Wednesday, September 21, 2011

Change? Passionate People Will Disagree and That's Good

One of my earlier posts, "The Same Inputs Will NOT Produce Different Results!", produced quite a bit of comment in the LinkedIn group "Work Comp Analysis". People in this industry are passionate about it because workers' compensation plays a very important part of our economy by providing some stability and security to our society.

Participants in the Linked In group responding to that post question whether a grass roots effort could really evoke change to a system as ingrained as workers' compensation.

Here is my response, edited for clarity and obvious typos:

First off, change won't happen overnight. Anything that is going to make any big difference will require years of hard work and dedication by those who believe in a cause and are willing to sacrifice for a cause.

Second, I believe that change will be incremental - and in that I believe it will take a relative small state to initiate change (hey, it was a small state that started the work comp trend in the first place) to make a proof of concept and a model that other states could follow. (e.g. Vermont tackling single source medical).

Third, whatever happens needs to account for the displacement of many, many self serving interests that are at odds with the ultimate outcome - AND -

Fourth, there needs to be agreement on what the ultimate outcome should be!

Indeed I think that defining the ultimate outcome is probably the most difficult item. Why? Because there is an inherent conflict tugging at the two primary constituencies: the employer and the employee.

The employer seeks financial stability and the most cost effective solution.

The employee seeks financial security (not the same as stability) and return to pre-injury life style.

These are largely mutually exclusive outcomes because financial stability/cost effectiveness focuses on controlling expenditures, where as financial security/return to life style focuses on controlling income.

So, what is the ultimate outcome? That requires a cultural change - hence why I think that #4 is by far the most difficult.

In America, we are taught that money fixes everything. That is our culture. That is why we pay money when someone gets hurt - because we have never figured out a different way of measuring the loss.

WHOA! See, even I am susceptible to the inherent cultural thinking of our society - why does it have to be viewed as a LOSS? It is just a change. Some change is more traumatic than other change, but if you analyze this objectively, there is no "loss" - that is a cultural view of change.

Example - sprinter Oscar Pistorius, who has born with no fibulae in both legs and uses carbon fiber "blades" to run said in a recent interview: "People ask me if God, Buddha, or whoever came down now and wanted to give me my legs back, would I take them? Probably not.... I mean, there's nothing wrong with me."

For Oscar, there is no loss. He doesn't know what that means. He's as normal as you and me as far as he's concerned - he has dealt with CHANGE.


So we start with culture. For example, it took us 100 years to figure out how to reward people for being disabled - some would say we still don't have that right.

But why reward someone for being disabled? They have incurred a change but that doesn't necessarily predicate a negative outcome.

The cost of workers' compensation goes up and goes down. When it goes up this is change that employers view as negative, and when it goes down this is change that employers view as positive. But this is monocular view - looking at the cost of a single component without taking into account impacts on other financial components on the balance sheet, expense OR income. The employer culture does not see a reward in workers' compensation. It is an expense component.

Our culture sees workers' compensation as a cost to be controlled - ergo a negative viewpoint. How about redefining workers' compensation as a benefit of employment? Not an entitlement cost, but an attractive benefit by which to attract good, capable workers?

A cultural change...

This is long enough for this post - you get the picture. The culture of workers' compensation has taken well over 100 years to evolve. Evolution takes time.

And I might add, the focus of culture change is not just on the employee, or the employer, but on all participants in this privatized social benefit system (which is what work comp is), from the government, to the underwriter, to the claims department, to the medical provider, to the bill reviewer, to the rehabilitation specialist, etc. etc. etc. This "industry" was built on a certain mindset, a certain culture that took 100 years to evolve.

So - bottom line: how do we define the ultimate outcome? Start with that as an ideal and work it backwards to find the elements that will drive that outcome. The ideal for most people is likely the same ideal that begat workers' compensation: prompt medical attention for work injuries, stabilization of employer risk, financial security for the worker.

If these are agreeable ultimate outcomes, next is creating a culture that takes advantage of 100 years of experience and study to create motivations consistent with the modern world. We are much more sophisticated than we were even just 20 years ago and we can take advantage of our greater understanding  in a much more calculated, precise manner.

I know for sure this is a sensitive topic and I'll either be vilified or praised, but in my experience that means only that people are passionate about work comp and willing to debate their passions - and THAT is the real start of change!

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