CHAPTER 12: Marketing

In the past marketing has been considered a dirty word by physicians and hospital administrators. Medical care was a professional service performed in a setting of mutual respect between patients and the medical provider. Physicians more or less dictated to the patients what services they would consume. The physician would prescribe a treatment or specify a diagnostic test without much regard for the opinions of the patient. Issues of comfort or adaptation to life were secondary and considered beyond the professional responsibility of the primary health provider. The idea that physicians or medical facilities might be in competition for the same patient was seldom voiced openly.

In metropolitan areas and many rural areas of the United States, this attitude has changed dramatically. In the current competitive environment, marketing is seen not only as necessary to preserve financial viability but as essential in order to respond in a timely manner to patients' needs. This second role of marketing is just as important as the salemanship aspect. Health care facilities and individual physicians must not only present their case to the public as to why their provision of medical care is superior or more desirable but must also accommodate the needs and preferences of patients and their families in order to retain their share of the "market" of patients seeking medical services. This means a good deal more than redecorating the waiting room and subscribing to a wider range of magazines. It may mean house calls, classes or group discussions, patient education programs, services that aid in daily living, relocation to quarters more convenient for patients, and changes in billing and other business procedures.

Marketing must be considered not only as a means of promoting a product or service but also a means of determining what the consumers of that product or service require and adapting to the needs of the consumer. Applied to medicine, marketing means listening to the consumer of medical care and adapting services to the convenience or benefit of the user.

In occupational medicine, the "consumer" of occupational health services is not necessarily the patient. Employers entering into contracts with medical facilities for the provision of basic care select the provider on criteria quite different from those that would be applied by the patient seeking a relationship with a personal physician. Medical services are exceedingly difficult for the lay person to compare in terms of quality. Employers are more likely to select a provider of medical care on the basis of cost and convenience of location and hours rather than attempting the difficult task of comparing medical capability and credentials of the staff. Most occupational medicine services, such as the acute care of work-related injuries or the provision of routine screening evaluations, do not require elaborate or sophisticated facilities and specialized expertise. The identification of occupational diseases, the appropriate application of rehabilitation services, and the provision of prevention-merited services are, in the minds of most managers, secondary considerations secondary to the provision of prompt basic acute care and inexpensive periodic or preplacement evaluations.

Services should be designed to satisfy the needs of employers and the expectation of workers. Waiting time must be minimal, turnaround time for reporting and paperwork must be quick, and the flow of occupational patients should not be mixed with those of family or primary patients.

Principles

Four basic principles underly the marketing of occupational health services and render it different from the marketing of personal health services:

  1. Locate the facility where the workers work, not where their families live.
  2. Adapt to local needs and prepare the facility especially to give good service to local employers and their workers.
  3. Develop a mix of large and small client employers.
  4. Keep occupational and personal health services strictly separate.

The first rule is to locate where the workers work, not where their families live. Many facilities attempting to provide both personal and occupational health care in the same facility locate in areas where the growth in residential population is likely to be greatest. Residential population means little in the provision of occupational health services because industry may be located at some distance from the homes of employees and is seldom in the same neighborhood. Clinics or other facilities positioned in a residential community to serve an expanding patient base for general medical services are often in a poor position to provide occupational services to employers in the industrial parks or districts where those same potential patients work. To build up an occupational health service, medical care must be taken to the worker. The workers will not be sent long distances by the employer for care if alternatives are closer. It is highly unusual for employers to send their workers with minor injuries across town just to be seen at a clinic with a good reputation, although this is common for executive health services. Most routine occupational health services do not require extensive specialty care and are seen as basic medical practice within the capability of any qualified physician. Rightly or wrongly, adequate is perceived as good enough and a reputation for excellence counts for little among managers if the injured worker is not seen as requiring fancy care. This attitude also holds true for periodic health evaluations (except for executives), preemployment evaluations, and other forms of fitness-to-work evaluation; most managers believe that any competent physician can perform a physical examination and assume that that is all that is required. As a result of such attitudes, most managers will not send their employees farther than is necessary to get adequate care.

     
     
     
     
     
      Table 12.1 Injury Rates by Industry, California 1977 and 1978.
     
     
                              Total No.         Disabling Injuries
     Industry*                Of Injuries       per 1000 Workers                         
     
     
     Mining                      2,388               86.4
     
     Construction               30,060               77.9
     
     Transportation and
     Public Utilities           24,049               49.1
     
     Manufacturing             100,453               48.7
     
     Finance, Insurance and
     Real Estate                 5,824               10.6
     
     Agriculture                15,635                ?**
     
     
          
     *    These industries represent 30% of the workforce, but are 
          responsible for 43% of lost time injuries.
     
     **   Not reported under the workers' compensation system.


Locations best suited for occupational health services are areas of high industrial growth. In particular, lower technology industries, such as assembly line manufacturing or automotive repair, tend to produce more work-related injuries and illnesses than capital-intensive high technology or automated industries. Table 12.1 illustrates the difference in injury rates for various industries in California. Labor-intensive industries, particularly those employing large numbers of untrained or partly trained workers with a high turnover such as fast food operations, tend to produce more acute injuries. Older, lower technology manufacturing industries are more likely to result in occupational injuries while higher technology injuries often present exotic problems in toxicology. Virtually all industries, including service industries with mostly desk jobs, generate large numbers of back complaints. Office operations and financial or information service industries require a larger proportion of preventive and educational services and may create a greater demand for health promotion activities. Particular locations will tend to attract one type of industry. Large employers will often be surrounded by many smaller ones providing support services and goods. In many cities, the downtown area is changing to a service core and manufacturing-related industry has moved to the periphery. Older health facilities serving the downtown area must consider whether the mix of services they have provided is now appropriate for their local industrial base.

One clinic known to the authors was established in a commercial area on the periphery of a large suburb in a metropolitan area in a location selected to be convenient both for young families in a residential area of that same suburb and to industry in an adjoining city. The building was accessible only by car, separated by a hill from a local housing development and by enormous parking lots from a shopping centre. Mothers with children and the elderly found the location highly inconvenient, even though on a map it appeared to be close to a concentration of homes. The major employer in the area never sent injured workers to the clinic because several physicians were within a shorter drive. The drive across town took 15 minutes in normal traffic even though this employer was on the same street. Professional marketing services costing thousands of dollars were engaged to promote utilization of the clinic but had little effect. After three years, this satellite had to be closed because it had adequately served neither industry nor residents. The location, having been compromised in order to satisfy both groups, satisfied neither since it was poorly located to serve the residential area and situated even worse to serve the occupational market. During its brief period of operation, several small industrial medicine clinics established themselves much closer to the primary market for occupational health services. It is not clear that this market will ever be tapped effectively by the group practice that sponsored the satellite.

The second general principle is that occupational health services must be adapted to local needs. As downtown industry is replaced by a clean, white-collar office and service workforce, the demand for services will be far different. Expansion of an existing clinic in the downtown area may be less advisable than, for example, the development of a satellite in a rapidly growing suburb from the standpoint of caring for injuries. A downtown location may make sense if prevention-oriented and health promotion programs are added to the range of services. The type of industry in the area will matter a great deal in generating demand for services but some problems, such as back pain, are important in virtually every industry and office. Nothing creates dissatisfaction faster than services not being available as described. Services that are being marketed must be in place before they are heavily promoted or the facility will rapidly lose credibility among local employers.

The third general principle is to go for a mix of contracts or client employers. Although it is desirable to have big clients to ensure a large volume of services, it is dangerous to depend on a few big contracts that could disappear overnight, particularly those representing employers in the same industry subject to the same market trends. Successful occupational health services usually develop a mix of large and small businesses in a variety of industries. Small business, of course, is "big" business in the aggregate and is just as important as big business itself in supporting a stable and profitable occupational health service.

The fourth principle is that occupational health services must be separated from personal health services. The type of services that will be needed in an occupational setting will be very different from those in residential communities, where many parents stay home to take care of children and where there is a higher concentration of the elderly. Occupational and personal health services mix poorly in the same facility and attempts to blend the two are often sources of dissatisfaction. When occupational medicine is mixed with personal care, patients with occupational problems are mixed with general medical and pediatric patients. This causes unavoidable delays that employers tolerate poorly, long waiting lines that workers and employers dislike, and often promotes an unfortunate attitude on the part of the staff that the patient is "just an industrial" and can wait. There is no equitable way to get around this problem. Patients who are waiting to be seen, especially with children, feel slighted when workers, often with minor or inapparent health problems, pass through the waiting room and bypass the lineup; giving priority to workers simply does not work in a clinic situation. Employers, on the other hand, expect rapid reporting, fast service, and adequate quality of care, as they see it. Time off the job because of injuries or routine evaluations costs the employer money that the smaller business in particular can ill afford to loose. Uncertainty over how long the employee will be away from work compounds the loss by causing confusion, inefficiency, and difficulty meeting schedules. Except for small individual private practices, therefore, it is best to insist on a strict separation whenever possible between occupational health services and general medical services, preferably by separating the two into separate facilities altogether. There are really no effective halfway measures. At a minimum, waiting rooms should never be shared.

If employers are not satisfied, they will often simply send injured workers elsewhere and feel that they owe the health facility no explanation. It is very important to cultivate clear lines of communication with employers and also with workers using the facilities to ensure that needs are met in a satisfactory manner. One way to promote such communication is by circulating to the persons responsible for workers' compensation and occupational health matters in each employer's organization a newsletter giving tips on health that can be reproduced for employees, news of the health care facility and its personnel, and items of significance to local industry in occupational health. This makes the health care facility less anonymous and promotes a more personalized relationship that is more difficult to break without explanation.

An even better way to achieve communication is by direct face-to-face contact between marketing representatives and employer's representatives. Most physicians are not good at this and their time is much too expensive to take on this function, beyond initial visits to a new client. Physicians are also often too threatening and imposing to non-physicians and will usually be treated more formally and with less candor than a non-physician. A good marketing representative, on the other hand, can visit at regular intervals and to trouble shoot problems and will get a more candid view of problems or complaints. Properly trained and instructed, a marketing representative can serve as the eyes and ears as well as the human face of the health care facility but caution must be exercised to keep the overenthusiastic types in line. It can be very dangerous - and expensive - to turn marketing responsibilities over to a contractor or independent representative who stays away for long periods without supervision. Marketing representatives must be careful not to over-sell the capabilities of the clinic and must not be too quick to agree to employer's requests for specific services since some of them may be ill-advised or even unethical. For example, one marketing representative committed a clinic to perform routine back X-rays for screening purposes on new employees, a procedure not considered acceptable practice. The representative had spent considerable effort selling local industry on the need for this unnecessary service and the clinic was put in an extremely embarrassing position. Experience has shown that the best marketing representatives for occupational health facilities are relatively conservative in appearance, appear professional in manner, have some health-related experience, and are willing to work closely with the professional staff of the facility. Former pharmaceutical representatives are often excellent candidates.

The economic viability of a for-profit clinic or satellite providing occupational health services should be the reason it is established, not efforts to penetrate a new community for the purpose of expanding the patient base for personal health care. Occupational health seminars should not be used as a "loss leader". This economic viability can be guaranteed in part by establishing agreements, either by an informal letter of agreement or formal contract, with local employers to utilize the services of the new satellite on a trial basis. An occupational health service does not imply the same commitment to continuing care as a family practice or a health facility serving personal health care needs. Although it should respect the physician-patient relationship and maintain the ethical standards common to all health care facilities It remains an obligation of the occupational health service to retain medical records and to provide respectful services. However, the management of occupational injuries and illnesses is a less personal commitment to health care than one expects in a family practice setting. Within the normal expectations of medical ethics, the level of obligation to the patient and the patients loyalty to the clinic is not the same. Satellites that are not economically successful within a reasonable time period should be closed and the resources used elsewhere. The exception to this general rule is when a community is expanding rapidly and it is desirable to establish a base of operations early in order to preempt competition. Since a larger organization has resources that a smaller competitor would lack, a hospital or large medical group practice can ride out a long period of underutilization as an operating expense that could not be absorbed as an operating expense by a smaller clinic. This stategy is fundamentally dependent on location and marketing and wrong decisions may prove disastrous when a commitment is made to a location that turns out to be ill-advised.

Marketing Services

A sound marketing strategy requires a knowledge of the range and levels of services that can be provided and the potential users of these services.

Figure 12.1 is a diagram known as a "marketing cube" that allows a three-dimensional representation of the possible combinations of levels of service, range of services, and users or "consumers" of these services. Bringing these three dimensions into one illustration helps one to visualize the possibilities and to identify opportunities for growth. It also identifies weaknesses in the system and sectors of the local economy in which needs are not being met.



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Figure 12.1 A "market cube" presents three dimensions of occupational health services: range of service, users of service, and level of service. Each subdivision of the cube represents a particular level of a particular service provided to a given category of user.

The range of services, presented in the horizontal dimension, is the easiest to conceptualize. "Medical care" includes routine health services, including first aid and surveillance, performed on-site in the employers' facilities. Industrial hygiene services must be provided on-site (usually with a laboratory as a base of operations elsewhere) but are not provided by physicians. Specialty medical care is rendered on a referral basis for special problems. "Occupational medicine services" includes specialty care provided by occupational physicians, usually emphasizing toxicology, administrative functions, and the design of programs rather than basic medical care.

Occupational health clinics providing services for multiple employers usually emphasize basic medical care and occupational medicine services. Large group practices are also in a strong position to provide specialty medical care. Relatively few facilities provide industrial hygiene services together with medical care. Industrial hygiene services are usually provided by consultants hired for the purpose by the employer, if they are not available in-house. This split between medical and engineering services may not be logical from the standpoint of resolving the problem but it reflects the different professional roles of the physician and the engineer. Where industrial hygiene services have been offered by clinics, they have often been undervalued or subordinated to the medical services despite their critical role in controlling hazards.

The level of services, on the vertical axis, represents a continuum from direct case management to prevention. Diagnosis, treatment, rehabilitation, and follow-up is familiar as the medical model but the approach of direct intervention also applies to the management of specific problems that arise in the workplace, such as hazards that have been identified or clusters of health problems suggesting that a hazard must be searched for. Consultation is a less direct intervention requiring particular insight and expertise, not only into the problem but also into the needs, motivations, and resources of those asking for the assistance. Education includes not only formal training sessions but opportunities to increase the awareness and sophistication of clients so that the services used are more highly valued. Most fundamentally, prevention is the foundation of sound occupational health practices.

Each level of service can be matched with each service type in Figure 12.1. The medical services may deal, for example, with treatment of individual cases or preventive services to groups of workers. These are the most common types of medical services but opportunities to provide consultative and educational services are often overlooked. While physicians, expertise may not be well utilized on a cost-effective basis by providing only educational programs, highly professional programs designed with physicians' input can be provided at reasonable cost by health educators or nurses and are very popular among some types of employers and groups of workers. Industrial hygiene services are usually provided on the case management or consultation level but a market can be created for periodic assessments for purposes of prevention and to ensure compliance with government regulations.

The users of the services, shown along the base of the cube in Figure 12.1, may include larger businesses, small business, public agencies, and, potentially, labor unions. Individual workers do not constitute a market for occupational health services in the same way that they and their families are a market for personal health care. The "consumers" of health care are those who use the system and make the choices. In the occupational health care system, it is usually the employer who makes the initial choice and who purchases (directly or through workers' compensation) health services on behalf of the worker. Even when an individual worker changes physicians or seeks care for an occupational health problem from his or her own doctor the system constrains the choice by allowing only a limited number of charges and refusing to pay for unauthorized referrals. In marketing occupational health services, therefore, the essential target is usually the employer. As a practical matter, the workers' needs must always be met but the employer's needs must also be reasonably satisfied or the relationship between provider and client may be brief.

Labour unions often have their own insurance plans and sometimes have their own medical consultants or services. They are potentially sources of referrals, often disputed or difficult cases. Members tend to rely on unions for advice on medical referrals for occupational problems more than on their personal physicians. Unions sometimes contract for educational and preventive services for their members but usually prefer to work with academic or non-profit organizations.

Examining the marketing cube leads to some interesting insights, as shown in Figure 12.1. Most medical services are limited to a narrow corner of the cube, as shown in Figure 12.2a. For facilities with larger staffs and specialty expertise, this can be expanded, as in Figure 12.2b. The addition of industrial hygiene expertise, either to the health facility or by collaboration with a consultant, can open additional opportunities not otherwise accessible, as in Figure 12.2c. Developing programs oriented toward education and prevention, however, fill up the cube even more as in Figure 12.2d. While no occupational health service is ever likely to develop fully all potential marketing possibilities, an appreciation of what can be done may lead the facility into a profitable and worthwhile new direction.

Executive Health Services

Major corporate executives are valuable to their companies. In order to avoid eroding the value of compensation by excessive taxation, major companies are always on the look-out for perquisites for their executives. Certain clever health care providers have combined those two facts and have created resort settings where major executives can have periodic (annual or otherwise) health evaluations combined with recreation and fitness programs. Outstanding examples of this include the Greenbrier (White Sulphur Springs, West Virginia), and Loma Linda's Rancho Loma Linda (near Dulzura, California). Attempts to do this without a resort atmosphere usually fail except in high prestige settings such as the Mayo Clinic and the Cleveland Clinic.

Executive health services are very attractive to medical group practices and hospitals as a way of increasing profitability and catering to an affluent clientele who may in the future choose the institution for various health care needs and for philanthropy. A congenial resort setting could be selected, such as a hotel. A wing or a floor could be equipped as a diagnostic clinic. Highly individualized services relating to fitness, health education, habit control, and nutrition would be offered with ample opportunity for the executive to enjoy sports and relaxation. Problems detected could be further evaluated, as needed. There are a number of drawbacks to the development of executive health services, however.



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Figure 12.2a Most clinics and practitioners limit themselves to providing acute medical care and clinical management of cases for employees of a mixture of larger companies, small business, and public agencies, such as city or state departments.



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Figure 12.2b Occupational health services with access to greater resources, such as hospital-based units or those associated with group medical practices, are in a position to provide specialty care and more in-depth consultation on technical aspects of occupational medicine.


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Figure 12.2c Addition of industrial hygiene expertise expands technical capabilities in health hazard evaluation and controlling, allowing a more comprehensive range of services to be provided to clients.



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Figure 12.2d Addition of programs in health education and health promotion complete the range of services that can be provided to clients.

Creation of a separate system to meet the less urgent needs of a privileged group often results in internal strains within institutions. It is not unusual for other patients and for staff to resent the special treatment afforded to executives and for staff to undermine efforts to cultivate the executive service by allowing delays to occur and refusing to give executives priority over other patients. Also, the creation of a "two-tier" approach to delivering medical services leaves the institution open to criticism for appearing to be discriminating in favor of the affluent and against the needy. Finally, workers who may be directed to occupational health services in the institution may suspect that their cases will be prejudiced or treated less sympathetically because the institution has engaged in an apparently "cozy" relationship with their bosses. These problems can be largely overcome by insisting on as complete a separation as possible between the executive health service and the rest of the organization. Ideally, this should be a separate facility, where a resort or recreational atmosphere may add to the appeal.

Such programs present an excellent opportunity to encourage sound health practices. The executive participants are likely to be more receptive to concepts of health promotion than they might be at home. Programs on stress reduction, smoking cessation, prevention of alcohol and drug abuse, health education, motivation, and exercise are very popular when combined with screening services. Lifestyle-oriented programs presenting healthier alternatives to the hard-driving executive workaholic stereotype are very attractive in today's more health-conscious society. Spouses of executives can be involved, also. Many of these programs can be offered at extra cost or as part of an attractive package within the executive health service.

Executive health programs should be based on sound principles of preventive medicine, however. Often the services actually provided are rather obsolete screening protocols emphasizing extensive clinical testing that may or may not be justified by the natural history of the disorder sought and by the sensitivity and specificity and predictive value of the tests applied. Since executive health services are a prerequisite of employment and are intended to identify and correct health problems in kay management personnel at a very early stage, the cost of such programs can be defended as an acceptable voluntary expense on the part of the employer when compared to screening programs for more general public health purposes. Even so, the tests incorporated in the program should be reasonably cost-effective, reliable, and safe.

Model Brochure

The text on the following pages is a sample brochure appropriate for marketing purposes by an occupational health facility serving many employers. Combined with regular visits by a marketing representative, literature of this type can raise the visibility of such services in an often fiercely competitive market.


EMPLOYER'S GUIDE TO OCCUPATIONAL MEDICINE SERVICES (Form 12.1)

ALLOW US TO INTRODUCE OURSELVES

We have a better idea for area employers. We provide a complete range of occupational medicine services, from the treatment of industrial accidents and the provision of pre-placement and periodic examinations to the most sophisticated consultation in toxicology and the design of company-wide programs to prevent health problems among employees.

Occupational medicine is our commitment and our specialty, not our hobby.

We think we have a better idea. We are committed to the following in the provision of occupational medicine services:
: EXCELLENCE... Not mere adequacy.
: EFFICIENCY...No fooling around.
: FLEXIBILITY... The services you need, not the services we can sell you.
: CONVENIENCE...Services when you need them, not just when we make them availab.e
: PREVENTION...Not waiting until the situation is out of control.

We have on our staff trained specialists in the key fields of medicine needed to provide high quality occupational medicine services for your employees.

HOW CAN WE MEET YOUR EMPLOYEES' NEEDS?


Care for the injured employee is the most basic occupational medicine service there is. We can provide your employee with comprehensive care for prompt treatment, timely followup, rehabilitation, and a speedier return to health and productivity.

We are ready to assist in each and every one of the following areas:
: Acute Care of the Injured Employee.
: Evaluation and Treatment of Occupational Illnesses.
: Rehabilitation and Evaluation for Return to Work.
: Consultation for Workers' Compensation Appeals Cases.
: Disability Evaluation
: Specialty Referral for Complex Cases.

QUALITY CARE FOR YOUR EMPLOYEES


Maintaining the health of employees is just as important as treating acute injuries. An employee who is later found to have been unfit for his or her job assignment can be an expensive proposition in terms of liability, bed feelings, and lost productivity. The provision of pre-placement and periodic examinations is a responsibility not to be taken lightly. Routine examinations should never become like an assembly line where the doctor just goes through the motions. We rotate the physicians who are doing routine examinations and limit the number that they do at any one time to ensure that they do not get tired, bored, or lose their mental sharpness. We believe that pre-placement and periodic examinations are opportunities to help the employee maintain his or her good health and to sustain the employee in a healthier, more vigorous, and more productive state in the work place. We focus on identifying both the employee's strong points and limitations and matching them against the job description which the employer provides to us for pre-placement evaluations. We also look for early signs of health problems which are correctable so that the patient can be warned or educated about his or her personal health and the loss to the employer in reduced productivity and health costs can be minimized. Mandated surveillance programs for employees exposed to specific occupational hazards are required under OSHA. We have designed programs in conformance to OSHA standards which meets the needs of the employees and employers and which are scientifically and medically sound. Some of the types of periodic evaluations we provide are the following:


: Pre-Placement Examinations
: Periodic Personal Health Evaluations
: Life-Time Health Monitoring Programs for Managers
: Surveillance Programs for Employees Exposed to Asbestos, Noise, Lead, Pesticide, and Other Occupational Exposures as required by OSHA
: Surveillance Programs for Employees Exposed to Other Occupational Exposures, Designed to Meet the Needs of Special Cases and Exposures Not Regulation by OSHA

WHERE CAN THE EMPLOYER TURN FOR HELP IN SOLVING PROBLEMS?


We can provide assistance in solving the occupational health problems of area employers. If a problem requires expertise which is not immediately available through our staff we will get it for clients through our network of affiliations and contacts. We invite area employers to invite us into their plants so that our medical staff will see the kind of work that their employee-patients perform and gain a clear picture of the possible job-related hazards. In the event that a problem arises, our staff is willing to meet with management and, if requested, employees, to assist in the solution of the problem and the education of all concerned about the health implications of the problem. In particular, if you are setting up a new plant or expanding an old one, give us a call for a consultation at no charge on the occupational health needs which the development of your plant may entail. We offer the following kinds of problem-solving services:


: Plant Visits and On-Site Consultation
: Technical Consultation and Problem-Solving by Occupational Health Experts
: Health Hazard Evaluations (In Depth Studies of a Particular Problem)
: Plant Walk-Throughs and Identification of Occupational Hazards.
: New and Expanding Plant Services.

AN OUNCE OF PREVENTION....

Prevention of occupational health problems is the best care of all. For a relatively modest investment up front, the health of employees can be promoted through programs designed to educate, entertain, involve, and break bad life-style habits. The best health promotion programs are those that capture the imagination of the employees and encourage their participation and commitment. These are precisely the kinds of programs which raise employee morale and lead to a closer knit work force. We can arrange for the preparation and supervision of a program tailored for the employees of any area firm, ranging from the smallest to major corporations, or it can analyze the situation in your organization to determine if such a program would be appropriate. The sorts of programs that can be developed may include any or all of the following:


: Smoking Cessation
: Fitness and Exercise
: Stress Reduction
: Back Injury Prevention
: Nutrition
: Cardiovascular Risk Reduction
: Hypertension Control and
Monitoring
: Mental Health
: Other Programs Tailored to the Needs of Your Organization

THE TROUBLED EMPLOYEE

The troubled employee is a difficult problem for any organization large or small. Employee Assistance Programs can be developed to salvage employees who have much experience and very real skills to contribute. A well-timed but firm intervention can be the key event in the employee's life. We do not provide Employee Assistance Programs itself because these programs are highly specialized and require extensive expertise in nonmedical as well as medical areas. Nonetheless, we can help your organization select appropriate employee assistance services and evaluate the options from a medical point of view. We can also play a gatekeeper role in the diagnosis of substance abuse and the referral of employees for treatment. Employee Assistance Programs cover a wide range of services, including:


: Treatment of Alcohol Abuse
: Treatment of Drug Abuse
: Mental Health Counseling
: Psychiatric Care
: Family Counsellling
: Financial and Credit Counseling
: Support for Individuals Undergoing Unusual Life Stress

CONSULTATION SERVICES

We recognize that not all companies are best served by contracting for services at a central location. The proper structure and development of programs at the work site may be necessary to meet the specific needs of a given plant or facility. We are prepared as a consulting service to assist clients in the development of their own programs. recognizing that it is up to each organization to decide what is cost-effective in its own situation. Some of the services which we can provide in this area include the following:


: Design of an In-Plant Employee Health Service
: Design of an Occupational Medical Records System
: Design of an Occupational Health Information System
: Provision of Continuing Education for Plant Medical and Nursing Personnel
: Development of an Absenteeism Monitoring Program
: Epidemiologic Investigations of Occupational Illnesses
: Perform a Needs Assessment on the Employee Population
: Development of Specific Prevention-Oriented Programs
: Trouble-Shooting Problem Areas and Designing Program Evaluation

RAPID REPORTING AND PROCESSING KEEPS YOU INFORMED AND WITHIN THE LAW

We realize that the provision of excellent medical care is not enough. Federal, state, and local regulations must be complied with and reporting deadlines must be met promptly. Within hours after your employee is seen, a preliminary report will be made by telephone or short form, followed by a final report in writing, summarizing the pertinent findings that pertain to occupational performance and estimating the likely time off work and level of disability. Supplemental reports and return-to-work evaluations are handled in the same expeditious manner.

Clerical and billing services are provided by personnel specifically trained in the management of workers' compensation and are supervised by knowledgeable administrators.

Our doors are always open to discussions on the needs of your organization and procedures that will help you meet your needs.

Assessing Need for Occupational Health Services

Although the use of a marketing representative can be very useful in providing feedback on utilization of occupational health strategies, this can be an expensive and inefficient strategy when just getting started. A simple survey of area employers is a less expensive alternative and puts literature in the hands of the appropriate company officers at an early stage. A survey establishes that an occupational health facility is concerned about eh needs of local industry and is making a genuine effort to be responsive. Such surveys have their limitations. They are not scientific studies and rarely achieve high return rates from busy and distracted managers. Even so, they can be very useful in surveying the needs of a community or in evaluating the changing needs and the perceptions of current clients.

The following survey has been tested twice in the field and both times achieved an unusually high rate of return, between 20% and 30%. Although this is not acceptable for purposes of scientific accuracy and validity, it is a substantial improvement over most direct-mail marketing surveys. Part I is intended to determine the perceived need for various occupational health services, emphasizing medical care. Part II is intended to determine the use of facilities and occupational health personnel by the employer. Part III and IV are intended to provide the respondent with an opportunity to express their own feelings and to communicate their own sense of priorities. The survey can provide anonymity to the respondent (or sponsor) or can be open.

SURVEY ON OCCUPATIONAL HEALTH SERVICES (Form 12.2)


Part I.  Please indicate your opinion of the importance of each 
         occupational medicine service by circling the number which 
         corresponds most closely; please indicate the way in which 
         each service is handled in your company by checking the box
         which applies.



                    Please check only one


 This service is    This service is   We need this      We have no need
 performed by our   performed by an   service but it    at present for
 in-house health    outside medical   is not now        this service.
 service.           service           being performed.




                        Please circle one

                        This service is:
                                         1 = not useful,    
                                         2 = helpful,
                                         3 = desirable,     
                                         4 = important,
                                         5 = essential.

Occupational Medicine Services


Treatment of on-the-job injuries         1   2   3   4   5

Safety inspections to prevent on-        1   2   3   4   5
the-job injuries

Treatment of job-related illnesses       1   2   3   4   5

Periodic health-hazard evaluations       1   2   3   4   5
to prevent job-related illnesses

Engineering and industrial hygiene       1   2   3   4   5
services to identify and
correct hazardous conditions

Reporting of job-related injuries        1   2   3   4   5
and illness to government agencies
(required by law)

Consultation with plant manage-          1   2   3   4   5
ment on an on-going basis to correct
problems as they appear

Preemployment physical examin-           1   2   3   4   5
ations to determine fitness for job
assignments

Regular oversight of workers' health     1   2   3   4   5
problems to detect problems early

Referral to outside specialists          1   2   3   4   5
when needed

Comprehensive diagnosis and treat-       1   2   3   4   5
ment in all specialties at one
location
                                                                         
Supervision, training, and con-          1   2   3   4   5
tinuing education of your in-plant
staff (nurses, safety officers)

Maintenance of health records for        1   2   3   4   5
all employees in one place

Annual physical examinations for         1   2   3   4   5
executives and essential personnel

Health promotion programs to keep        1   2   3   4   5
essential personnel fit and healthy

Examination to determine disability      1   2   3   4   5
for injured employees

Rehabilitation therapy and treatment     1   2   3   4   5
to minimize disability

Consultation with management to          1   2   3   4   5
determine needs and to design
occupational health services
tailored to your company's needs

Consultation and visits to control       1   2   3   4   5
liability and insurance costs
by reducing risks to employees


Special programs of the following types:

  Worker education about safety          1   2   3   4   5

  Worker education about health          1   2   3   4   5
  hazards from hazardous
  substances (toxic chemicals)

  Health promotion for workers           1   2   3   4   5
  (physical fitness and
  disease prevention)
                                                                         
Special programs of the following types:

  Noise control and hearing              1   2   3   4   5
  conservation

  Alcohol abuse detection,               1   2   3   4   5
  diagnosis, treatment

  Drug abuse detection, diagnosis,       1   2   3   4   5
  treatment

  Mental health counselling for          1   2   3   4   5
  employees

  Stress reduction programs for          1   2   3   4   5
  employees

  Screening programs to detect           1   2   3   4   5
  early diseases as an
  employee benefit (not
  preemployment examination)

                                                                         


Part II.  Please circle the answer which comes closes to your 
          opinion or the policy of your company.


Question l.  Do you have an in-house medical service?       Yes     No

                 (If you have answered No, please go to Question 2.)

             a.  Is it staffed by a physician?              Yes     No
             b.  If so, is the physician full or
                   part-time?                               Full    Part
             c.  Is your service staffed by a 
                   registered nurse?                        Yes     No
             d.  Is your service staffed by a
                   licensed nurse practitioner?             Yes     No
                            


Question 2.  Do you use an outside medical service?         Yes     No

                 (If you have answered No, please go to Question 3.)

             a.  Does this service have a full 
                   range of specialists?                    Yes     No
             b.  Does this service have industrial 
                   hygiene and engineering services
                        available?                          Yes     No
             c.  Is this service convenient for 
                   your workers?                            Yes     No

             d.  Are you satisfied with this service?       Yes     No


             e.  Please write in what occupational medicine services you
                 obtained last year from an outside medical organization:


                 _______________________________________________________                                                                         
                                                                         
 


Part III.  Please circle the numbers which best represent your opinion
           or the policy of your company.

Question.  What characteristics would you look for in selecting a
           medical organization to handle your employees' occupational 
           medicine problems?  Please rate each characteristic by 
           importance.  It would be helpful if you could also rate your 
           present service on the scale indicated.



Characteristic in Selection           How important      How do you rate
                                         is this          your present
                                      characteristic?    service?


                                          This            Our present
                                    characteristic is:   service would
                                                          be rated:
 
                                     1 = not import,      1 = poor, 
                                     2 = of minor         2 = unacceptable,
                                         importance,        
                                     3 = desirable,       3 = good,                    
                                     4 = important,       4 = very good,               
                                     5 = essential.       5 = superior.


High quality of medical care         1  2  3  4  5        1  2  3  4  5

Respectful and interested attitude 
toward your employees                1  2  3  4  5        1  2  3  4  5

Availability of all services in   
one location                         1  2  3  4  5        1  2  3  4  5

Conscious effort to contain costs    1  2  3  4  5        1  2  3  4  5

Reputations of the physicians 
involved                             1  2  3  4  5        1  2  3  4  5

Positive, friendly attitude          1  2  3  4  5        1  2  3  4  5

Interest in solving problems 
facing the employer                  1  2  3  4  5        1  2  3  4  5

Convenient, accessible location 
for employees                        1  2  3  4  5        1  2  3  4  5
 
Other:  (Please write in)            1  2  3  4  5        1  2  3  4  5

       _____________________________




Part IV.   Please use this space to comment on responses to any of the
           questions above or to offer your options. We very much would
           like to hear your views on occupational medicine services.






















Would you like to receive a report on the findings of this survey?
If so, please supply your name and address below:


Name  _______________________________________  Title  ___________________                                               

Company  ________________________________________________________________

Mailing Address  ________________________________________________________

                 ________________________________________________________

Industry or product line  _______________________________________________


                                                  

Further Reading

The Health Care Marketer's Handbook. Health Care Marketer, 4550 Montgomery Ave., Suite 700N, Bethesda, Maryland 20814.