So there we were, still a very young start-up (2-3 years old) now with our first, full-scale project. To us it was a “big client” in every way - a diversified power company with a nearly 100 year history at the time. Not only a storied NJ brand headquartered in its largest city, but a company who was in the throes of a major culture change effort all while serving millions of customers across a large swath of NJ with a growing number of people employed. It was our first “population health” effort - in this case a population that numbered 8,500 or so. Of course we didn’t really know it that way at the time (the term didn’t really exist) but that was definitely the objective, to meaningfully improve the health-related outcomes, most specifically the number 1 or 2 driver of claims (Musculoskeletal Health) of the group, including how those outcomes were distributed across locations, operating units and even business units. Kathy, an energetic, health-oriented human resources professional who was making a career with the company was our connection. She was at the helm of designing, implementing and leading the company’s wellness effort and we were going to be a big part of it.
Our greatest asset was the trust we had built with both the management teams and the 3 major unions. Having made several stops in “the field” over the years, Kathy knew this all too well which is ultimately why she selected us over the flashy well-heeled firms selling “ergonomic technologies”. We understood the people and the unique subcultures. They trusted us to work hard and be honest, but ultimately to stay out of their way, because on any given day in a business that worked with “the most volatile commodities on the planet”, anything could happen.The first curveball was thrown in Lawrenceville, NJ when a division-level manager who eventually became a strong supporter of the effort and who, as of this writing (2023), sits at the very highest level of the organization, challenged us in a way that would change the model instantly and significantly. They say great leaders start by asking hard questions and communicate in simple terms. We should have known right then that Ralph had the stuff. It totaled 5 words and the answer would hold major implications. As we explained the mini-clinic model, the great results we got in the pilot phase and all the great benefits that would be brought to the electric side of the house, he simply asked: “Who’s time is this on?”. We explained that the pilot was done first thing in the morning with capped hours, but ultimately “on company time”. That was not going to work in his opinion, it would hold up work and could grind the operation to a halt.
We learned all about “downstream effects” (another not-yet-popularized term in health care) in the next few minutes. Scheduled work, sub-contractors, police escorts and more would all be impacted. If there was high utilization on any given day and a line formed, well, it’d be worse. Not unlike the proverbial “butterfly effect”, where a small change has massive implications down the line, we would be releasing a major butterfly into their system and that was simply too much risk. He liked us and the idea but ultimately, contract or no contract, the answer was “not in my operation” unless it was on personal time. Oof.
Kathy told us not to worry that it’d work out and, as it turned out they were both right that day. As a young, idealistic and energetic group who would learn to be incredibly agile over the next 10 or so years, we said yes and got to work devising creative solutions on how best to work within the conditions presented.
It took a while but it eventually became a routine - up at 4:20A, out the door early enough to make the 60-90 minute drive required to be onsite by 6 or 6:30A, visit with the handful of people waiting as the word spread of “the back guy” who could help with aches and pains, give a short talk either with slides or in a “huddle” on any topic that would help increase traction, quickly deal with the line of impromptu questions that came up after the meeting (but not too long to irritate the supervisors or violate the “not on company time” mandate), meet with local leaders, which ironically included several of those same irritated supervisors about their questions/concerns once the crews left and then either pack up and head to the next location, maybe an office building or a power plant at lunch hour, or back in the direction of home in time to start seeing patients.
As the first few years ticked by we learned all about “the J curve” of change. That is, how innovations actually spread through organizations and populations, that things often got worse before better and that each level, like nested dolls, had different needs and goals which rolled up. We had to internalize the laws handed down from the parent organization while remaining sensitive to the unique goals, pain-points and rivalries of the sibling business units all while effectively navigating the “local customs” in each of 70 or so locations. We came to realize it was not about the magic that we could do with our hands or “to” the bodies in front of us, but whether we could nudge the minds in a direction that allowed them to find joy in the grind, to not only survive until retirement but thrive when they got there. The outcomes the client received were nothing-short-of amazing and we were given the latitude to be creative while we learned many of the details we needed to build a strong system and the process steps that are now working with a dozen or more populations. Yet, looking back, perhaps the most important lesson was the one Kathy taught us - when the goal, in one way or another is “change” and the target is people, bet big on trust.
-Mike E.
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