Earlier this year, Amazon threatened to fire two employees who spoke out against the company’s stance on climate change. In addition, the company also issued a new employee communications policy.
The protest started last April when a group calling itself Amazon Employees for Climate Justice published a letter signed by more than 8,700 employees. It called on Amazon to adopt a company-wide plan to address climate change. As the protests intensified, Amazon ultimately reacted with the new policy and the job threats.
What legal issues do these employee protests, and Amazon’s reaction, raise?
Kate Bischoff and I had the pleasure of guesting on the XpertHR Podcast to share our thoughts. You can listen below, or in your podcast app of choice.
The role of HR is vast. You’re in the weeds, and the amount of duties you’re expected to perform is significant. It can include onboarding, benefits, recruiting, culture building, harassment complaints and more.
While new HR managers have previous experience in the field, becoming a manager brings about many new challenges — whether they’re an HR team of one or leading a team of many individuals.
These challenges aren’t insurmountable, though — especially with some HR 101 lessons from seasoned HR professionals. These people have learned through their years rising the HR ladder what skills and relationships are especially valuable to develop in the first months on the job.
Building relationships
The most successful HR managers focus on developing strong working relationships with their peers and business partners, said Judy Whitcomb, senior vice president of HR and learning & organizational development at retirement community developer Vi. A strong relationship with their peers helps them learn about existing HR practices, processes and available tools.
Judy Whitcomb, Vi
Meanwhile, “listening and understanding business challenges and opportunities not only helps HR professionals develop his or her business acumen, it helps an HR manager develop a common understanding with business partners on how HR professionals can help develop strategies to contribute to successful business outcomes,” Whitcomb said.
The relationship between the new HR manager and their new business partner won’t develop overnight, she said. “They should expect that trust is earned over time and that the best partnerships are those you realize success together.”
One issue that may exist between HR managers and business leaders in other departments is that sometimes they don’t understand each other, said Bradford Charles Wilkins, chief human resources officer at real estate company Altisource and 2015 Workforce Game Changer.
Many people in business hold the stereotype that all HR does is “hire, fire, give a raise, promote or throw a party,” he said. They don’t necessarily think of the strategic duties HR managers can have.
Recruiting is a good example, Wilkins said. A manager may instruct a recruiter in the HR function to look for a candidate for a position. They may ask for someone like a person with a degree from an exclusive Ivy League school or with many years of experience. In short, they may think they know what they want, but the qualifications they’re looking for aren’t realistic, Wilkins said.
In general, “They assume the business knows what they’re asking for,” he said. But they have the opportunity to do more.
They can ask questions like, what are you trying to solve with this hire? Why is the degree important? Couldn’t someone without a traditional four-year degree also have the necessary experience? And, what would the residual effect of this business decision be on the company and that individual’s team?
Building relationships with employees on the front line is also important, said Lisa Murfield, human resources manager at Florida-based law firm Hill Ward Henderson. She suggests that new HR managers get out of their office, go around and meet all the employees the organization.
“You’re going to learn a lot from the people on the front lines and how they feel about the organization. They’re probably always going to have recommendations,” Murfield said. “It’s’ a good thing for the HR manager to get to know people because then [they] get that relationship where people are going to be comfortable coming to [them.]”
The most vital skills to develop as a new manager
Both the role of HR and the technology HR has access to has changed a lot in the past couple decades, Wilkins said.
“The best practice 10 years ago is not a best practice today,” Wilkins, who has been in HR for 15 years, said. The change of pace is quick in the field, people who do well in leadership roles are willing to try new things and learn from mistakes. “Now it’s not as much about learning as it is about experimenting,” he said.
One major change is the onslaught of technology like artificial intelligence and automation, he said. People who do well at their organizations know how to think abstractly in ways that machines can’t and tend to be more creative.
Business school is one place to pick up these skills, of course, but not necessarily through an HR degree, he said. “HR people going to business school is becoming more popular,” he said. “It’s easier to teach core HR — a lot of classic HR is black and white [like] rules, laws and policies — but the amorphous piece of HR and the business side of it are much more challenging.”
Bradford Charles Wilkins, Altisource
Murfield is an example of an HR manager who received an MBA in management, giving her a holistic education in finance, marketing and operations.
She stressed the importance of having some understanding of all aspects of the business. “I’ve seen HR professionals, unfortunately, who get siloed into doing HR and they don’t always understand the business of where they work.”
Finance is a key area of the business to understand, at least at a basic level, she said. Skills like knowing how to read a financial statement can be valuable. “Get to know the CFO or head of accounting,” she said. “They will be able to help you get access to numbers and analytics that may be helpful to you, if you don’t already access to that within an HRIS system.”
Further, legal knowledge is important for an HR manager, Murfield said. Keeping up with changes in employment law may be challenging, considering the complexity of the legal environment and how laws are constantly changing. Still, the legal environment can greatly impact HR duties and organizational policies.
As the HR manager as a law firm, she’s able to speak to experts within her own company, but not every manager has that luxury. “If you don’t have legal counsel, maybe that’s something you can recommend that you do have that available to you,” she said.
What to expect the first few months
First-time managers should try to set realistic goals for themselves, especially since they may experience a large volume of requests, VI’s Whitcomb said. Getting all of it done just wouldn’t be realistic.
Whitcomb suggests that managers work with their business partners to set these goals and prioritize different projects.
The learning curve is very real at first, but people new to this position can have a positive attitude when making tough, managerial decisions for the first time. At her first managerial job, Murfield learned the importance of not being hard on yourself. One of her first tasks was to handle an indecent exposure complaint.
“I remember being calm and collective on the outside as we did this investigation but inside I’m going, ‘What am I doing? Am I doing the right thing?’ ” she said. “You have to go in, exude confidence — even if you are shaking on the inside — and, if nothing else, look like you know what you’re doing even if you’re doubting yourself inside.”
HR managers can show compassion and patience toward themselves and make the best decision they can make with the information they have, Murfield said. Equally important, though, is showing the same kindness toward others in your organization.
“You just never know what they’re going through,” she said.
There are more open jobs than talent to fill them and companies are willing to try anything to win this war. That’s great news for recruiting technology firms that promise companies innovative solutions to find, engage and hire quality candidates.
Venture capitalists continue to court the recruiting tech sector, delivering yet another record-breaking year of investment. By the end of the third quarter of 2019, VCs had invested more than $4 billion in recruiting technology firms, and the industry was expected to cross $5 billion by the year’s end. Many of those investments went to recruiting platforms, including Jobvite, which received $200 million in February to acquire three new recruiting platforms for its portfolio; SmartRecruiter, which raised $50 million in May; and Fountain, a platform to hire gig and hourly workers that landed $23 million in October.
“The war for talent is not going away,” said Denise Moulton, vice president of HR and talent research at Bersin, Deloitte Consulting in Boston. However, companies are getting smarter about how they select and validate the impact of their recruiting technology.
“There are new solutions coming to market all the time,” she said. That is putting pressure on vendors to demonstrate value if they want clients to stick around.
Some companies need tools that will help them more effectively uncover passive candidates, figure out how to mine the former applicant pool and identify internal talent who might be perfect for a current opening. Others are more focused on automation tools to help them engage with candidates, conduct video recording or improve and track the candidate journey.
AI Is Finally Paying Off
Many of these tools now feature artificial intelligence to add to the value proposition. And that’s finally a good thing.
The industry has been talking about AI in recruiting for years, but the current generation of tools are actually making an impact, Moulton said. “AI is boosting productivity, helping to analyze candidate pools, and making it easier to keep track of people who you want to keep in your funnel,” she said.
The use of AI and automation is freeing recruiters to become advisers, focusing on building relationships and capturing data to track outcomes, said Jared Goralnick, group product manager for LinkedIn in San Francisco. “Analytics are helping them set realistic expectations about the size of the talent pool, and the ability to reach new talent.”
AI driven analytics are also reducing the time to fill key roles, and helping companies address diversity and inclusion goals. “These tools can be game changers,” Moulton said. Though as always they only work if you have the expertise to ask the right questions and enough data to generate meaningful unbiased analysis. “The more data you can feed (a system) the smarter it gets over time,” she said.
Skills Versus Experience
The other big trend in recruiting tech is the rising use of assessments, as companies look for ways to vet candidates’ skills and attitude, along with their qualifications and experience. “Assessments are critical if you want to build a funnel of candidates that will be relevant today and for the long term,” Moulton said.
Several vendors have acquired assessments companies, including SHL’s November purchase of Aspiring Minds, an AI-driven talent assessment and interviewing platform; Hired’s February acquisition of Py, an app that assesses candidates coding skills; and Mercer’s 2018 acquisition of Mettl, an India-based talent assessment firm.
And other firms are building their own assessments. Most notably, late last year LinkedIn launched its Skills Assessment feature, which lets users complete dozens of free skills assessments that they can add to their profiles. The early assessments focus primarily on technical skills, but the company plans to introduce soft skills and personality assessments over time.
“It will make it easier for candidates to highlight their skills, and for recruiters to filter their searches,” said Goralnick. It will also make the search process more relevant for candidates and companies. He noted that LinkedIn research shows 69 percent of professionals think their skills are more important than their college education, and 76 percent would like to be able to verify their skills as a way to stand out in a candidate pool. The assessments will help them do that, he said.
Moulton urged companies to be thoughtful about the technology they choose and to be sure it will add measurable value to the talent acquisition process.
“You can’t pick up every shiny new penny,” she said. “You have to figure out what your team will really use and how it will integrate into the workflow.”
Engaging employees is a struggle for many employers, despite the many practical or trendy solutions that different thought leaders and advisers suggest. Workforce is spending the month of February collecting old and new articles about employee engagement in one place. Meanwhile, the Human Capital Media research department gathered data to explore why engagement matters and how many employees are disengaged.
Moving up the chain of command is discouraging in a lot of companies. The further you go, the more white and male it gets.
This disappointing trend of diversity recently was in the news. The Wall Street Journal also reported that “women held more U.S. jobs than men in December for the first time in nearly a decade, a development that likely reflects the future of the American workforce.” Despite this development, we’re still seeing a population of leaders that is mostly male.
The Washington Post recently published an article about the frustration many black coaches have over the National Football League’s hiring process. While nearly 70 percent of NFL players are black, potentially only three head coaches will be after a series of vacancies are filled this year.
Said one black position coach about Kansas City Chiefs assistant coach Eric Bieniemy, according to the article: “Watching E.B. get passed over has a big ripple effect because now you have guys who are questioning if there is even a chance to elevate in the NFL. You want the best coaching candidates, regardless of race. And if you’re biased against black coaches, you’re overlooking a lot of talent.”
Other black coaches expressed concerns that they were only interviewed for the position to check a box or that no matter what advocacy or interview rules got adopted, that wouldn’t change the conscious or unconscious biases of the interviewers and decision makers.
I have a few responses to stories like these (none of which are “surprise”). The first is, given how many companies preach their commitment to diversity and how many companies love to showcase their diversity and inclusion initiatives, how aren’t the results there? Why is the group of people with the most power and the highest salaries still mostly homogenous in so many fields? How long will it take for unconscious bias training to have an impact in hiring decisions, especially for jobs higher up the career ladder?
My research department colleague Grey Litaker and I worked on a story about this topic last year. Litaker dug up research on diversity in the pool of MBA graduates versus diversity in leadership positions. The percentage of educated, diverse MBA graduates was not close to matching up the the (very low) percentage of diverse people in leadership positions.
One quote from Molly Brennan, founding partner and executive vice president of executive search firm Koya Leadership Partners, really stuck out to me when creating this story, and I think it applies to non-corporate organizations like the National Basketball Association as well. “This idea that there’s not a lot of qualified candidates [from] underrepresented groups out there is a false one. There’s a whole host of diverse, qualified people who are ready, willing and able to take on leadership roles.”
We’re in a new decade now, and I’d encourage company leaders to think critically about their D&I strategy and if it’s enough. Forget the marketing speak and the press release-friendly quotes about how much you value diversity. How is that actually translating into which employees get the opportunity to get a promotion, and which employees are held back by the attitudes and assumptions of decision makers? Rather than focusing on brand-speak that sounds good to consumers, focus on making substantial changes that could actually even the playing field.
Most hourly employees have dealt with shift scheduling problems at one time or another.
I’ve witnessed it first-hand with my kids. After a 10-hour Saturday night shift at a restaurant slinging beer and burgers until 2 a.m., I would hear one of them quietly creep into the house. OK, they were actually pretty noisy coming in and banging around in the kitchen. As I dozed back off I just prayed that they wouldn’t fall asleep after popping a frozen pizza in the oven.
The good thing was they got home safe and sound. And the kitchen was not charred to an ember when I woke up the next morning. After that kind of a late-night shift I expected them to sleep in late.
Nope. No sleep for the weary in the restaurant biz.
Somebody had to pull themselves out of bed and work brunch at 10 a.m., and guess who was on call? Yep, my sleep-deprived, bleary-eyed child. Not just once. Or twice. This insidious sleep deprivation technique was a regular occurrence.
I mean, who is doing this on-shift scheduling? What sadistic clown is shift scheduling an employee who closed at 2 a.m. the night before to be back on the clock to pour mimosas and serve bacon and two eggs over easy at 10 a.m. that same morning? Oh, right. A restaurant owner. Or the manager, who likely is on the same scheduled shift because, well, restaurant managers are just a different breed.
I know, restaurants and hospitality exist in the fast lane — fast cash, fast life for many employees. Seriously, how many industries lavish itself with weekly industry nights?
The cruel and unusual shift scheduling was a regular occurrence back in the day when I punched a time clock as a bellman at a resort hotel in San Diego. Work the late shift until the final check-in at midnight then back in at 6 a.m. for the early checkouts.
I’ve even heard the mad scramble to find replacement workers when I’m getting a roll of quarters at the service counter of my grocery store. The manager, who is a really kind, caring woman, is frantically on the phone to staff her Saturday evening shift because so-and-so just called off sick and two others are already on vacation. (Why am I getting quarters on a Saturday evening? Don’t ask.)
Unfortunately, it seems that pretty much every hourly employee short of a union pipefitter is subject to such short-sighted shift scheduling. Want to burn out your hourly employees and watch them leave for greener pastures? Give them a day’s notice, schedule them that evening and then tell them they need to be back in bright-eyed and bushy-tailed early the next morning.
Come on, people! This is not complicated! Your employees have lives. You have a life. Well, unless you’re a restaurant manager. Make the shift scheduling process as painless and humane as possible. For starters:
No on-call shift scheduling. Ever. Telling employees to call in before a shift to see if they are needed and then sending them home if the shift turns out to be slow is incredibly hard-hearted. Don’t be hard-hearted.
Provide your employees with work schedules well before they are supposed to show up. Like two weeks before. Minimum 10 days. That gives them time to switch shifts should an emergency or a really good party pop up.
And you know what? Go digital. Paper-based timekeeping? Really? I know, it’s hard to break a routine that’s been in place since, oh, the Bicentennial. But seriously, check your timekeeping software options.
One thing that I constantly harp on is engagement and communication. Engage your employees through sensible, predictable shift scheduling. Your workers are happier because they’ll have a predictable life. As predictable as life can be, I guess.
And it’s not a stretch to say that a happier workforce means a more engaged workforce, which cuts down on burnout and puts the clamps on the bane of all hourly employers – turnover.
It may not prevent your kid from torching the kitchen with that forgotten frozen pizza in the oven, but they won’t be nearly as bleary-eyed the next morning, either.
Jenny just walked into your office and confessed her life is falling apart due to an addiction to Vicodin.
Tom just showed up in a dress and used what appears to be the wrong bathroom.
Your reaction to these events says a lot about how ready you are to be a manager in the coming decade. Your company is not likely to be of much help.
I recently finished reading Mike Isaac’s “Super Pumped: The Battle for Uber.” It’s the story of how Uber rose from humble beginnings to become a Silicon Valley unicorn, then stumbled from the top as its bro-tastic culture caused it to be tone-deaf to the world around it via repeated PR fiascos.
The cultural challenges led to the ouster of founder and CEO Travis Kalanick, who was replaced by former Expedia leader Dara Khosrowshahi (still CEO at Uber).
To illustrate the cultural overhaul underway at Uber, let’s look at some old founder-driven values under Kalanick, then compare those to new values rolled out under Khosrowshahi:
Old Uber Values: Meritocracy, toe-stepping, always be hustlin’.
New Uber Values: We build globally/live locally, we celebrate differences, we do the right thing.
Company values must evolve over time. Uber was late to make the cultural change, which underscores an important reality in most workplaces. Almost every people manager faces change happening faster than organizational infrastructure or company values can accommodate.
Great managers adapt before they are forced to and usually before the company sponsors cultural change.
Change is everywhere in society and comes at us fast. You’re reading about the drug use facing corporate America in this issue of Workforce. Opioid addiction, legalization trends and more are upon us. Company policy regarding hot button issues naturally trails the change we see outside the workplace. The fact that cultural change happens faster than companies can pivot is why one of the most important manager competencies in today’s world is rapid inclusion and empathy.
Consider the following realities:
You’re a leader.
You’re full of personal thoughts, a specific background and some bias.
When change comes and you’re asked to consider the rights of yet another special class of people or individuals, you may react as if it’s a burden or worse. You can say it’s all gone too far. Some will agree with you.
But you’ll ultimately acknowledge the rights and needs of the segment of people in front of you, or you won’t be allowed to lead anymore.
History shows this cycle of events to be true. Look at all societal change and trailing legislation from yesterday’s Title VII to today’s LBGTQ+ conversations and emerging laws. Once societal change reaches critical mass, mandates come to the workplace. It’s just a matter of time.
Most of us don’t work for a company like Uber in crisis and as a result, cultural expectations related to inclusion and empathy are less clear. That means you’re on your own as policy at your company trails societal change. What if you weren’t late the game? What if you as a leader made it a priority to make all feel welcome and equal in your company and on your team?
Great managers adapt before they are forced to and before the company sponsors cultural change.
If that was your approach, you’d find the people in question — the special class of people currently causing others discomfort — incredibly willing to work for you and, just as importantly, freed to do their best work. You’d be maximizing your ability to get great work from the employees you have.
Many of you are HR pros and leaders working for companies stuck in the middle. Your company is slow to pivot on societal change for many reasons.
But that glacial corporate reaction to change is an opportunity. While you likely can’t change corporate policy in an agile fashion, you can still lead and train others on the business opportunity that happens when you treat people the right way.
When you’re early on inclusion and show empathy, a funny thing happens. Performance and the ability for someone to do their best work goes up. Word spreads about your empathy and the candidate pool expands. Managers start to have their own gravity from a cultural perspective
None of us are perfect when it comes to the change required as society evolves. But the best managers and leaders are moving quicker through the cycle to acceptance, and they’re viewed as a manager of choice as a result.
Uber was not an inclusive or empathetic company until it was forced to change. You don’t have to wait on your company to dictate inclusion. Be early on acceptance.
Public health experts have been studying for decades the role that poverty, race, environment and other external factors play in citizens’ overall health, but an increasing number of employers are seeing how social ills impact their workforce.
The concept of social determinants of health, which the World Health Organization defines as “the conditions in which people are born, grow, live, work and age,” is gaining momentum in the employer world.
In 2019, UnitedHealthcare and the American Medical Association teamed up to create medical insurance codes so that doctors can identify social factors that lead to poor health. If accepted by the Centers for Medicare and Medicaid Services, the new codes would become effective Oct. 1, 2020.
Also in 2019, bipartisan legislation called the Social Determinants Accelerator Act was introduced to provide grants and technical assistance to underserved communities. It’s considered to be the first federal proposal on social determinants.
“It seems to have entered employer conversations in the past two to three years,” said Karen Moseley, president of the Health Enhancement Research Organization, a nonprofit think tank focused on workplace health. “Public health has been talking about this issue for years and years and now employers are adopting the same language. It started out as employee and employer collaboration to improve public health and has evolved into companies and communities working together.”
In a recent report on the relevance of social issues to employers, HERO outlines steps that companies can take to address community problems that affect their employees and highlight employers with innovative programs. For example, Cisco, LinkedIn and Pure Storage help fund a nonprofit in Silicon Valley that supports affordable housing initiatives, and Tom’s of Maine pays its lowest-paid workers more than 25 percent above a living wage.
The report recommends that employers create a corporate philosophy that values the needs of its employees and adopt policies and practices that support that.
“It often starts with one issue that is the greatest need in the community,” Moseley said. “Employers need to shift their focus from shareholder value to employee value. I really love this metaphor I heard at a conference about a fish tank. If we feed the fish but ignore cleaning the tank, ultimately the fish are going to die.”
A lot of conversation focuses on helping people manage the day-to-day stress that comes with modern life and the modern workplace.
Whether it is looking at financial well-being (or the lack thereof), the stress of constant change, and the greater demands placed on an always-on workforce, we know there’s a problem. Diagnosing the root cause can be difficult, and that’s why I was so struck by my friend Aaron Hurst’s summary of the six unintended consequences of the modern workplace. He presented it at Purpose 2030, his company Imperative’s annual conference that focuses on aligning people and organizations around purpose and connection. (Full disclosure: I’m on Imperative’s board.)
One of the most important insights from their recent research is that creating deeper connections among people is a vital element to the success of organizations. I left their event inspired about how to build those connections on our team and thinking a lot about the idea that a leader’s job now includes creating an environment that supports deep and meaningful connections among colleagues, whether they are sitting side by side in an office or working in various locations around the world.
But that’s hard to do if we don’t examine why work has become a place that often creates the opposite of connection — loneliness and isolation. Looking at some of the unintended consequences we’ve created gives us a path for starting to solve them.
Productivity and communication tools like Slack can increase efficiency and collaboration, promoting quicker decision-making and information sharing. But the volume of communications can be a challenge.
As quantity increases, stress can too, and many interactions feel transactional rather than personal. For benefits teams, these new tools can be a daunting new feedback channel to manage as well. Several of our clients use them to promote benefits in creative ways, but keeping up with employees’ dialog and questions can become a full-time job.
Questions to consider: How do we support conversations that are meaningful? And how can benefits teams with limited resources embrace new tools?
Remote work is an amazing thing. It has expanded the possibilities for the way we work and with whom. For our team, it has been a vital tool for us to bring on key talent, and I think supporting remote work is beneficial in countless ways. But, with less room for casual and face-to-face interaction, authentic connection among employees can be lost.
Questions to consider: How can we enable a sense of belonging and connection with those working remotely? How can benefits create ways for people who work remotely to feel connected and supported by their organizations?
Diversity and inclusion are key goals for most of us. The connection to benefits and the ways we build support programs for various employee groups is a hot topic.
But fully embracing a diverse and inclusive environment creates unique new challenges that require a lot of intentional new behaviors. This side of D&I is not always fully acknowledged or discussed.
As Aaron Hurst says, “The workforce is growing more diverse in every way. It is building a more inclusive society and economy as well as bringing new perspectives to work that drive innovation. When we work with people who are similar to us, the norms of communication and interaction are pretty clear, and it is easier to feel psychologically safe. When we have a diverse workforce, the old models of communication and collaboration are no longer adequate.”
Questions to consider: What does a workplace look like that can fully address the psychology of diversity? How do benefits and other programs build connections and support full inclusion?
Many modern corporations have adopted open-plan designs, hoping it will increase collaboration and productivity. In reality, workers often find that removing physical walls can decrease the quality of connection with those we work with and make focused work more challenging.
Questions to consider: How can we retain the benefits of open spaces while also restoring more intentional connection? Can benefits like mindfulness training or well-being challenges help individuals and teams get better connected inside and outside of the office walls?
The negative side effects of engagement as a main measurement tool and the challenges of shrinking tenure are also among the unintended consequences Aaron covered. What are the other unintended consequences of your modern workplace? And how are you going to use this year to solve them?
Employers have found ways to manage health care costs, but need to step up their efforts to tackle a more vexing problem — eliminating wasteful medical care spending.
A recent Journal of the American Medical Association study found that 20 to 25 percent of medical spending is unnecessary.
“As long as we are in a fee-for-service world we will get services whether we need them or not,” said Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions. “We need to shift from paying for volume to paying for value, and employers need to put pressure on providers to get this right. They should be asking for spending reports from vendors, like Blue Cross Blue Shield, and they should be analyzing claims and identifying waste. The problem is not new and neither is value-based medicine, but there are new efforts to address wasteful spending.”
The estimated waste hovers between $760 billion and $935 billion, with administrative costs such as claims processing, billing and transferring medical records making up the largest share at $266 billion annually, according to the JAMA study.
Yet, more than half of employers aren’t actively doing anything about it, according to a 2018 report by the NAHPC. While the first step for employers should be identifying the problem, nearly two-thirds of businesses surveyed don’t collect or analyze data to track waste.
“Employers should be asking for reports from the vendors and analyzing claims data to identify waste,” he said. “Part of the reason why vendors don’t offer this information is because they’re responsible of getting rid of it.”
Employers need to take a more proactive role in tackling wasteful spending, according to Daniel Wolfson, executive vice president and chief operating officer for the American Board of Internal Medicine. He urges them to speak not only to health plans but also to health care providers about what they are doing to minimize the problem. Wolfson leads Choosing Wisely, an ABIM initiative designed to encourage patient-doctor dialogue around the overuse and misuse of medical services. The program, which was launched in 2012, publishes a list of more than 400 recommendations on treatments that patients and physicians should question.
The Washington Health Alliance looked at 48 common medical treatments, tests and procedures and found that an estimated $341 million was spent on unnecessary health care in the course of a year.
“I think employers are absent from the conversation,” he said. “They have not used their leverage to impact this problem. Employers have had a tremendous influence on quality issues but they are not using their leverage, their power, their influence and their thinking when it comes to wasteful health care spending. They should be saying ‘If we’re going to be purchasing health care services from you we want to hold you accountable.’”
Some employers are using the Choosing Wisely recommendations, which were created by 17 national medical specialty societies. Each list offers information on when tests and procedures, such as imaging for lower back pain or breast cancer treatments, are appropriate.
In Washington state, the Washington Health Alliance looked at 48 common medical treatments, tests and procedures and found that an estimated $341 million was spent on unnecessary health care in the course of a year. Of the 2.9 million services examined, nearly half were found to be unnecessary.
The prescription of opioids for lower back pain was the most wasteful treatment, followed by the use of antibiotics for upper respiratory and ear infections, annual EKGs for low-risk patients and imaging tests for eye disease.
In Missouri, the St. Louis Business Health Coalition partnered with the Midwest Health Initiative in 2016 to identify unnecessary care. It found $303 million in wasteful spending to vision screenings, imaging tests, EKG services and pre-op lab studies in 2016.
In 2017, the coalition examined emergency room use for upper respiratory infections and found that $2 million a year could be saved if patients went to an urgent care clinic instead of a hospital emergency department.
Louise Probst, executive director of the employer coalition, said that benefit plan design can help through increased copays for ED visits.
“We all have a problem with low-value care,” she said. “It’s important to ask employees to think about that as an individual and then as a company. Look at incentives in your plan design, look at contracts, look for partners. Get the best data that you can and keep track of it. Employers, hospitals, physician organizations, labor unions, and other community partners need to come to together with a single focus of improving value in health care.”
This disappointing trend of diversity recently was in the news. 
Your reaction to these events says a lot about how ready you are to be a manager in the coming decade. Your company is not likely to be of much help.
Whether it is looking at financial well-being (or the lack thereof), the stress of constant change, and the greater demands placed on an always-on workforce, we know there’s a problem. Diagnosing the root cause can be difficult, and that’s why I was so struck by my friend Aaron Hurst’s summary of the six unintended consequences of the modern workplace. He presented it at Purpose 2030, his company Imperative’s annual conference that focuses on aligning people and organizations around purpose and connection. (Full disclosure: I’m on Imperative’s board.)