Do you have proper balance between your personal and business lives?  Or are the demands of your work infringing upon the quantity and quality of time you have with family, friends, hobbies, and community?

The following work/life balance quiz will tell you the degree to which you should be concerned about work/life balance: 

Work/Life Balance Quiz 

1. Do I work 60 or more hours per week?
2. Do I have little personal down time?
3. When I get home from work, am I exhausted?
4. Does there seem to be precious little time to enhance personal relationships?
5. Is “fun” no longer a word in my vocabulary?

If you answered “Yes” to 2 or more of the statements above, you owe it to yourself to learn more about work/life balance.

The term work/life balance first appeared in the 1970s.  The expression means having equilibrium among all the priorities in your life.  It is interesting to note that state of balance differs from person to person.  However, if there is little or no balance over an extended period of time, the vast majority of people experience stress and, eventually, burnout. 

Persistent stress results in fatigue, frequent illness, eating disorders, upset stomach, headaches, forgetfulness, sleep deprivation, aggravation, and irritability with colleagues, family, and friends.  Research indicates that the workplace has become the single greatest source of stress.  Let’s look at a handful of scenarios that create stress in the workplace.  Do any of these statements belong to you?

• I have little impact or control over decision making
• My expectations of work performance do not meet those of my superiors.
• There seems to be little opportunity for growth, development, or promotion.
• My workload is very heavy, requiring long hours and infrequent breaks.
• My role is not clearly defined.
• The level of communication within my firm does not meet my level of satisfaction.
• I am involved in routine tasks that offer little or no professional stimulation.
• My work environment is unpleasant.

Today’s intense, competitive business climate has created corporate cultures that demand more and more from agency principals, sales managers, producers, account managers, claim consultants, loss control specialists, and customer service representatives.  To get ahead, 60-to-70-hour work weeks appear to be the new standard.  Work overload has been exacerbated by computer technologies that were intended to make our lives easier.  Technology has allowed our clients to view the insurance and risk management profession as a 24/7 business, making the achievement of work/life balance very challenging.

History
In the early 1920’s, the average work week was 50 hours including a full Saturday work day.  Soon thereafter, pressures were put on businesses to cut Saturday to half a day or have the day off completely.  The ability to have two days of rest was unprecedented.  However, by 1927, half of all employers adopted this new practice. 

This new practice was short lived.  Beginning in the late 1920s, advertisers persuaded Americans that happiness would not come from leisure rather from the purchase of commodities – the mentality of “consumerism.”  Social scientists believe that this point in history radically changed the way Americans view life and work.  A shift from scarcity to consumption was adopted – a state of being that has grown stronger over the years. 

In the 1980’s, the computer revolution increased the demands of employee output.  It also brought new complaints of work/life balance-related stress.  The cases of stress and depression jumped dramatically during this timeframe.  As an example, the number of workers’ compensation claims from “mental stress” rose from 1,844 to 15,688 cases in the state of California alone from 1980 to 1999.  There was also a significant increase in workplace violence and absenteeism.

Burnout
Burnout is the last act of the stress cycle.  Stress turns into burnout when one suffers a loss of physical and emotional resources too great to be replaced.  When our coping efforts fail to produce results, we are prone to crash and burnout.  Burnout triggers include overwhelming workload, lack of support and reward, loss of control, and interpersonal conflict.

Burnout develops from a condition of endless, chronic stress, in which emotional resources are stripped away until there is nothing left to counter the drain.  It is the gradual depletion of an individual’s pride, purpose, and passion.  The result is a three-way, mind-body shutdown as evidenced by:

1. Emotional exhaustion
2. Physical fatigue
3. Cognitive weariness.

The financial services industry is a main culprit of burnout.  Pressure to perform in our industry requires significant time, energy, and commitment.  Conditions of burnout continue to rise at an alarming rate in the field of insurance and risk management. 

Strategies to Achieve Work/Life Balance
You must make room in your life to take care of your physical and mental well-being.  It is essential that you attempt to balance all priorities of your life.  The following represent 10 suggested strategies to achieve work/life balance:

1. Self Awareness.  The first and most important step to achieving proper work/life balance is your understanding of the importance of mind, body, and spirit.  Being “aware” will allow you to monitor stress levels, see danger signs, and take personal responsibility for your physical and mental well-being.  As your self-awareness grows, you will gain a sense of confidence over work/life balance.
2. Support from Family and Friends.  In our great quest for balance between work and life, there is perhaps no more important attribute than your relationships with family and friends.  Getting the family aspect of your life right will enormously help you achieve and maintain life-to-work balance.  Support and encouragement from friends is also essential.  As you embark upon strategies to improve work/life balance, begin by turning to family and friends.
3. Nutrition and Exercise.  Physical stamina is not a luxury in today’s fast-paced business climate – it is a required element for high performance.  Your mind and body cannot operate at full potential if you have poor nutritional habits.
4. Exercise is also an important strategy to work off stress.  Exercise is essential to being healthy.  Choose an activity you enjoy.  Possibly one of your hobbies can be combined with an exercise program.
5. Hobbies.  You may be so busy with work that you no longer have time for hobbies.  Having a hobby is essential to work/life balance.  It lets you escape from the rigors of work to focus upon something you enjoy.  Time completely absorbed in an activity unrelated to your business will do wonders for your productivity.  It will also give your mind and body a well-deserved rest from work.
6. Recovery Strategies.  Professional athletes plan recovery cycles into their intense training programs.  They understand that their mind and body need time to recuperate from strenuous activity.  Work is no different.  Your work/life balance plan should incorporate recovery breaks into your daily or weekly routine.  These can be anything from a 5-minute walk at lunch time to dinner and a movie with family and friends to a weekend golf game.
7. Sleep.  Sleep deprivation is a major issue for people under stress.  If you make it a habit to skimp on sleep, you may not even remember how it feels to wake up fully rested.  Sleep is an essential ingredient to work/life balance.  Make sleep a priority for a week and see how it impacts your performance.
8. Stuff.  For many people, it is the “stuff” in their lives that causes stress.  Stuff runs the spectrum from unfinished projects to personality clashes with co-workers to a messy office.  Too much stuff depletes energy and causes stress and anxiety.  Stop and recognize all the stuff in your life.  You will gain immediate confidence and clarity as you begin to remove the stuff from your life.
9. Learn How to Say “No.”  High achievers get ahead by taking on projects and handling them efficiently and effectively.  Far too often, the same high achievers are the go-to people in the office.  It is logical.  If a high achiever is so good at projects, let him or her handle more and more problems and issues.  If you are a high achiever, you must learn to say “No.”  Do not let someone else’s problem or responsibility become yours.
10. Time Management.  You have heard the term “time management” a thousand times.  You may not have a time management issue.  Rather, you have become so conditioned to multi-tasking that you have forgotten to do just one thing at a time.  Your ability to focus on one issue at a time will reduce anxiety and stress.
11. Rearranging Priorities.  Work/life balance means having equilibrium with all priorities of your life.  Please consider a simple exercise.  List the priorities of your life from 1 to 5.  Your priorities may include personal interests, family time, hobbies, and exercise.  Now, analyze the percentage of time you currently spend on these priorities.  It is likely that you experience frustration from the fact that your priorities are out of order.  Rearranging your priorities and designing a plan to measure progress is an important component of your work/life balance plan. 

Work/life balance is essential for a rewarding career.  You owe it to yourself to make sure that the proper balance is in place.

The medical portion of Workers’ Compensation claims now meets or exceeds 60% of claim costs. That fact alone should easily convince payers to focus on the rich medical information in their data. Very powerful information residing in claims data is virtually untouched—diagnostic codes in the form of ICD-9’s. The problem is few in the industry really understand ICD-9’s or in what ways they could inform powerful medical management.

ICD Defined
ICD-9 codes are not unique to Workers’ Compensation. ICD-9’s are the World Health Organization's International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). They are a standardized method of describing injuries, illnesses, and related issues worldwide.

ICD is the classification that codes and classifies mortality data worldwide. The ICD-CM is used to code and classify morbidity data from inpatient and outpatient records and doctor’s offices.

The purpose of the ICD and of WHO (World Health Organization) sponsorship is to promote international comparability in the collection, classification, processing, and presentation of mortality statistics. New revisions of the ICD are implemented periodically so that the classification also reflects advances in medical science.

ICD’s in Standard Billing Forms
Those who bill for medical services in the U.S. are required to use one of two CMS (Center for Medicare and Medicaid) standard forms, the HCFA-1500 (Health Insurance Claim Form) for outpatient and UB-04 Unified Billing) for hospitals and other facilities. Both standardized forms require the medical provider to list ICD-9’s appropriate to the medical procedures for which they are billing. The verdant data derived from these forms should be analyzed and incorporated into managed care processes.

Unwieldy and Ignored
Bill review organizations and payers capture data from the standardized billing forms in their systems. Nevertheless, while the ICD information is documented in systems, it’s use usually stops there. ICD-9’s are difficult to interpret.

ICD-9’s on bills are displayed in the form of codes, not descriptions of injuries and illnesses and they number in the thousands. Individuals cannot remember the codes, nor do they have the time to look up codes for interpretation. Instead, they simply ignore them.

Secret Power of ICD
Incremental essential knowledge resides in ICD-9 codes that can be translated to powerful medical management. When they are monitored electronically and concurrently, they reveal and inform.

ICD-9’s Reveal Migrating Claims
For instance, migrating claims accrue ICD’s. Migrating claims are those that are not going well, are becoming more complex and costly, often an insidious process that is missed by claims adjusters and medical case managers until considerable damage is done. What happens in migrating claims is the injured worker is not recovering for some reason and is referred to multiple specialists. Each specialist adds new ICD-9’s to the claim.

As a claims migrates, the number of ICD-9’s associated with it mounts.

Computer Monitoring
Using a computerized system especially designed to monitor ICD-9’s is a powerful knowledge solution. Alerts are sent to appropriate persons when the number of ICD-9’s in a claim increases beyond a designated point. Migrating claims cannot be missed and intervention is early, therefore far more effective.

ICD-9’s are Predictors
Another way to tap the secret power of ICD-9’s is to score them individually for medical severity, the seriousness of the injury or illness. Each claim then contains a total ICD-9 score in the system for medical severity. As ICD-9’s are added during the course of the claim, the claim ICD score increases. As a claim migrates and accumulates ICD-9’s, an appropriate person is automatically notified by the system. Migrating claims cannot go unnoticed.

Claims with high ICD-9 scores are predictors of risk and cost. Claim ICD-9 scores can be monitored from the outset and throughout the course of the claim.

ICD-9’s Scores Level the Playing Field
The claim ICD-9 score reveals the seriousness and complexity of a claim. Medical doctors managing difficult claims can be differentiated from those handling less arduous claims, thereby creating fairness in measuring provider performance.

Many indicators are used for claim monitoring and provider performance including medical cost, frequency and duration of treatment, indemnity costs, return to work and multiple other factors. The claim ICD medical severity score automatically predicts trouble and alerts the appropriate medical managers.

Moving on—ICD-10
The ICD-9 contains thousands of codes. Moreover, the ICD-10 revision will more than double the number of codes, making its information value exponential. ICD-10 is slated to be activated in October of 2014.

Location plays a critical role in the insurance industry. The issue of place is central to business acquisition, channel management, underwriting, and claim adjudication, to name a few insurance business functions. However, most insurers are challenged by how to find, access, and use the requisite geographic information to improve decision-making, operations, and customer service. Fortunately, one potential solution to the challenge is emerging through the use of three groups of technologies – social media, location intelligence, and mobility – which some technology and telecommunication firms are beginning to support and/or package together into one set of interdependent capabilities called SoLoMo. Ovum's recently published report SoLoMo: Social, Location, and Mobility Join to Enhance Insurance Commerce and Service describes what SoLoMo is and discusses SoLoMo's stages of engagement, major capabilities, and revenue opportunities for insurers. One revenue possibility is offering telematics value-add services such as discounts at restaurants to reward good driving behavior.

SoLoMo is a set of capabilities that “knows” about the longitude and latitude of a geographic area and, to some degree, knows in real time about the tangible assets (e.g. buildings, vehicles, livestock) within it, whether those tangible assets have embedded sensors or not. SoLoMo creates and delivers its knowledge in a real-time, geographically defined context. The contextually determined knowledge is created by streams of information captured on a device as a person travels to or moves through a location. That information includes the needs of the person using the device, the device's location, and the location's tangible assets. The information also includes social media and business enterprise social network feeds about the location and its tangible assets. Currently, a SoLoMo device could be a smartphone, tablet, or vehicle with an embedded sensor.

There are four stages of real-time engagement between a SoLoMo device and its surroundings. SoLoMo devices can already support some of the capabilities of the first three stages of engagement:

• Stage 1 – Passive engagement: This is the basic level of SoLoMo engagement, and it offers a "for your information" purpose about the location of homes or businesses.
• Stage 2 – Active engagement: This level of engagement includes the commonly available turn-by-turn directional guidance with or without voice navigation. However, it could also include receiving information from other smartphones or tablets in the geographic area.
• Stage 3 – Interactive engagement: This level of engagement enables insurance stakeholders to receive and incorporate information from sensor-embedded tangible assets in the geographic area concerning their state (e.g. damaged or destroyed).
• Stage 4 – Autonomous engagement: This level of engagement enables the SoLoMo device to accomplish everything in Stage 3 but without human intervention.

SoLoMo will need to encompass six major capabilities to support insurance company commerce and service requirements as the levels of engagement evolve through the four stages. The objective of each capability is:

• Determine: This capability enables users of a SoLoMo device to determine if a physical artifact exists in a given location, whether the person using a SoLoMo device is stationary or moving through the geographic area.
• Share: This capability enables users of a SoLoMo device to share ideas with personal social media or enterprise social network (ESN) members about the state of the physical artifact and its content.
• Capture: This capability enables users of a SoLoMo device to capture information about the location and its tangible assets (and possibly the contents of each tangible asset).
• Interact: This capability enables users of a SoLoMo device to interact with a digital avatar representing the tangible asset and its content. The digital avatar would store the date and nature of the interaction as well as the name or other identification of the SoLoMo device (or person using the device) engaging with it.
• Integrate: This capability enables users of a SoLoMo device to integrate third-party data sources (e.g. NOAA, Marshall & Swift/Boeckh) and information from the insurer's ESN, core administration, and customer relationship management or customer experience management (CRM/CEM) systems together on the device.
• Personalize: This capability enables the user of a SoLoMo device to receive personalized information based on the insurance stakeholder's needs and the geographic area.

SoLoMo offers insurers an opportunity to provide fee-based value-added services. This is important because it helps insurers diversify their earnings from being primarily risk-based premium revenue. Examples of value-added services that insurers could offer policyholders or prospective clients include the following, which could be augmented with social media feeds or, where appropriate, the insurer's ESN content and real-time commentary:

• Telematics services – Insurers could offer: (1) discounts at restaurants based on good driving behavior; (2) safe driving programs that provide discounts on automobile insurance premiums to policyholders willing to install a device, or an app on an existing device, that prevents the driver from using a smartphone while the vehicle is in motion; or (3) information about the closest authorized automobile repair shop.
• Remediation services – Insurers could provide a buying service for requisite items to restore retail customers’ homes or commercial clients’ business facilities, including bundling reviews from other policyholders or the general marketplace about the quality of products and services from companies selling the replacement products.
• Child or elderly parent safety monitoring – Insurers could offer clients monthly geo-fencing monitoring of children or elderly parents' movements within a target location.
• Business interruption cost estimation – Assuming the enterprise has a sufficient number of embedded sensors in the facility's structures and content the enterprise sells, insurers could estimate the state of each of the enterprise's tangible assets (existence, destruction, damage), compare that with data sources relating to labor and material cost to replace or remediate the tangible assets, and wirelessly report that information to the enterprise's CFO and chief risk officer (and to the insurer's actuarial and claim departments).

Almost every morning, we hear about another problem with the Healthcare.gov website.  The Obama administration has committed to fixing the problems by Dec. 1, but the delays will still cause problems that we should be considering.

Each carrier or health plan that developed rates for the exchanges developed rates that would apply for 2014.  Although the initial enrollment period could extend past Jan. 1, most carriers assumed that a significant portion of the enrollment would begin no later than then. Rates for 2014 are based on projected claims for the full year.  This projection reflects health-care inflation, in addition to many other key assumptions.  A complete 2014 claim period would be centered on July 1.  Any delays in enrollment would push back the center date.  For example, a 10-month period ending Dec. 31 would be centered on Aug. 1.  Because health-care costs rise as the year progresses, a delay in enrollment would increase the cost of the average claim, even though the monthly rate paid by the person buying the insurance would remain the same. Assuming an illustrative annual rate of 8% increases in health-care costs, there would be about a 0.64% per month understatement in projected claims being paid by carriers.  Because anticipated margins in exchange rates likely fall in the 2% - 4% range, delays in enrollment can significantly lower projected margins.

Beyond the inflationary impact of enrollment delays, there is a strong likelihood that the delay may lead to a bias in the average morbidity or health status of the enrolled population.  Individuals with the best health have the least need to enroll in the exchanges.  Therefore, one might expect healthier individuals to be the slowest to enroll.  The individual mandate penalty may appear small compared with the premium for even the least expensive bronze coverage. Delays in enrollment would likely have an adverse impact on the health plan’s assumption for average morbidity under the program, because a disproportionate share of the less healthy individuals will be enrolled into the exchanges.  In other words, the pool of people being covered through the exchanges will be less healthy than insurers expected when they set rates. With margins at just 2% - 4%, a small swing in morbidity would eliminate a carrier’s margin independent of the inflationary impact.

Issues related to the demographic mix of the population that insurers assume will enroll add to the potential problems. Since health-care reform has limited the rate variation by age to a 3:1 maximum, rates for older individuals have been reduced while younger individuals pay a subsidy.  In reality, the actual costs by age exhibit a higher ratio, probably closer to 4:1 or 5:1.  If younger individuals delay enrolling or don’t enroll at all, rather than pay to subsidize older individuals, carrier margins are expected to deteriorate even more.  For each 10% proportionate reduction in enrollment by those under age 45 compared to that assumed in rate development, margins are reduced by about 1.1 percentage points.  A proportionate reduction of 20% could eliminate most, if not all, of a carrier’s margin.

A less obvious concern to some, yet perhaps even a more important issue, is the impact of the delays on the 2015 rates on the exchanges.  Without delays, the rates for 2015 will be based on a very limited experience base, probably just the first quarter of 2014.  With delays, the rates will be based on even less.  In light of the delays, the 2015 rates will be based upon projections of 2014 rates, continued uncertainty, and confusion about actual financial results in 2014.  Unexpected losses will force carriers to increase future rates to make up deficits. 

Bottom line:  The delays matter and, if not carefully managed, will create serious financial implications in 2014 and subsequent years.

Sifting through the claims and complaints of those involved in California’s complex workers’ compensation system could leave both the casual observer and the seasoned veteran wondering when, if ever, this multibillion-dollar program will ever get properly aligned. It would be fairly easy to say, “Not during our lifetime.” But that would be too cynical even when discussing a system that for the past several decades could easily invoke cynicism.

Every participant in workers’ compensation has two faces. Some employers provide benefits, have a compliant return to work program and enforce a culture of safety at the workplace, while other employers view employees as a necessary evil. These latter employers view adherence with the legion of local, state, and federal laws and regulations regarding the workplace as burdens that need only be acknowledged if employers are required to do so, generally in the form of a legal proceeding against them.

We have seen the abuses in the medical system from unnecessary surgeries, overuse of Schedule II medications, and downright fraud in billing insurers and other payers, and yet if there is one indispensable party in the workers’ compensation system beyond labor and management it is medical providers. As recent events have demonstrated, we have yet to figure out how to empower the noble practitioners of the healing arts while keeping the venal away from injured workers.

Claims administrators vary in expertise, motivation, and professionalism, as do the various service providers and the tactics they employ to provide services and collect fees. “Insurers” have borne an unfair brunt of criticism largely because it is an easier talking point to cast such a broad brush than to single out any one bad actor or group of them. Without the ability to transfer risk, however, the workers’ compensation system could never be sustainable.

Each system participant has a particular grudge against the others. We allow policyholders to sue insurers for claims handling practices, and, in far narrower circumstances, an injured worker may pierce exclusive remedy and sue a claims administrator when conduct is so egregious that it goes beyond the grand bargain that is at the core of workers’ compensation.  Periodically, claims administrators and service providers resort to the civil courts with a variety of complaints over unfair business practices.  And, of course, the Workers’ Compensation Appeals Board is the forum where all participants flock with even the slightest provocation.

The appellate courts weigh in on a wide range of benefit delivery challenges, as well. Their decisions in Guzman and Ogilvie were two of the main incidents inciting changes in permanent disability benefit determinations codified in Senate Bill 863 (De León). Even today, we are litigating issues over the apportionment changes brought about in Senate Bill 899 (Poochigian) enacted almost a decade ago. Litigation in federal court is rare, although not unprecedented, as the current challenge to the lien activation fee in SB 863 demonstrates.   State-imposed fee schedules have periodically worked their way into federal court on the theory that reimbursement rates are so low that they are confiscatory – a challenge unlikely in California while the fee schedule is not mandatory, but still possible given the breadth of authority that the Division of Workers’ Compensation has been given to develop fee schedules for virtually all service providers.

“Well, that’s just California workers’ comp.”  That may be the case, but such resignation does tend to take the focus away from core problems that magnify the multiple personality disorder that plagues this system. As we work our way through the implementation of SB 863, we must also recognize that not every solution to the high cost of comp, both in dollar and human terms, can be put down on paper in Sacramento or Oakland.

While compliance is part of best practices, it does not define them exclusively. To be sure, the new costs associated with complying with SB 863 are consequential. As is inevitably the case when new comprehensive workers’ compensation laws are enacted, there will be considerable friction moving from one set of rules to another. The threat of litigation will hang over the changes made in this legislation just as it has in prior iterations of reform. It will take years to sort this all out.

In the meantime, there is much work to be done to improve the system even if it is not in  reaction to a new law or regulation or judicial decision. As has been the case all too often over the past two decades, laws are driven by anecdote. The adage “bad facts make bad law” applies equally to the legislative, regulatory, and judicial processes. Navigating California’s complex system is never easy. If claims administrators expect the process by which laws are made and interpreted to provide the necessary clarity and simplicity we crave to do our jobs, then we are all sadly mistaken.

Yet, when we commit to best practices both as employers and claims professionals, we can create better outcomes than Sacramento could ever hope to achieve. The challenge, therefore, is not what legislators or regulators or justices will do for us, but rather what will we do for ourselves?

California employers have a legal duty to respond to certain employee complaints.  Failure to respond or failure to respond appropriately can result in significant liability.  This is particularly true with complaints of harassment, discrimination and other unlawful conduct.  Accordingly, employers should never take employee complaints lightly.  Even if no legal duty to investigate exists, a well-managed response can minimize or even eliminate problems and improve employee morale.

Achieving the well-managed response is not easy.  It takes careful planning and execution.  Fortunately, most employers do a very good job of managing their employees, and complaints are infrequent.  Unfortunately, this means most employers have little experience at managing the complaint process.  Being aware of and strategically planning at each step of the process can help make up for the lack of experience.

Here’s how you do it:

Receipt of the Complaint

How an employee complaint is received can be critically important.  If the employer has not created a culture of trust and respect, employees will not be comfortable coming to management with complaints.  That may mean fewer complaints but will also mean bigger problems — employees are not required to complain to the employer before filing a lawsuit.  Consistent with the culture of trust and respect, the manager receiving a complaint should express an interest in and concern for the employee making the complaint.  Remember, the employee is not happy about something.  A closed-minded, uncaring demeanor during the first contact will only make the unhappiness grow.

It is also very important to be aware of and address the complaining employee’s expectations.  If the employee requests that the complaint be kept confidential, the manager must be able to explain why it cannot be kept completely confidential and must be able to do so in a way that does not alienate the employee.  The manager should also address the employee’s expectations for the process and the result.  Obviously, it is too early for the manager to make promises about the result, but he can help build confidence in the fairness of the process.

Act Immediately

Once a complaint is received, the employer should act immediately.  Any delay in taking action on an employee complaint will be magnified tenfold in litigation, and the employer will have a very difficult time overcoming the perception that the complaint was dismissed as unimportant.

Conduct an Investigation

Every employee complaint warrants an investigation.  That does not mean that every complaint requires a lengthy, formal process conducted by professional investigators.  The investigation might be as simple as asking the employee a few questions.  Regardless of its scale, the investigation’s purpose remains the same: to get an accurate understanding of the facts.  Only with a solid understanding of the facts can the employer make an informed decision on the complaint.

As an initial matter, the employer must determine who will conduct the investigation.  Will it be conducted by a single individual or several people working in coordination?  Will it be conducted by the employer’s own staff or by an outside investigator?  In either case, the employer should consider the following factors:

• The nature and seriousness of the complaint.  Complaints about the speed of the copy equipment do not warrant the same level of investigation as complaints about sexual harassment.
• The skill and experience of the investigator.  Whether an employee or outside professional, the investigator should understand how to conduct a good investigation and have the skill to do it.  In some cases, an internal investigation is preferred.  If the employer does not have a skilled investigator on staff, the employer should hire an expert to guide and coach the employee conducting the investigation.
• The investigator’s neutrality regarding the facts and witnesses.  Any bias, real or perceived, can render the investigation useless.
• The investigator’s quality as a witness.  The investigator may well be a key witness in future litigation.  The ability to speak well and inspire confidence is essential in that arena.  It is equally important in giving the complaining employee and witnesses confidence in the investigative process.
• The outside professional’s qualification.  California law requires outside investigators to be either a licensed private investigator or an attorney.
• Whether creating a legal privilege around the investigation is important.  If it is, the investigation must be conducted by an attorney and conducted in a manner that maintains the privilege.
• The scope of the investigation.  The investigator should find the facts and assess the credibility of the witnesses and information obtained.  The investigator should not make legal conclusions or suggestions on what actions to take, even if he is an attorney.

It is important to understand that the investigator or investigators cannot follow a set formula or pattern in every investigation and expect success.  A specific and strategic plan is always advised.  The plan will include consideration of who will investigate, who will investigate which parts, what order witnesses will be interviewed in, where they will be interviewed, what kind of record will be created and who will be responsible for communications.   As important as it is to have a strategic plan, it is even more important to not follow it blindly.  As facts are uncovered and circumstances change, the plan may need to be adjusted.  By definition, a good investigation will be flexible enough to ensure that all of the relevant facts are uncovered with a minimum of collateral damage.

Review the Investigation and Respond

The employer bears the ultimate responsibility for responding to the complaint.  Doing so appropriately requires a clear and complete understanding of the facts.  If the employer is uncertain about any facts contained in the investigator’s report, they should be clarified.  If the employer is not confident that the investigation was thorough, further investigation should be ordered.  With all the facts and confidence in them, the employer will decide what actions to take on the complaint.  This is the point where an employer should be interested in legal conclusions, particularly if the complaint is serious.  The deliberations about what actions to take and why should be protected against disclosure.  Often, it is advisable to have such deliberations protected by the attorney-client privilege.

While the deliberations may be secret, the decisions resulting from them are not. They will need to be communicated to the complaining employee and other interested employees and communicated effectively.  Once again, a strategic plan is critical.  How something is communicated is often as powerful as the content of the communication.   The effort put into the investigation and the problem-solving potential of the complaint process can all be lost by careless final communications.

Employers cannot escape the duty to investigate employee complaints.  Nor should they want to.  Employee complaints can be healthy for an organization.  They can uncover problems before they cause significant damage.  They can also be a vehicle for increased employee morale and productivity.  But the positive aspects surrounding employee complaints can only be achieved with a properly handled complaint process.

Although there is a backlash against meetings in some quarters—Intel used to order executives to calculate before a meeting how many processors would have to be sold to cover the portion of participants’ salary being spent in the meeting—there is a system of meetings that can produce remarkable results. The system involves regular, planned meetings that leaders have one-on-one with subordinates that support seven important processes:

• Communications
• Effective, supportive relationships
• Targeted management development
• Solid delegation
• Strong accountability
• A high-performance culture
• Continuous improvement

A disciplined One-on-One Meeting System will not only increase productivity but will help your direct reports become better leader-managers. Your employees will see what great leadership looks and feels like, and the experience will be a game changer.

Unfortunately, leaders in most fast-paced, mid-market companies typically become caught up in the wave of day-to-day work and devote little thought to one of their most significant leadership opportunities: growing performance capacity.  A business keeps growing, but the people don’t.

There are three common adversaries that hold companies back in their quest to stay competitive:

1. Keep doing the same thing
   “It’s still working, so why should we change?” is something we hear in businesses that do not actively look for ways to improve performance. A surprising number of mid-market companies have that exact mind-set. The problem is generally that leaders don’t know what they don’t know and won’t venture into areas where they have no knowledge. Change has not become an ally.
2. Superficiality
   This means not digging deeper into understanding people and systems, and their impact on business results. Spending time with direct reports addressing performance opportunities usually only occurs when a problem arises. Even then, there is often little preparatory work.
3. Inconsistency
   In our humanity, we struggle to keep our good habits going—the bad ones. . . not so much. What is good for us often loses to competing demands that are easier to deal with. (I often cite exercise and diet as examples of difficulty in staying the course.) We often embrace a new process for several months until some crisis throws us off course, then go back to old patterns.

As with just about anything in life, the quality of the outcome of the One-on-One Meetings depends on the quality of the preparation. In this system, the direct report is charged with preparing the agenda and providing it to the boss in advance of the meeting. (You should assist your direct reports; over time, you will all get better at creating agendas that support high-impact meetings.)  We suggest regular consideration of the following kinds of subjects:

• Budget status
• Action plan progress – status of key projects
• Growth and development
• Issues of concern
• Developing people. Who are the stars? Who needs coaching?
• How you are developing your successor?
• Systems improvement initiatives
• How you feel about your job and our working relationship – what could be better? Am I giving you enough support?
• What can I be doing to support your growth and development?

Authors Marcus Buckingham and Curt Coffman reported some jarring information about managers in their book, First, Break All the Rules: What the World's Greatest Managers Do Differently, for which they interviewed more than 80,000 managers in 400 companies:

First, on the down side, managers were usually the reason someone left an organization. It wasn’t compensation or benefits that, as a rule, caused people to leave their companies. It was the kind of manager they worked for. People generally stay in their jobs if they like or get along with their managers. A poor manager will usually cause good people to leave. The big downside is that poor managers allow poor performers to keep them company.

Second, the managers who ultimately became the focus of Gallup’s research were those who excelled at turning each employee’s talent into performance. And performance is usually dependent on three critical factors – talent, knowledge and skill.

Accordingly, we believe that mid-market companies have a significant opportunity to improve performance by developing their managers.

As a CEO, I was often satisfied with good performance because I had not yet gained the knowledge about what would turn good performance into great performance. To achieve the best outcomes, leadership issues need to be addressed, and One-on-One Meetings will help you do that.

As the GOP settles in for a long-term fight about what it would like to put in Obamacare’s place, it should look hard at a just-released reform plan from the House Republican Study Committee written principally by Reps. Steve Scalise (R-La.) and Phil Roe (R-Tenn.).

The most revolutionary aspect of the House plan — officially titled the American Health Care Reform Act — is its decoupling of insurance from employment.

Americans have gotten health insurance through their jobs essentially since World War II, when wage and price controls forced employers to compete for workers by offering generous fringe benefits, like health insurance. This insurance, of course, is simply tax-free income provided by employers.

Individuals, by contrast, have had to purchase coverage with dollars that have already been taxed.

This system puts entrepreneurs and the self-employed at a significant disadvantage — and limits people’s employment choices. Workers may stay in jobs they don’t want, simply so that they don’t lose their health insurance, particularly if they or their family members have a pre-existing condition.

The RSC health reform plan would give a tax deduction of $7,500 to every American — and $20,000 to every family. If a person bought coverage that cost less than that, then he could keep the difference as untaxed income.

This system would help arrest the non-stop growth of health costs. After all, most Americans over-consume health care because their employer-subsidized coverage insulates them from the full cost of their care. Such over-consumption drives up costs.

The RSC plan would also grant consumers the ability to purchase health insurance issued in other states, where it may be cheaper.

That makes a lot of sense. There is no reason that health insurance should cost two and a half times as much in Rhode Island as in Alabama. Increasing the size of the insurance marketplace — and therefore increasing competition — will drive down prices.

The RSC proposal would inject consumerism into the healthcare marketplace in other ways, too. For instance, it could lead to more use of Health Savings Accounts (HSAs). These accounts allow patients to save pre-tax dollars for health services — and to keep whatever they don’t spend. Consequently, HSAs encourage Americans to take care of their health and shop smartly for care. About 15 million Americans today have HSAs.

The RAND Corporation estimates that the average American worker who switches from a traditional health plan to a consumer-directed one uses 14 percent fewer medical services – without any associated adverse effect on health outcomes.

Overall health costs come down, too, because providers have to compete for patients’ business. According to RAND, expanding the share of employers with HSA-style plans to 50 percent — from the current 13 percent — would reduce national health costs by $57 billion per year.

Critics of consumer-driven care claim that it prevents those with pre-existing conditions from finding affordable coverage. All the tax-free savings in the world won’t be of use if coverage is too expensive.

The Study Committee’s plan would ensure that folks with pre-existing conditions could get affordable coverage by devoting $25 billion in federal funding for state-level, high-risk pools. Premiums in these pools would be capped at 200 percent of the average premium in the state.

Finally, the RSC plan attempts to rein in the more than $100 billion spent every year on unnecessary treatments and testing ordered by doctors trying to protect themselves from the threat of lawsuits. GOP lawmakers would limit the amount of lawyers’ fees and non-economic damages in medical liability cases.

The RSC plan isn’t perfect. Tax deductions favor the relatively well-off; those with lower incomes often can’t take advantage of the full value of the deduction. So lawmakers should swap out the deduction for a refundable tax credit that applies equally to all Americans, regardless of income. In addition, while the intent is right on limiting lawyers’ fees and damages, tort reform of this sort is better left to the states, which traditionally have jurisdiction in medical-liability cases.

The House Republican Study Committee plan is also incomplete. Lawmakers must reform Medicare and Medicaid, too. Spending in the two programs already exceeds private health insurance spending — and will only grow in the future.

Congress must bring Medicare and Medicaid outlays under control — and vouchers for beneficiaries and states are the best way to do so. Empowering individuals and state leaders to spend their Medicare and Medicaid dollars as they see fit will inject much-needed competition into the healthcare marketplace — and thereby reduce costs.

Although the House Republican Study Committee’s plan is an exciting starting point for replacing Obamacare, it ought not be the finish.

“The workplace is the last crucible of sustained human contact for many of the 30,000 people who kill themselves each year in the United States. A coworker’s suicide has a deep, disturbing impact on work mates. For managers, such tragedies pose challenges no one covered in management school.” (Shellenbarger, 2001)¹

Five things employers need to know about workplace mental health and suicide include some bad news…

1. Depression is a top driver of health care costs to employers.^{2 3} Depression represents employers' highest per capita medical spending. (The per-capita annual cost of depression is significantly more than that for hypertension or back problems, and comparable to that for diabetes or heart disease. People with depression also have more sick days than people suffering from other conditions.)⁴
2. If we take a snapshot of any workplace at any given point in time, at least one in five people will have a diagnosable mental health condition.⁵ The most common are mood disorders like depression or substance abuse disorders like alcohol abuse.
3. The majority of people who die by suicide are of working age. While other groups’ suicide rates are holding steady or decreasing, the rates for men and women in the middle years have increased significantly over the last decade.

And some good news…

4. By engaging in simple preventative steps (e.g., stress management or depression screenings) anyone can help maintain their own mental health. By learning practical tactics (e.g., becoming suicide prevention gatekeepers or referring coworkers to employee assistance services) employees can help promote the mental health and safety of others.^{6 7}
5. A comprehensive and evidence-based approach to suicide prevention and mental health promotion exists,⁸ is cost-effective⁹ and gives employers a clear guide on what to do. By being “visible, vocal and visionary” leaders, employers can set the expectation that a culture of health and safety is a priority and that mental health promotion and suicide prevention are a critical part of that priority.

While managers often feel responsible for the well-being of the people they supervise, very few have been given any substantial training in how to identify people in a suicide crisis and how to link them to life-saving care. Employers can play a critical role in closing this gap through a comprehensive approach.

A five-year analysis of the nation’s death rates released by the Centers for Disease Control and Prevention found that the suicide rate among 45- to 54-year-olds increased 20% from 1999 to 2004, while rates for youth and elderly persons are decreasing. The Surgeon General’s National Strategy for Suicide Prevention targets employers as critical stakeholders in the prevention of suicide.¹⁰

While suicide prevention may seem to be too intensive for workplaces to take on, there are many upstream prevention strategies that do not take much effort but yield tremendous results. Here are low-cost, high impact strategies employers can take to promote mental health and prevent suicide:

1. Promote the Suicide Prevention Lifeline. This free resource (1-800-273-8255 [TALK]) is available to employees 24/7 and used by both people in crisis and those who are trying to support them. The line connects to local crisis call centers and is answered by certified volunteers, most of whom have had more training and experience in de-escalating suicidal behavior than many of our mental health professionals.
2. Participate in National Screening Days.  Whenever we can identify a health condition early in its course, we are in a much stronger position to prevent it from escalating. Employers can help coordinate screening days as a part of a larger national awareness effort. Mental Health Screening offers workplaces promotional and screening tools for National Depression Screening Day (October), National Eating Disorders Awareness Program (February), National Alcohol Screening Day (April), and National Anxiety Disorders Screening Day (May). In addition, their WorkplaceResponse program gives employees an anonymous opportunity to self-screen for depression, bipolar disorder, Post Traumatic Stress Disorder, generalized anxiety disorders, eating disorders, and alcohol use disorders.  These screenings offer immediate results and referrals to an organization’s employee assistance program and community-based resources.
3. Reward Mental Wellness. For example, the Working Minds program offers a contest every year to workplaces that have developed mentally healthy policies and practices that demonstrate positive outcomes like retention, lower absenteeism, and higher employee satisfaction. These workplaces then become the model for others.
4. Change the Conversation Through Social Marketing.  By showing models of people who have experienced significant psychological distress and who have recovered and are thriving, employers can show that struggles are normal and increase a sense of efficacy among the hopeless. For example, workplaces can develop a multimedia campaign that lets people know they are not alone if they are thinking about suicide and that many resources exist to help. If the company’s leaders are courageous enough to model this message, the culture of the organization usually shifts accordingly.
5. Offer Educational Programs on Mental Illness. Employee assistance professionals can provide “lunch-and-learn” sessions that increase awareness about the signs and symptoms of depression, bipolar disorder, alcohol dependence, and other mental illnesses that can lead to suicide.  These presentations should share how treatments are effective while dissipating misperceptions people have that create barriers to care.
6. Training Staff to Become Suicide Prevention Gatekeepers. In addition to offering general training, workplaces should train key people in suicide prevention gatekeeper methods. The concept is similar to CPR – train lay people to know the warning signs of a life-threatening situation and how to sustain a person’s life until they can be linked to professional care. Many models for this training exist, including Working Minds, QPR, and ASIST. For more information, review the gatekeeper matrix on the Suicide Prevention Resource Center website.

As our workplaces accelerate from the industrial age to the information age and beyond, we come to increasingly rely on our mental muscle to get us through our workday. Like any other muscle, our mental muscle can get injured or fatigued, and we can experience high levels of distress, sometimes leading to a suicide crisis. Workplaces can prepare for this in many ways and develop a comprehensive approach to reduce suicide risk and promote mental resiliency.

For more information, visit WorkingMinds.org. Working Minds is one of the first programs in the country to provide workplaces with a comprehensive approach to suicide prevention. Working Minds is a priority program of the Carson J Spencer Foundation based in Golden, Colorado. In a little more than a lunch hour, employees at all levels of a workplace can be taught how to identify warning signs and risk factors and help link distressed coworkers to appropriate care.

¹ Schellenbarger, S. (2001, June 13). Impact of colleague’s suicide is strongly felt in workplace. The Wall Street Journal.

² Mental Health America (n.d.) Depression in the Workplace.

³ Witters, D. (2013, July 24). Depression Costs U.S. Workplaces $23 Billion in Absenteeism.

⁴ Managed Care Magazine (2006, Spring) Depression in the Workplace Cost Employers Billions Each Year: Employers Take Lead in Fighting Depression.

⁵ Gray, T. (2004) ValueOptions Articles - Managers.

⁶ Paul, R. & Spencer-Thomas, S. (2012). Changing Workplace Culture to End the Suicide Standstill. National Council Magazine. (2), 126-127.

⁷ Spencer-Thomas, S. (2012). Developing a workplace suicide prevention program. Journal of Employee Assistance, 42(1), 12-15.

⁸ National Action Alliance for Suicide Prevention (2013) Comprehensive Blueprint for Workplace Suicide Prevention. Retrieved from https://actionallianceforsuicideprevention.org/task-force/workplace/cspp

⁹ National Institute of Mental Health (2007, September) Workplace Depression Screening, Outreach and Enhanced Treatment Improves Productivity, Lowers Employer Costs.

¹⁰ U.S. Department of Health and Human Services, Public Health Service. (2001). National strategy for suicide prevention: Goals and objectives for action, p. 67.