Tag Archives: american journal of preventive medicine

Broader Approach to Workplace Violence

With the recent terrorist attack in San Bernardino, CA, fresh on people’s minds, workplace violence has received major media coverage, but little to no attention is paid to deaths by suicide even though rates in the U.S. have gone up considerably in recent years. Suicides claim an average of 36,000 lives annually, and, while most people take their lives in or near home, suicide on the job is also increasing.

The Bureau of Labor Statistics reported that workplace suicides rose to 282 in 2013, the highest level since the numbers have been reported. In 2014, the suicide rate went down slightly to 271, but that is still the second highest level. The annual average number of suicides deaths that occurred at work during the time period 2003 – 2014 is 237, for a total of 2,848. Since 2007, the numbers have been above the average.

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Source: U.S. Department of Labor, Bureau of Labor Statistics, Census of Fatal Occupational Injuries

The rise in suicide rates at work is even more significant given that overall homicides in the workplace have been steadily decreasing since the mid-’90s.

The obvious question is: Why is this startling rise in suicide rates at work occurring?

“The reasons for suicide are complex, no matter where they take place,” said Christine Montier, CMO of the American Foundation for Suicide Prevention. “Usually, many factors are at play.”

Many suicide prevention experts linked the increase in one way or another to the Great Recession. I believe the recession played a major role because it put a triple whammy on people. Housing, which has traditionally been the major investment and retirement source for Americans, was in the toilet. Foreclosures were at an all-time high. Companies were laying off people, and job prospects were slim.

I believe that many working people experienced daily stress about employment. Every day, they might be laid off. Many were severely overworked because they needed to pick up the slack caused by reductions in workforces. They faced continuous fear of taking time off for vacations or illness and had few options to leave because jobs elsewhere were scarce.

Put all these issues in the pot together, and some people could not see their way out of their dilemma except through suicide.

Researchers in a study published by the American Journal of Preventive Medicine suspect that suicides occur at work because the perpetrators wanted to protect family and friends from discovering their bodies.

In the midst of the fear of terrorist attacks and active shooting incidents, organizations are significantly challenged in how to deal with the spectrum of violence they may face. However, it is critical that organizations not shy away from addressing these issues and muster the resources to engage their employees.

Managers need clear guidelines on healthy approaches to manage and prevent violence in the multiple forms it can take. Two industries that have taken the issue of suicides at work head-on are construction and law enforcement.

What can management do?

Promote awareness

Stop thinking and acting like “it couldn’t happen at your company.Provide regular communications through the channels that are most effective in your company regarding the potential warning signs that employees or others are at risk of acting in a violent manner. See a list of the classic early warning signs of workplace violence here. Many of the signs are also telltale signs symptoms of depression and suicidal behavior.

Sally Spencer-Thomas, Psy.D., co-founder of Working Minds, a Colorado-based workplace-suicide-prevention organization, described a giveaway that’s more obvious than one might suspect: The employee will tell you.

When contemplating suicide, a person can be entirely consumed by the thought, she said. The problem may be coded in conversation—the individual may talk about death often, for instance.

As uncomfortable as it may seem, it’s important to bite the bullet and ask the awkward questions. “It is very hard to resist a human who is coming at you with compassion,” Spencer-Thomas observed. She suggests that HR professionals frame their questions in an understanding manner, giving the employee the opportunity to explain his or her condition. Statements such as, “I’ve noticed that …,” “It’s understandable given …,” and “I’m wondering if it’s true for you…” should be followed by a nonjudgmental statement.

Promote resources available to help employees

If your firm has an employee assistance program (EAP) or your healthcare provider offers counseling service, make sure that managers are trained about the program and skilled in how to make an effective employee referral. If your employee usage rates are below your industry average, you need to assess why and take action to increase usage. Talking to a professional counselor can make a big difference to a troubled employee.

If your firm does not offer an EAP, then identify community resources that can assist your employees and keep the list current.

HR should also have a strategy to deal with the devastating impact of a homicide or suicide at work.

I believe the time has come for executives to take a comprehensive approach to violence that occurs in the workplace and especially to bring mental health and suicide issues out of the closet into mainstream workplace conversations. We are past the point where organizations can think of suicide as a dirty little secret and hope it will go away. The time has come for meaningful action.

Don’t wait until something happens and people lose their lives. If you really mean that your employees are your most important asset, now is the time to step up.

UPMC Wellness Plan Meets Seinfeld: It’s About Nothing

There is a saying:  “In wellness, you don’t have to challenge the data to invalidate it. You simply have to read the data. It will invalidate itself.”

Nowhere is this truer than in the University of Pittsburgh Medical Center’s (UPMC) wellness program, results of which were just released in the October issue of the American Journal of Preventive Medicine, a journal that functions largely as the wellness industry’s house organ. All you need to do is read UPMC’s own words to learn that nothing happened in its wellness program. According to the article, over the course of the five-year study: “The proportion of low-risk members increased by 2%.”

Two whole percentage points! After penalizing employees thousands of dollars ($2000 in 2011 alone for employees on the family plan) to compel them to submit to blood draws and other screens and answer very personal questions on health risk assessments, 2% was all they had to show for it?

I hear a few people saying: “Wait a second, Al, you said nothing happened. They did get a 2% increase in low-risk members. While trivial, that is not literally nothing.”

Well, first, it wasn’t really 2%. UPMC has 55,000 employees. But by the time they culled out everyone who didn’t meet the various requirements of participation, they were down to 13,627 people. Hence this entire conclusion was based on roughly 272 people reducing a risk factor. UPMC is the largest private-sector employer in Pennsylvania, a healthcare company that presumably knows a thing or two about health, and a major proponent of wellness programs. Yet all UPMC could manage after five years and millions of dollars was to reduce risk for 272 people.  

Some Punchlines

This self-admitted trivial risk reduction performance is not even the punchline. Usually there are three punchlines in these situations. The first punchline is usually that even though the results were uninspiring they were also overstated because the perpetrator left out both non-participants and dropouts from the analysis, which of course UPMC did. Because dropouts and non-participants typically have worse risk factor performance than participants (which is often why they drop out or decline to participate), it’s likely that the risk factor deterioration of the 41,000 employees left out could easily have more than offset the aforementioned improvement by the 272 people.

The second punchline is that UPMC “matched” participants against a passive reference group of non-participants, a study design sleight-of-hand that is an excellent way of locking in savings. The reason that methodology is loading the dice is that a passive reference group (people who are matched “on paper” because their claims files happened to be available) are never given the chance to decline to participate, or to participate and then drop out.

Hence the control group is not comparable. That would seem like common sense, and it is, but no need to rely on common sense. Another wellness vendor, Health Fitness Corporation (HFC), admitted the problem. As you can see on the slide below, HFC’s would-be participants improved vs. the reference group in 2005 by 9%, even though the program didn’t start until 2006.

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The third punchline is that UPMC didn’t “plausibility-test” its results by seeing if wellness-sensitive medical events – like heart attacks — declined for the population over the period. Most companies that don’t do this analysis, like Pepsico, say that they didn’t track wellness-sensitive medical events because they didn’t have access to the event rate data. But obviously UPMC had plenty of access to this event information – it is self-insured by a health plan that it itself owns.

All three of those mistakes are inexcusable in light of the fact that, by this point, everybody knows that you need to address them all to show valid results.

Savings:  Also About Nothing

Of course, UPMC also claimed to show substantial savings – who doesn’t? But the savings – according to UPMC’s own article – could not have been because of the wellness program. The only three preventive care services that the participants consumed more of than non-participants were checkups, colon cancer screens and breast cancer screens. Checkups have no clinical valuecost money and on balance may be slightly more likely to do harm than good. The intervals and start points for both colon and breast cancer screens have both been relaxed since this UPMC study was performed (2008 to 2011), because doing fewer was deemed by the U.S. Preventive Services Task Force to be a healthier idea than doing more, because of lack of efficacy and overdiagnosis/overtreatment potential and (in the case of colonoscopies) a risk of complications. In any event, whatever money screens save would be years off, as the idea is to find tumors early and spend the money now rather than later. So, screening people does not generate short-term savings and in fact costs money in the short term.

Bottom line: This study did nothing – there is no credible source to attribute savings to, no appreciable risk reduction and lots of liberties taken in study design, and the most important analysis (for plausibility) was conveniently overlooked. Why did UMC even publish this, knowing that it was meaningless? Simple — UPMC sells this stuff…and it is hoping your western Pennsylvania counterparts will sell it for them, using code language to make sure brokers know that sales come with commissions.

Like every other wellness vendor, UPMC is hoping to entice you with those commissions. Like every other vendor, UPMC gives you a talking point, in this case a conclusion helpfully summarized on the first page, that “wellness programs are a useful tool in managing health and costs.”

Yes, these programs carry commissions, and, no, they are not subject to the same commission disclosure requirements that you must make when selling health plan services. But if you’ve read this far into this posting it’s because you want to do what’s best for your clients, even if it means forgoing short-term commissions. In the long run, you are doing your clients much more good – and, not coincidentally, increasing your chances of keeping those clients – by selling them only the products that are best for them, a list of products that does not include workplace wellness overscreening programs like this one.