Tag Archives: healthcare

Get Ready for the New Healthcare Debate

While we all long for a return to normal once we tame the coronavirus, when it comes to healthcare in the U.S., we can’t go back to normal. “Normal” didn’t work.

It will take a while for the new contours of healthcare and health insurance to appear, because the focus must stay for now on the acute, short-term dangers to our physical and economic well-being. But the policy fights will come.

When they do, they will have to produce at least a national layer of public health capabilities so that, next time (and we all seem to now realize that there will be a next time), individual states and healthcare systems won’t have to fend for themselves so much. The fights will also accelerate trends in the healthcare world that are moving toward health care, rather than sick care, and will change the roles of many of the players in the industry, likely including the mammoth health insurers.

The need for more public health capabilities is obvious from just a cursory look at how the U.S. experience with COVID-19 compares with that of many other developed countries. Taiwan, for instance, has had only seven deaths. (I’d tell you what multiplier to use for that total to account for the difference between Taiwan’s population and ours, but what’s the point when Taiwan has had so few deaths that some people can probably name them all?) South Korea, with about a sixth our population, has had 263 deaths and is down to nearly zero new cases. Germany, with more than 8,100 deaths, at about a quarter of our population, has done far worse than South Korea and Taiwan, but has fared much better than the U.S. and is seeing almost no new cases. The country has only 5.8% unemployment, while economists say the U.S. is on its way to 25%, so Germany, like South Korea and Taiwan, has seen far less economic disruption than we have. Yes, Spain, Italy and France have done worse than the U.S. in deaths per 100,000 people, but all have their curves headed to zero for daily new cases while the U.S., despite recent progress, is still above 20,000 new cases each day. Only the U.K., among major European countries, has both performed worse than the U.S. in deaths per 100,000 and has failed to drastically reduce the number of new cases.

So, even in today’s hyper-politicized world, it’s hard to escape the conclusion that the U.S. has handled the pandemic poorly. The questions for the future will be: Why? And, more importantly, what can prevent a recurrence?

A significant chunk of the blame will accrue to the federal government, which received increasingly strong signals of danger through January but did little to build testing capability or to take containment measures until well into March. But there’s also a systemic problem with our healthcare system, at least in terms of our ability to respond to a pandemic.

While South Korea responded to the pandemic almost immediately by setting up drivethrough centers in parking lots where anyone could be tested for free, the U.S. system is, “Call your doctor.” That doesn’t work especially well under the best of circumstance, because individual doctors and their health practices have to figure out what guidelines to use for testing and have to fight for supplies, while interacting with health insurers and local, state and federal authorities. The process just takes too long when you’re dealing with a virus so contagious that one case can produce 59,000 new cases in less than two months (based on the R0, or R-naught, of three that seems to be the rule of thumb for the coronavirus at the moment).

Then you add in that many people who don’t have a doctor to call. Some 44 million Americans don’t have insurance, and a further 38 million have limited enough insurance that they likely don’t have a strong relationship with a doctor. Because about half of Americans get their insurance through employers, even those with insurance become vulnerable as a pandemic devastates the economy and people are laid off — like the 36 million Americans who have filed unemployment claims since the pandemic began. How can you do testing through a “Call your doctor” program when maybe a third of the country doesn’t have a doctor to call?

The U.S. briefly tried a South Korea-like system of mass testing. You may recall the Rose Garden announcement in mid-March of a website that Google was supposedly developing that would soon direct people across the country to testing centers in parking lots of major retailers. But the problems were just too hard, and the administration quickly moved on from the plan. The last I read, the website was still just a test in a few counties in California, and testing centers had been set up in only five parking lots.

It seems clear that, where future pandemics are concerned, there needs to at least be a national overlay on the current system. That overlay needs to include detailed planning ahead of time so we can go straight to the South Korea model of widespread national testing, no matter who someone’s doctor is or whether the person has insurance. The funding needs to be ample and permanent — no raiding the cookie jar even if we go 15 or 20 years before another crisis. It seems we also need to agree on what kinds of restrictions on business and individual movement are philosophically acceptable, so we avoid a repeat of the current situation, where a health crisis has somehow become a partisan issue devolving into debates about who’s more patriotic.

I hope we can get to the sort of “germ games” that Bill Gates has been promoting for five years, as he has repeatedly warned that a pandemic would show up soon enough. His idea is that, just as the military conducts war games, why wouldn’t we conduct similar exercises to make sure we’re ready for the viral threats that, as we’re now all painfully aware, can cost the lives of many tens of thousands of people just in the U.S. and create trillions of dollars of economic damage?

I hope, too, that we won’t just stop with planning for the next pandemic, because the current crisis has brought into sharp relief some major problems that we can start to solve even as we’re throwing trillions of dollars at the acute, short-term issues. I saw, up close and personal, how this can work when I was involved in a Stimulus Act project at the Department of Energy in 2010. The leaders were charged with getting $36.5 billion into the economy as quickly as possible but took a very strategic focus and, in the midst of the chaos, made a series of investments that have helped drive prices way down for solar, wind, batteries, electric vehicles and more in the ensuing decade. The same strategic approach can be taken now with our healthcare system.

In particular, it’s clear that we have to do something about “health equity,” which may finally get the attention it deserves because of the hugely disproportionate effect of COVID-19 on minorities. Because of some occasional work I’ve done with the American Medical Association, I’ve heard for a while about “the death gap” — the fact that people born in one part of Chicago have a lifespan 30 years longer than those born just eight miles away — and it’s nice to see that unconscionable disparity get national attention, including on the editorial pages of the New York Times. There’s no simple solution, because so much of the disparity relates to what are known as the social determinants of health. (Even if you have access to healthcare, what does it matter if you don’t have the money to buy a refrigerator and can’t afford to eat well?) But we can start by building on the need for pandemic coverage to make sure everyone has access to a minimum standard of care.

If the dominoes start to fall, then we can look at a broader issue: the need to switch from sick care to health care. At the moment, healthcare providers get paid for each service or medicine they provide, so they focus on sick people and help them get better. But the goal with the pandemic is to keep people from becoming infected in the first place, and some of that prevention thinking needs to infuse the whole system. Healthcare providers are actually much more inclined at the moment to get away from fee-for-service, because so many people are avoiding any interaction with the healthcare system that they can, for fear of coming in contact with those infected with the coronavirus. That fee-for-service income has dried up. If doctors were paid a sort of subscription fee for keeping patients healthy, medical practices wouldn’t be suffering so much. In addition, the pandemic has helped telemedicine finally come into its own. It offers a way to keep doctors in touch with patients easily, going well beyond that seven-minute annual visit that is the way many of us experience healthcare now.

Switching away from fee-for-service and increasing the use of telemedicine means changing payment models, which finally brings us to the health insurers.

They take a beating these days for two main reasons. First, the insurers catch much of the blame for the fact that the U.S. spends twice as much per capita on healthcare than other major economies while getting average care. Second, while everyone wants and needs health insurance, nobody likes it. Dealing with health insurance is simply painful.

In this case, they have the potential to lead the way. While they can’t be expected to do anything deliberately that would cut into their lush profits, they can easily drive adoption of telemedicine and use that as the tip of the spear in efforts to move away from sick care and toward health care, earning good will without much change to their business models.

Even if insurers choose not to lead, the pandemic will drive others to demand change, so the insurers might end up following.



P.S. Here are the Six Things I want to highlight from the past week:

Firms’ Top Priorities During the Pandemic

Change management, flexibility and risk management have exposed their critical importance.

How to Adapt to a VUCA+V World

In a world they haven’t seen before, insurers must do what they haven’t done before if they want to stand a chance to succeed.

Access to Care, Return to Work in the Pandemic

Beyond the pandemic, claims teams will need to know how to prioritize medical care for injured workers.

Hurricane Season: More Trouble Ahead?

As if COVID-19 isn’t tough enough, the Atlantic hurricane season looks to be active, with a higher probability of named storms making landfall.

Getting Back to Work: A Data-Centric View

By the time the world gets to the new normal, insurers must have created an “information mesh.”

The Pandemic and a New Ecosystem

As much as we all wish coronavirus had never happened, it has supercharged innovation in the insurance industry.

Securing Your Internet of (Medical) Things

Internet of Medical Things is no longer a thing of the future; it can be rightly called a thing of today. Worldwide, a plethora of hospitals, health facilities and labs have adopted IoMT systems of iconnected devices and big data, which allows them to render error-free, personalized and overall superior healthcare services to their patients. On top of that, the demand for digitalized healthcare is growing, especially among younger generations, who are more likely to opt for medical providers offering digital capabilities.

Such a system, however, can actually become a source of security and privacy threats to a medical facility and its patients. This vulnerability is a downside of the rapid emergence of healthcare IoT, which neither the equipment makers nor medical practitioners were prepared for. For now, healthcare institutions and legislative bodies are working hard to catch up and impose medical security practices, yet many facilities remain drastically behind the curve.

In the light of grave consequences for human health and life, as well as possible financial and reputational harm to a medical facility, being ill-prepared for IoMT security violations is off-limits for healthcare executives.

It’s high time you homed in on making your healthcare IoT impregnable, and this article will serve as a guide on this journey. Read on and learn about the most common security threats that an average Internet of Medical Things is susceptible to and, most importantly, the ways to shield your connected healthcare environment against conceivable cybersecurity risks.

What Makes IoMT Vulnerable?

Put into practice, the Internet of Medical Things is a vast and miscellaneous entity, often amounting to thousands of connected devices. On average, between 15 and 20 medical devices for monitoring and treatment are implemented in a single ward in the U.S. This number is only predicted to grow: According to a study by Frost & Sullivan, by 2020 the number of operating appliances – from insulin pumps to pacemakers, from imaging systems to MRI scanners – will reach up to 30 billion globally.

So, on the face of it, detecting vulnerabilities in such a system is similar to looking for a needle in a haystack. In fact, there is a definite pattern of security flaws that most healthcare IoTs are susceptible to, and being aware of them is a stepping stone to rendering the system invincible.

See also: Why Medical Records Are Easy to Hack  

Let’s go over the most common weak spots of an average IoMT infrastructure.

Legacy Systems

IoMT emerged surprisingly swiftly and in a sense caught medical authorities off guard. Healthcare facilities were unable to build designated environments from scratch due to monetary or time constraints, so the majority established their medical IoT on their legacy systems.

These systems were flawed and outdated more often than not, lacked crucial cybersecurity controls or all of the above. With time, a small share of organizations revamped their legacy systems, while the majority, according to a Forescout report, still operate on the Windows versions that are to expire by 2020, which would leave them unsupported and highly vulnerable to cybersecurity breaches.

Outdated Medical Devices

Medical devices used to be designed with no or few security considerations, and this used to suffice, as they were standalone, and threats were close to zero. Now, healthcare IoT requires medical devices to be connected within a single network, making outdated hardware a potential source of critical data exfiltration.

Apart from this, a fair share of older medical devices are not in line with the cybersecurity guidelines of the Food and Drug Administration (FDA), require manually implemented patches or are beyond repair, which makes them exposed to all kinds of internal and external security threats.

System Sprawl

The undeniably positive trend toward increasing the number of connected medical devices has a downside: It expands the attack surface. The vaster the medical network becomes, the more foothold cybercriminals gain for infiltration. Besides, the devices commonly come from a variety of vendors, which complicates compatibility between the tools and hinders unified security measures.

Best Practices to Mitigate IoMT Security Risks

Network Segmentation

When you have a vast IoMT legacy system that you do not plan to shift away from anytime soon, limit the potential attack surface by segmenting your medical IoT.

The segmentation principle rests on individual needs and priorities: You can separate vulnerable devices only from the main network or segregate them based on their function or user types. Also, the FDA guidelines insist on separating unpatchable devices from the rest of the network and minimizing the traffic to them.

Applying this unsophisticated measure, one can successfully isolate potentially vulnerable tools from sensitive data and more secure devices, and prevent a possible malware infection from spreading across the network. Segmentation also facilitates supervision of the disparate IoMT environment.

Regular Updating and Patching

Thorough updating and security patching can become an effective preemptive measure against data breaches. However, because the medical IoT system consists of software and hardware from miscellaneous vendors, expect patch and update releases to be numerous and irregular.

This can be managed in two ways: by appointing a dedicated team to implement new versions and bug fixes as soon as they come out or automatically streamlining this process, which will require elaborate development.

Another challenge of updates in medical facilities, especially in intensive care wards and such, is that a great many life-sustaining devices cannot become inoperative even for several seconds.

Data Encryption

Protected health information (PHI) is a coveted prize for cybercriminals who target healthcare facilities, and, in a medical IoT environment, data is more ubiquitous than ever. There is a constant flow of patients’ information within the network of devices, and a fair amount of critical information is stored on servers and devices – all an easy target unless protected.

Encryption is a baseline measure for securing the integrity of PHI. The encryption process involves using a specific algorithm to render data incomprehensible, decipherable only with a confidential key. Encryption keys should also be properly secured, and access to them should be limited to select people. Therefore, in the worst-case scenario when PHI does get stolen, a threat actor could hardly access the data or assign any meaning to it.

See also: Insurance and the Internet of Things  

Machine Learning

Machine learning (ML) can help diminish security concerns related to the Internet of Medical Things. It can serve as an extra-sensitive risk detector, recognizing suspicious activities across all the network’s devices and endpoints in real time. Beyond that, ML can monitor data exchange within the facility as well as with external entities and detect anomalies in the data flow. The technology can also be leveraged for predicting system vulnerabilities, analyzing the facility’s big data and recommending corresponding security measures.

Still, for the time being, machine learning is too young as a technology to be left to its own devices, so considerable human supervision and correction is still required.

With IoMT, It’s Better Safe Than Sorry

Internet of Things has proven to be a disruptive technology for healthcare, used to diagnose more accurately, monitor treatment progression closely and perform sophisticated procedures, to name but a few applications. At the same time, the IoMT environment is very complex, demands financial investment and upkeep and, among all things, can be the loophole for a security breach or a data loss.

Still, it is better to prevent than to treat problems, and health professionals know this like nobody else. Do not wait for the worst to happen – instead, be aggressive and implement relevant security measures to keep your facility and patients from harm. After all, with so much at stake – money, reputation, health and even lives – inaction is inexcusable.

Walmart May Redefine Primary Care

When Catalyst for Payment Reform hosted a webinar that provided a glimpse into Walmart’s healthcare strategy and management plans, Lisa Woods, senior director of U.S. benefits, talked about a new program to simplify and improve healthcare, particularly primary care, for Walmart’s million-plus associates and their families.

She alluded to Walmart’s well established and continuously expanding Centers of Excellence (COE) programs, as well as two new programs. First is a personal healthcare Assistant, powered by healthcare navigation firm Grand Rounds, that helps Walmart associates with billing and appointment issues, finding a quality provider, understanding a diagnosis, coordinating transportation, arranging child care during appointments and addressing other important patient needs.

Walmart has also broadened its telehealth offerings, including for preventive health, chronic care management, urgent care and behavioral health. All video visits have a $4 copay, and associates can book an appointment with a primary care physician within one hour and a behavioral health visit within one week, making services highly accessible. Partners for this program are Doctors on DemandGrand Rounds, and Healthscope Benefits.

Daniel Stein and Matthew Resnick, from physician profiler partner Embold Health, described how their data collection/analytics approach identifies physicians with histories of providing the most appropriate care. In three markets – Northwest Arkansas, Tampa/Orlando and Dallas/Ft. Worth – Walmart’s “Featured Provider” program will connect patients to the high-performing providers that Embold has identified in eight specialties: primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology. Walmart has been a key partner in the development of Embold Health – Stein, the CEO, Stein is a former Walmart medical director – and its efforts to accurately profile the quality of healthcare delivery at the individual physician level. The health outcomes improvements and savings associated with only using high-performing physicians should be profound.

See also: 11 Ways Amazon Could Transform Care  

The changes that Walmart has announced reflect a laser focus on solving specific problems, like overtreatment and patient difficulty with navigating the system, that plague all primary care programs. The company has been tinkering with and testing different primary care models for a decade or more. As with its COE program, the goals of Walmart’s new healthcare programs are a more refined, disciplined and methodical set of innovations focused on driving better care, a better patient experience and lower cost and that, for the most part, are not yet available to most primary care patients elsewhere in U.S. healthcare.

As a side note, it’s worth recognizing that, in an ideal world, the major health plans – e.g., United, CIGNA, Aetna, Anthem – with many millions of lives covered, would have pioneered these approaches to manage healthcare risk, to improve health outcomes and to reduce cost. The fact that payers haven’t been motivated along these lines is a reflection of the perverse incentives that have driven the U.S. health system for decades, that all patients and purchasers are up against and that have facilitated the kinds of innovations discussed here.

Walmart attacked these problems because it is at risk for its population and its costs. Few employers have the resolve and the resources available to develop key innovations that can move an industry like healthcare forward.

Not surprisingly, Walmart appears to see an opportunity here and has larger plans. Walmart almost certainly believes its healthcare efforts are applicable beyond its own population, and, like HavenKroger and Costco, has staked out a healthcare business strategy. Primary care are logical services to begin with, and Walmart has announced that its pricing will be 30% to 50% below conventional primary care prices. Walmart’s focus on improving experience, health outcomes and cost, combined with its national footprint and deep resource base, could immediately catapult it to the first rank of competitors in this space.

No doubt, Walmart has its eye on providing primary care services to groups as well as individuals. Relationships with health plans would allow the company to share in the savings it generates through the primary care platform and associated programs.

Think about the territory covered here. Walmart intends to:

  • Develop highly price competitive primary care clinics across the country.
  • Offer very low-cost telemedicine that can be a convenient pathway to primary care and other care, streamlining care processes.
  • Implement a personal healthcare assistant that can simplify navigating the healthcare system and expedite a much enhanced patient experience.
  • Connect to the highest-performing local physicians and regional COEs in each specialty, driving appropriate and disrupting inappropriate care and cost, in strong contrast to the inappropriate care and cost patterns that have come to dominate U.S. healthcare.
  • Develop some tie to health plans that would allow the company to benefit from the health outcomes improvements and savings that its management approaches create.

A vigorous primary care campaign by Walmart would undoubtedly threaten traditional primary care models and spur competitive innovation among progressive primary care organizations, especially if the company publicly conveyed a dedicated focus on transparent management of full continuum health outcomes and cost. This would powerfully differentiate Walmart’s primary care efforts from those of competitors like Walgreens and CVS, whose convenience care primary care models are mainly dedicated to maintaining the status quo.

See also: Avoiding Data Breaches in Healthcare  

Walmart’s activities in this space are one signal that the old paradigm in health care is waning and that a new, value-based healthcare market is emerging. It can’t happen soon enough.

Fixing the EMT Crisis in Rural America

What if you call 911 during an emergency medical situation and no trained emergency medical technician (EMT) and ambulance responds to the call? This scenario is a very real medical crisis facing rural America today.

What if you are unconscious or extremely disoriented during a medical emergency when EMTs arrive? Virtually every emergency room physician has to handle such a patient during every shift in a community hospital.

NBC national news recently ran a lead story about the EMT shortage that threatens rural communities across the country. Roughly 70% of EMTs in rural America are unpaid volunteers with full-time jobs and families to take care of. Their numbers are rapidly dwindling, causing a terrifying crisis where 57 million people face the risk of losing vital emergency medical services. In many small towns, there is no local doctor, and the EMT/ambulance community serves as a front-line safety net.

This crisis is exacerbated by the fact that EMT services are not funded in 39 states because they are not considered “an essential service” like police or fire. Try telling that to the person who just had a stroke or heart attack. In the case of a stroke, which is the second leading cause of death worldwide, a person receiving treatment within three hours of the onset of symptoms has the best chance of not only survival but living a normal daily life.

As much as 60% of local EMT ambulance services are typically paid for through community fundraising, such as spaghetti dinners and fish fries. The longer a person must wait for medical care during an acute medical event, the less likely that the person will have a positive outcome. What if you call 911 during a medical emergency such as cardiac arrest and nobody shows up? People who could have been saved will die.

It is estimated that one third of all emergency medical services in rural America are in danger of closing due to the lack of funding. The system designed to save American lives needs a rescue now. It is time for the federal, state and local governments to respond to what medical experts describe as a dire situation.

See also: Musings on the Future of Driverless Vehicles  

My second scenario, in which a patient arrives unconscious but with no visible signs of trauma, is so common that emergency rooms physicians have a shorthand term for it: AMS, or “altered mental states.” With AMS, the emergency room physician is essentially flying blind as to the root of the medical emergency. The patient could be facing any number of underlying medical problems. Has the patient suffered a stroke, heart attack, seizure, serious infection, allergic reaction, diabetic coma or overdose of prescription or illegal drugs? All these potential medical issues are just the tip of the iceberg faced by the ER medical staff.

The ER physician must do a rapid assessment of the ABCs: patient’s airways, breathing and circulation, including pulse and blood pressure. The first few minutes may be critical. The rapid assessment is known as DON’T. Does the patient need Dextrose for diabetic shock? Does the patient need Oxygen to the brain? Does the patient need Narcan due to an opiate overdose? Does the patient need Thiamine due to alcoholism or encephalopathy?

DON’T covers immediately life-threatening conditions that can cause a patient to be in AMS, but that an ER physician cannot always find. Typically, ER physician’s end up ordering a lot more lab tests, EKGs, CT scans, etc. just to confirm a suspected diagnosis. The first few minutes are focused on the array of things that may cause AMS that can also kill you quickly. The average time to complete comprehensive medical testing in the ER is six hours.

But what if ER physicians and staff knew your medical history and who your primary care physician was, had access to your online medical records and knew what prescription drugs and dosage you were taking and what allergic reactions you may be dealing with before you even arrive at the emergency room? Many lives could be saved every day. What if simultaneously your family, spouse, friends, worksite and babysitter were notified of the situation and what emergency room hospital you were being taking to by the EMTs? Without question, the patient would have a much greater chance of not only a better and less expensive patient experience, but the notifications could save lives and prevent lifelong disabilities. The average time it takes an ER to contact a patient’s emergency contacts is four to six hours. That statistic includes patients who are fully conscious.

Tim Lally, president and CEO of My Notification Services (MNS), has been working on the development of such a program for what he describes as a “10-year pilot program.” MNS provides enrolled members from a sponsoring organization with a kit that includes a bright yellow emergency sticker, which is placed on the back of a driver’s license or other form of identification such as a student ID or insurance card; a sticker for an auto, truck or RV is also provided, along with an option for an array of MNS medical alert bracelets that can be worn 24/7.

The enrolled member receives a unique ID number through an online process that allows each member to provide potentially critical medical history and contact information. Each member then has 24/7 access to update any medical or contact information and the ability to print out any additional personal MNS ID cards.

EMTs are trained to look for emergency medical cards or other forms of medical alert information for patients who are unconscious or dealing with AMS. The EMT sees the MNS sticker and calls the 800 number, which is then answered by 1 of 22 call centers around the country and Puerto Rico. The call center operators fax or email all the pertinent medical history, primary physician contact information and insurance coverage to the hospital emergency room in this pre-planned process within five minutes of the initial call, prior to arrival at the hospital ER.

See also: Using High-Resolution Data for Flood Risk  

This program can both save lives and provide peace of mind and can be sponsored by an endless list of organizations, associations, corporate and union health benefit plans, along with a vast array of insurance programs. I have the sticker in my wallet and my car windshield. You should, too.

New Guidelines for Preventing Suicides

The American Association of Suicidology (AAS), American Foundation for Suicide Prevention (AFSP) and United Suicide Survivors International (United Survivors), announced their collaboration and release of the first National Guidelines for Workplace Suicide Prevention on World Mental Health Day (Oct. 10, 2019). The guidelines — built by listening to the expertise of diverse groups like HR, employment law, employee assistance professionals, labor and safety leaders and many people who had experienced a suicide crisis while they were employed — aim to jump start the ability for employers and workplaces to become involved in suicide prevention in the workplace. For employers and professional associations ready to take the pledge and become vocal, visible and visionary, please visit WorkplaceSuicidePrevention.com.


Over two-thirds of the American population participates in the workforce; we often spend more waking time working each week than we do with our families. When a workplace is working well, it is often a place of belonging and purpose — qualities of our well-being that can sustain us when life gets unmanageable. Many workplaces also provide access to needed mental health resources through employee assistance programs and peer support. If we are ever going to get in front of the tragedy of suicide, we need to widen our lens from seeing suicide only within a mental health framework to a broader public health one. In other words, when suicide and suicidal intensity are seen only as the consequence of a mental health condition, the only change agents are mental health professionals, and the call to action becomes a “personal issue” that people take care of with their providers — but not all problems will be solved by getting a bunch of employees to counselors. When we understand suicide through a public health framework, many additional solutions are available. Through this broader lens, workplaces now understand the importance of a culture that contributes to emotional resilience rather than to psychological toxicity, and they can take steps to create a caring community of well-being.

Guidelines Development Process

After the CDC’s 2018 report that ranked suicide rates by industry, some employers started to feel more of a sense of urgency and requested tools to protect their workers from this form of crisis and tragedy. The Workplace Committee of the American Association of Suicidology resolved to do something more important: to create a set of National Guidelines for Workplace Suicide Prevention. Over the next two years, the group enrolled over 200 partners into the effort and subsequently forged a core partnership to conduct an exploratory analysis (the full 100-page report of findings can be found at www.WorkplaceSuicidePrevention.com). The ultimate purpose of this needs and strengths assessment was to guide the development an interactive, accessible and effective on-line tool designed to help employers and others achieve a prevention mindset and implement best practices to reduce suicide intensity and suicide death. Some of these best practices are about supporting despairing or grieving employees, and others are about fixing psychosocial hazards at work that can drive people to suicidal despair.

Goals and Target Audience

The collaborative partners’ goal is to enroll workplaces and professional associations to join in the global suicide prevention effort by building and sustaining comprehensive strategies embedded within their health and safety priorities. Across the United States, workplaces are taking a closer look at mental health promotion and suicide prevention, shifting their role and perspective on suicide from “not our business,” to a mindset that says “we can do better.” We hope this ground-breaking effort helps provide the inspiration and the road map to move workplaces and the organizations that support them from inactive bystanders to bold leaders.

See also: Blueprint for Suicide Prevention  

Many different employer roles can benefit from these guidelines, including leadership, HR, community collaborators who will partner in the process, investors who can contribute resources for the development and sustainability of these guidelines, evaluators who can assess the effectiveness of workplace suicide prevention, peers (co-workers, family and friends) who want to help and many others.
The newly developed guidelines, designed to be cross-cutting through private and public sectors, large and small employers, and all industries will:

  • Give employers and professional associations an opportunity to pledge to engage in the effort of suicide prevention. Sign the pledge here: WorkplaceSuicidePrevention.com.
  • Demonstrate an implementation structure for workplace best practices in a comprehensive, public health approach.
  • Provide data and resources to advance the cause of workplace suicide prevention.
  • Bring together diverse stakeholders in a collaborative public-private model.
  • Make recommendations for easily deployed tools, training and resources for short-term action inside of long-term change.

Nine Recommended Practices

The exploratory analysis also uncovered a number of suggestions for nine areas of practice. They are:

  • Leadership: Cultivate a Caring Culture Focused on Community Well-Being
  • Assess and Address Job Strain and Toxic Work Contributors
  • Communication: Increase Awareness of Understanding Suicide and Reduce Fear of Suicidal People
  • Self-Care Orientation: Encourage Self-Screening and Stress/Crisis Inoculation Planning
  • Training: Build a Stratified Suicide Prevention Response Program
  • Peer Support and Well-Being Ambassadors: Set Informal and Formal Initiatives
  • Mental Health and Crisis Resources: Evaluate and Promote
  • Mitigating Risk: Reduce Access to Lethal Means and Address Legal Issues
  • Crisis Response: Prepare for Accommodation, Re-integration and Postvention

See also: Social Media and Suicide Prevention


This exploratory analysis is a starting point to develop guidelines and best practices to help employers and professional associations aspire to a “zero suicide mindset” and implement tactics to alleviate suffering and enhance a passion for living in the workplace. The process identified high-level motivations for (predominantly around worker safety and well-being) and barriers (lack of leadership buy- in and resources) that prevent the establishment of national guidelines for workplace suicide prevention.

To learn more and take the pledge, please visit WorkplaceSuicidePrevention.com and follow along on Facebook, Twitter, Instagram and LinkedIn.