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Innovations in Occupational Medicine Novartis Business Services Different: Reflections from an Occ Doc* Robert Goldsmith, M.D., MPH, FACOEM Mid-Atlantic Regional OEM Conference October, 2018 *Not really Novartis Business Services The goal of this session is to spark ongoing systematized discussion about the future of occupational medicine, and the role of MARCOEM in sustainability, growth, innovation and excellence in the field. The next hour is not intended to find all the answers. Rather, it seeks to uncover the essential questions. *Dr. Goldsmith is a FT employee of Novartis Services, Inc. There are no conflicts to disclose. A Mnemonic for Pulmonary Edema Circa 1983 Morphine Digoxin or digitoxin Oxygen Aminophylline IV diuretics Mercurials Sit ‘em up Phlebotomy (or Paste) Tourniquets Novartis Business Services 3 Business Use Only The Secret’s Out Novartis Business Services 4 Business Use Only Injury Rates are Down-Hooray! Nonfatal Occupational Injury and Illness Incidenc Rates by Case Type, Private Industry 2003-2016* *Source: U.S. Bureau of Labor Statistics Novartis Business Services 5 Business Use Only So What’s the Problem? Novartis Business Services 6 Business Use Only An (old) Internist’s Perspective • The pace of true innovation in OH is far behind every other medical specialty. The law of process limits is largely ignored. OSHA is an impediment to advancement in the field. NIOSH relies on industry and academia for innovation. OEM has significantly ignored precision medicine, in favor of population health. • OH services are generally viewed by employers as a cost center. Medical Directors have not developed a value-based approach to occupational health. Without considering value, the practice of OH will always be under pressure. • New Occ Docs are training as generalists, rather than following their true passions. Their career choices are handicapped by overwhelming student debt. • Employers claim to give a crap about health and safety, but very often, they really don’t. • OEM may have an identity crisis. Novartis Business Services 7 Business Use Only Identity: Some Existential Questions 1. Is OEM a better fit within HR or within HS&E? 2. Should OEM be more aligned with public health or medicine? 3. Does OEM appropriately consider both nature and nurture? 4. Do occupational health clinicians advocate for employees or employers? 5. Do OEM training programs adapt to the changing landscape? 6. Does the field aspire to achieve excellence or compliance? Let’s start with innovation... Novartis Business Services 8 Business Use Only One of My Innovation Heroes 1. Japanese-American 2. Former world record holder 3. Now boycotts world championship 4. Lives to eat 5. He’s more than a hot dog. Novartis Business Services 9 Business Use Only As Long as We’re Having Fun... 1. Former American Olympic athlete 2. Track and field 3. Gold medal winner-1968 4. His innovation was a flop Novartis Business Services 10 Business Use Only What Drives Innovation in OEM? It ain’t the government “OSHA recognizes that many of its permissible exposure limits (PELs) are outdated and inadequate for ensuring protection of worker health. Most of OSHA’s PEL’s were issued shortly after adoption of the Occupational Safety and Health (OSH) Act in 1970”. Novartis Business Services 11 Business Use Only Meanwhile, in Medicine... • BRCA1 Discovered in 1994 • Test commercialized in 1996. • Current testing cost-$199 (23andMe) Novartis Business Services 12 Business Use Only And From Business... The job isn’t to catch up to the status quo; the job is to invent the status quo. -Scott Godin Novartis Business Services 13 Business Use Only Is this Good Enough? Nonfatal Occupational Injury and Illness Incidenc Rates by Case Type, Private Industry 2003-2016* *Source: U.S. Bureau of Labor Statistics Novartis Business Services 14 Business Use Only How Much “Better” Can We Get? Or do we need to “think different”? Process Limit Innovation opportunity Novartis Business Services 15 Business Use Only A Standard Ergonomics Improvement Plan Post-injury New hire Annual Implement Early assessments training retraining controls intervention Treating the job and the injury I/I Rate 0 Novartis Business Services 16 Business Use Only Find the Personal Resiliency Factor (Hint: there is none) Novartis Business Services 17 Business Use Only There’s a Method to This Madness “If I’d asked them what they wanted, they would have said, ‘faster horses’.” -Henry Ford “Sometimes you gotta’ throw out the baby with the bathwater and start a new family”. -Anonymous Novartis Business Services 18 Business Use Only There’s a Method to This Madness 1. Be inspired by the world around you. 2. Ask people who know nothing about your business. 3. Turn the existing process backwards, upside down, or inside out. 4. Think crazy thoughts. See if they still make sense the morning after. 5. Develop a tollgate system The UHC Garage System 24 hours No Develop Nuts? PoC TG TG Start program Concept 1 x An idea is born Yes Novartis Business Services 19 Business Use Only Precision Medicine Meets OEM Will OSHA respond? (Hint: no) Will employers? Is there value in precision OEM? Novartis Business Services 20 Business Use Only Let’s Talk Value “If I asked my boss for a million bucks, he’d laugh my face!” -Former big pharma medical director Novartis Business Services 21 Business Use Only Novartis Business Services 22 Business Use Only The Curious Case of New Hires Are they 100% ready to go? • Young • Healthy • Energized Traditional OEM plays defense • Fully productive Day 1 100% Healthy Strain Aspiration I/I Disability Current state Separation Novartis Business Services 23 Business Use Only The Curious Case of New Hires Playing offense creates (+)value Stressed Chronic ? Healthy Behavior disease care ? Fit modification Not 100% productive Stress management Aspiration Day 1 <100% Healthy Strain I/I Disability Current state Separation Novartis Business Services 24 Business Use Only The Currency of Business Form of Currency Estimated OEM Contribution Marketing and sales 0 Product development 0 Productivity +++ Cost avoidance + Compliance ++++ COPQ + EoC ++ Visibility + Community service 0 Novartis Business Services 25 Business Use Only Creating Value Through OEM Novartis Business Services 26 Business Use Only It Must be Measured, Analyzed and Improved Novartis Business Services 27 Business Use Only The Next Generation of OEM Clinicians What the kids are thinking “My passion is to help people and save lives. I also like dance.” -Not Yet Famous OEM Physician Novartis Business Services 28 Business Use Only Novartis Business Services 29 Business Use Only Care for Professional Dancers-2018 OEM Sports Medicine Kinesiology PT Orthopedics OEM Novartis Business Services 30 Business Use Only What’s Right with this picture? Sports Medicine Kinesiology Orthopedics OEM PT Novartis Business Services 31 Business Use Only Or this picture? Sports Medicine Kinesiology OEM PT Orthopedics Novartis Business Services 32 Business Use Only Starting Deep in the Hole According to the Association of American Medical Colleges, the median four-year cost to attend public medical school exceeds $240,000. A private medical school degree can exceed $340,000. An institutional scholarship can ease this burden, but the typical four-year award is only $18,000. Fewer than one medical student in five receives $100,000 or more in financial assistance. Because few medical students are wealthy enough to pay cash, most borrow heavily. The median education debt of a new medical school graduate is $190,000. Fourteen percent start their residency training owing $300,000 or more. • How will debt impact the careers of next gen of occupational physicians? • How will this debt burden impact the next gen of occupational medicine? • What’s the plan? Novartis Business Services 33 Business Use Only A Possible Strategic Shift Medical Degree Financial planning assistance OEM Residency Expanded elective menu Pass the Boards OEM Generalist Subspecialty Training Subspecialty dabbles MBA/MHA Fellowship Corporate Medicine OH Subspecialty Novartis Business Services 34 Business Use Only Entrepreneurship, hmm... Novartis Business Services 35 Business Use Only A Couple of Final Ideas to Munch On 1. Consider building strategic planning into the MARCOEM OS. 2. Update the mission statement for OEM. Re-define the goals, objectives, scope, business case, stakeholders, customers, and KPI’s. 3. Identify basic value streams and currencies. Build models based on value to the employer. 4. Consider reviewing residency and fellowship curricula • Financial planning and debt resolution • Business, project management and leadership training • Nurture curiosity • Career decision support • Full-time plus part-time work • OM-PCP hybrid models • Linking OH with personal passion 5. Reposition OM as a medical specialty, that innovates in step with other specialties. Consider nature as an equivalent (or greater!) determinant of human occupational health. Novartis Business Services 36 Business Use Only “The secret to my managerial success is keeping the people who hate me away from the people who haven’t yet made up their mind!” -Casey Stengel Thank you! 37 NovartisBusiness Use Only Business Services.
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