, a very common theme runs through all of the professions, from nurses to attorneys," says James E. Leemann, PhD, Scottsdale, AZ-based president of The Leemann Group (a management consulting group that offers the use of systems thinking approaches to redesigning organizations) and an adjunct professor with the Tulane University Center for Applied Environmental Public Health. "They speak to a much higher degree of frustration in doing their work, difficulty in getting programs implemented, and the struggle of having to deal with things like downsizing and retirements. Many of these senior folks see their younger colleagues becoming frustrated sooner and leaving the field, transitioning into a totally unrelated area they believe will provide a greater chance of advancement. There also seems to be a lack of students to come behind them."
His insights are in large part informed by his directorship of the Pulse of the Professions project. Currently in its initial phase, the project may ultimately take the pulse of more than 200,000 environmental health and safety and occupational medicine professionals. The pulse project is a joint initiative of the Scottsdale-based Center for Environmental Innovation (CEI), of which Leemann’s group is an affiliate, and the Wharton School at the University of Pennsylvania in Philadelphia.
The initial phase, which consists of numerous focus groups and a general survey of industry professionals, has so far involved occupational health nurses, OSHA professionals, environmental health and safety attorneys, and insurance company loss professionals. Most participants have been in their profession a minimum of 15 years.
But Leemann’s observations, and those of his colleagues, are not limited to these focus groups. "At the Wharton School, we have one meeting after another among students who are concerned with this matter," notes Paul R. Kleindorfer, PhD, co-director of the Pulse project.
"Some of the main challenges we see involve an aging organization. The average age for members joining AAOHN [The American Association of Occupational Health Nurses] is 44, and the average age of all members is 51," says Denise Gillen, RN, BSN, COHN-S, CM, director of the New Mexico Spine Center in Albuquerque. "What we’re feeling is right on target with why Jim [Leemann] is doing the project in the first place — we’re not bringing in as many new professionals as are leaving the profession."
Gillen, who participated in one of the focus groups, cites another challenge raised within the groups and reinforced by real-world experiences: "Sometimes occupational health professionals are having to almost sell or justify the cost-benefit of [being] on staff," she notes.
Are we really necessary?
Gillen’s comment touches on what Leemann sees as by far the most serious challenge facing the profession: justifying its existence.
"It all comes back to the overarching belief in many quarters that the whole issue is passé — that it’s been taken care of," he says. "[Environmental health and safety] policies are in place, all the regs are there, so what’s the problem? And management believes that employee health also has been and is being taken care of. So, unless there is just a massively significant change or rollout of new regs, a lot folks in management believe that essentially technologists can do what they need done — they don’t even need registered nurses. What we see is a downgrading of professions, which plays into Joseph LaDou’s paper," he continues (see Occupational Health Management, October 2002, p. 109). "It’s absolutely on the mark; everything becomes an issue of economics."
That’s why, he says, being able to make the business case for your position is so critical. "It will be the difference between whether or not these positions will survive in the future," he predicts.
But it’s more than just being able to make a business case, he continues. "You must be able to communicate in the terms business uses," he explains. "In the past, we have not articulated our case in business management’s terminology — what we’re trying to do and how this will add value. What these professionals need to do is understand the inner workings of the business, something as simple as when the budget cycle is, so they can present programs in a timely fashion. If the budget is already set, your programs are dead."
In other words, says Leemann, you don’t just need to know how to calculate return on investment — you need to know how to sell it, the cycle in which it must be sold, when you can push and when you must wait for a better time. "You have to know what’s going on economically in the company — for example, can it afford to go beyond compliance? Those are nuances that go beyond being able to measure dollars."
Gillen couldn’t agree more. "You need to be able to speak MBA or engineering language, because often the people who make key decisions are senior management who often have that background," she explains. She recalls that when she worked at Phillips Semiconductor and was trying to sell her ergonomics program, "I had to show them it would help in production. I had to show them how ergonomics could streamline the workflow, therefore increasing the bottom line."
Technology plays a role
The rapid pace of technology also is having an impact on the profession, notes Kleindorfer. "The inexorable march of science and what that does in this area gives rise to more and more specialized knowledge — increasingly specialized subfields," he observes. "The certification process for professions like occupational health nurses attempts to keep up with it, but some difficulties reside in the fact that we are continually generating more knowledge about what is risky, how to behave, and so forth." New information technology techniques for linking people together also have to be the radar screen, he adds.
One of pushes of technology, notes Kleindorfer, has been in the direction of virtual corporations, which involves the extensive use of outsourcing. The whole impetus, of course, is to save money. "Our particular problem is the area that involves detailed science, where it’s difficult to codify the service you are getting," he says. "It’s difficult to assure yourself that what you get from the local outsourced lab reports is the same as what the old-time employee doc or nurse was giving. It brings with it specific problems for science-based capabilities — good quality is difficult to verify in a spot-market transaction."
A third key issue, he notes, is that with the recent Wall Street scandals. "The level of trust in corporate America, if not at an all-time low, is not far from the bottom. Many of the scandals have been directed toward greed and the financial issues, but distrust paints with a thick brush [that threatens to include] environmental, health and safety issues."
If you put all three trends together, you get a very difficult balance to maintain, says Kleindorfer. "With technology expanding at a rate of 20% per year, I see a real boiling pot of contradictions and tensions between environmental health and safety needs, the needs of companies and the expectations — at least implicitly — for these professions," he predicts.
What is being done?
Fortunately, the profession has begun to respond to these challenges — albeit just recently. "AAOHN is big on this, and offers business tools on its web site [www.aaohn.org]," notes Leemann.
The organization is also addressing the shrinking pool of nurses. "AAOHN is trying to partner with programs at nursing schools to make sure occupational health nursing is part of the clinical studies," notes Gillen. "We’re working strategically with members across the U.S. at the grass-roots level."
For example, Gillen has personally made contact with the University of New Mexico and has started a dialogue with them and has offered to precept several students. "Atlanta [AAOHN headquarters] provides the documentation that could help them set up the curriculum," she explains. "One of the other challenges schools face right now is that they have limited resources — like instructors and locations for clinical rotations. What we can provide with many large employers are locations for these nursing students."
Leemann is also doing his part on the grass-roots level. "What I tell folks in my class at Tulane is, seek out a mentor on the business side of your company, or a neighbor — someone who will help you begin to learn the subtle nuances of business," he says. "The best mentor is someone within their organization who can tell them. Here the kind of metrics we use at the business level, here’s how we calculate them. That’s the real entrée. Get a set of metrics, and ask someone if they can help you understand how they are put together."
Cautious optimism the rule
Despite the daunting challenges faced by occupational health professionals, experts remain cautiously optimistic that they will be overcome. "I know at OSHA, they see the void coming because a large percentage of their people are very near retirement," notes Leemann, restating one of those key challenges. "However, you can probably say that those people will work a couple more years because their portfolios are now smaller, which is fine in terms of the profession. It gives us a little more time to prepare the work force."
Unfortunately, he adds, some people in management just don’t get it when it comes to the proper role of occupational health. "The responsibility for health and welfare rests on management; that’s what they’re paid for," he notes. "You are there to offer your skills. Some managers feel they are giving up too much power [to the occ-med professionals]."
In the end, however, Leeman is optimistic. "Once you reach the point where survival becomes such a weight on your shoulders, most people will tend to grasp hold of this and run with it," he says.
And it will ultimately be a matter of survival, Kleindorfer insists. "There’s no way you can simply ignore these trends without putting entire companies at risk," he asserts. "This would be along the lines of saying, OK, there’s managed care out there,’ but ignoring it. If you’re a big hospital, of course, you have to pay attention to managed care."
Most employers, he says, understand this, but just aren’t doing anything about it yet. "These people [occupational health professionals] have to have sufficient autonomy to use the professional competence they have fought so hard to get and sufficient recourses to exercise that competence at the right level," he insists. "There has to be meaning in their lives, and they have to have a long-term future."
If employers fail to act, he warns, "No one will come into the profession, these companies will be standing there naked, and some bad stuff will happen."
Gillen, for one, does not believe things will come to that. "In five to 10 years, I see occupational health and environmental health and safety professionals becoming more savvy out of necessity," she predicts. "And we do have many individuals who have already moved more toward that type of role — in human resources and senior management, and as business analysts. The most expensive resource most companies have are their human resources, and who better to help manage them than a nurse who can help evaluate productivity, health, and safety as well."
Gillen says she is very optimistic about the future prospects of occupational health nurses growing in a business perspective and finding themselves on business management teams. "Their status will increase — they will no longer be seen as the nurse who just hands out aspirin," she says. "They will be seen as business professionals who can also look at productivity and help make benefits choices as well as continue to serve the employee population."
Kleindorfer hopes the pulse project will play an important role in this evolution. "In addition to making a business case, there has to be a model for connecting people and their daily lives and their articulated careers to that model," he says. "You can’t just have a static model on how many occupational docs and nurses to hire. You need to know what the framework should be, how to establish, that framework, what the right level is, and how to maintain it.
"We hope to derive some good ideas — what are the ways in which you can legitimate and undertake to do this task in a way that the business case is satisfied, and there are a group of happy people doing good things? That’s what we hope to uncover as we go through this process."
[For more information, contact:
• James E. Leemann, PhD, Center for Environ-mental Innovation, Pulse Project Director, 23068 N. 77th Way, Scottsdale, AZ, 85255-4125. Telephone: (480) 513-0298. Fax: (480) 513-0299. E-mail: email@example.com.
• Denise Gillen, RN, BSN, COHN-S, CM, Director, New Mexico Spine Center, 201 Cedar S.E., Suite 6600, Albuquerque, NM. Telephone: (505) 724-4387.
• Paul Kleindorfer, PhD, The Wharton School, Philadelphia. Telephone: (215) 898-5830.]