Computachem
E-Newsletter
Editor:
Neil Johnston
Regular Contributors:
Rollo Manning
Leigh Kibby
WWW (Who, What, Where) + E-VENTS
This
month we are regarding our publication as a watershed edition.
We have just witnessed the most successful Olympic Games ever, underpinned
with efficient information technology, yet simultaneously Australia
has been accused of belonging to the "old economy". Currency rates of
exchange have been severely downgraded because of the opinion of international
financial forces.
We revisited pharmacy, to see whether pharmacy was a truthful reflection
of this statement.
Except for an occasional spark in isolated circumstances, we have to
agree with the internationalists. Therefore, in this edition, we have
limited the number of articles, but have created depth in the subjects
we believe need your attention, particularly the area of Information
Technology (IT).
We highlight the fact that the Pharmacy Guild appears to be developing
an IT project (see "Guild and E-Commerce" article), and while we are
all aware of some aspects of this program, we don't really have the
vision or the substance of what is being developed on pharmacist's behalf.
Perhaps you can frame some suitable questions?
Because of the "old economy" tag clearly applying to pharmacy today,
we have provided some insight as to how you can set up your own IT division
(see "Where is your IT Division?" article). We have talked around this
subject in previous editions, but movement and commitment is definitely
required by individual pharmacists now.
Leigh Kibby has touched on more aspects of men's health. Given the overall
serious plight of men and their health, it seems obvious that pharmacists
should be looking to assist. However, pharmacies are not "men friendly"
as we have previously highlighted, even though there is a definite economic
benefit in catering to male needs. Is the Internet a partial answer?
We touch on some aspects in this edition.
Finally, a look at the Galbally Report and its implication for pharmacists. Rollo Manning has been doing some research in this area. He says:
"The last opportunity for pharmacists to have a say on Schedule 2 and 3 scheduling is drawing near. The 6th October is the closing date for comment on the draft Final Report of the National Competition Policy review of Drugs, Poisons and Controlled Substances legislation. The recommendations, if followed, will allow advertising of a price list for Schedule 4 products, the removing of mandatory recording of Schedule 3 products and adherence of a code of practice in the handing out of clinical samples to the medical profession. Pharmacy Boards should enforce professional practice standards in the provision of information in the sale of medicines by pharmacies. These "sensitive" issues to pharmacists need comment now as after the event will be too late."
We
know of one pharmacist, Peter Brown of Pharmacy Direct, who will be
extremely interested in the outcome, for he alleges the Guild have threatened
legal action against him if he issues one more catalogue. Hang on Peter,
Rhonda Galbally may deliver the goods!
Of more concern is how pharmacists will manage these schedules to ensure
"value-added" services to eradicate "information asymmetry". With all
that a pharmacist is involved with on a daily basis, can he/she fulfil
the obligations of these schedules? We believe maybe not, and that down
the track a rethink may have to occur in the form of a formalised delegation
of counselling, supported with tools such as Internet information sites
and patient specific information delivery by e-mail. Be warned, you
may be vulnerable in this area unless consumer expectations are met.
Our "Roundup" column devoted to rural and isolated issues discusses the concept of extending nurse practitioners activities in rural and isolated communities to suburban communities, and the cost implications. Perhaps another pharmacy opportunity?
CONSULTATION
TIME ENDS ON NCP REPORT ON SCHEDULING
From Rollo Manning
The
invitation has been there since 12th September for consultation on the
final report of the Rhonda Galbally chaired National review against
National Competition Policy guidelines of the controls affecting the
distribution of drugs, poisons and controlled substances.
This comes at a time when discussion is taking place on the occurrence
of "patient counselling", how this should occur, and the impact of the
Trans-Tasman Harmonisation Agreement of 1998. The conclusion drawn by
the review is that "the restrictions on access to medicines are done
on the assumption that health professionals (pharmacists) will exercise
their skills and knowledge to redress the consumers’ information deficit.
This enables the consumer to use the medicine safely and effectively.
"If this professional input does not occur, the effectiveness of the
control is undermined. The standards that professional practice is expected
to meet, is managed through the legislation regulating professional
practice and the professional practice boards in each jurisdiction."
The commercial aspects of competition are not addressed as the legislation
under review is towards outcomes for the consumer, and not the financial
viability of the professional expected to provide the advice. The fact
that pharmacists financial future depends largely on the maintenance
of restrictive legislation is a reason why there has been so little
discussion on the proposed changes or conclusions. The question really
is whether it is possible to support the arguments in favour of restriction.
Consumer outcome focussed points need to be made in support of the "status
quo".
An examination of the rationale for review is necessary to understand
the context within which to frame arguments.
The reason for restriction on the sale of medicines is that there exists
"information asymmetry".
This means there is a deficit of information on the part of one party
(the consumer) and the health professional (the pharmacist). In order
to address this asymmetry the regulation is put in place. This then
allows the consumer to be in possession of as much information as the
pharmacist to decide whether the product should be used or not.
This put simply is the basis of the discussion. It assumes an asymmetry.
It assumes this will be addressed.
It assumes the pharmacist is going to address the asymmetry.
If the asymmetry is not addressed it follows the restriction must be
questioned as to whether it is in the consumer’s interest.
The additional price placed on the product due to a restrictive marketing
regulation is also brought into question. Why should a consumer have
to pay a premium to receive information if this service is not provided?
It then becomes a matter of judgement on the part of the pharmacist
as to whether information is provided or not.
There can be no second-guessing. The judgement has to be towards the
benefit of the consumer. This presents a difficult judgement as illustrated
in recent postings to the Internet pharmacy bulleting board "Auspharmlist".
A recent posting noted that depending on " what sort of patient mix
you have at certain times, it may or may not be possible to counsel
each one of them (consumers)" . It went on to say that "as long as you
do your best and let them know through your staff and procedures that
you are available for consultation…. that is enough to set the difference
between pharmacy and non-pharmacy availability of s2 and s3."
Another judgement needs to be made by reviewers of the restrictions.
Is this good enough?
How often is counselling every consumer possible?
How many consumers need counselling?
What proportion of consumers request information to correct "information
asymmetry"?
Does "information asymmetry" really exist or are consumers educated
enough through product advertising?
And so the need for quantifiable data becomes paramount to support the
contention that "information asymmetry" does exist, can be addressed,
and that restrictive legislation is the only way of achieving the balance.
All pharmacists could contribute to the discussion, but not by generalised
statements. How about some hard facts on the frequency of counselling?
The number of consumers requesting it? And the number who believe they
know all they need to know to use a medicine safely?
It is after this an objective judgement can be made on the need for
regulation in the sale of medicines. The review is to advocate the use
of "Third Agreement" professional development money to research the
subject. Agree? The next three years provide a period for data collection,
after which time the question of combining Schedules 2 and 3 will be
reconsidered.
ends
The comments and views expressed in the above article are those of the
author and no other. The author welcomes any comment and interaction
that may result from this and future articles. The editor would be pleased
to publish any responses.
The
Guild have been involved in the development of a B2B e-commerce platform
for the past two to three years, which involves pharmaceutical manufacturers,
pharmacy wholesalers, hospitals and community pharmacies (known as PECC).
It involves the formation of strategic alliances, many of which would
not have been considered possible under the "old economy", and the whole
process involves efficiency and cost reduction at the "back end" of
business by tapping into the global economy in a seamless and paper-free
environment.
Whether we like it or not, our future survival in the "new economy"
depends on our ability to seek out and be part of a major alliance,
which is much like being part of a giant franchised market group. Governments
at all level are encouraging and driving this process (although they
have not been too successful with their own procurement platforms as
yet), and initiatives such as Internet sites for the electronic lodgement
of various tax returns and business registrations, are seen by government
as driving the goal of having an information technology literate population.
The importance stressed on this development can be assessed by looking
at the dismal recent performance of the Australian dollar compared to
other currencies. This has occurred despite the fact that our economy
is one of the highest performing economies in the world, but has been
judged as being substantially "old economy" based, which could become
seriously devalued, given the speed at which changes occur these days.
A similar example is illustrated in the pressure the Australian share
market placed on major retailers who were not considering an e-commerce
extension to their business. With depressed share values, both Woolworths
and Coles joined major procurement alliances, and immediately promoted
their token (to that point) B2C websites.
What then, the value that will be placed on pharmacies who have not
a viable e-commerce extension?
While this is a simplistic observation, share values in both the companies
noted, have moved upwards, and all this has occurred in the last nine
months!
So it is heartening (with some reservations expressed further along
this article) to see that the Guild is moving towards a B2C extension
of its e-commerce involvement. This is partly driven by the government's
decision to develop a system of electronic records for medication (The
Better Medications Management System), which will provide the first
electronic link between doctors and pharmacists.
It is also being propelled by the activities of Pharmacy Direct (the
darling of the consumer groups). Legislation planned for July 1st, 2001
is currently being drafted to allow doctors to transmit patient prescriptions
electronically, in a "seamless" transfer to pharmacists.
This opens up some totally uncharted territory, which could see, in
some cases, ethics being discarded with the bathwater. While I am certainly
not opposed to change, it always amazes me how a tried and tested process
can be seemingly discarded for a completely untested alternative.
The following should be noted:
* The potential for "channelling" increases enormously through the availability
of this process.
* Both patient and pharmacist rights will have to be clearly established
and protected, to prevent doctors from manipulating the processes downstream.
The Guild will need to be vigilant to prevent the process becoming a
source of power and control by doctors over pharmacists and patients,
rather than as a successful health outcome.
* Privacy immediately becomes a prime issue as information accumulated
about patients, becomes more able to be accessed by organisations who
will claim "rights" e.g insurance companies, government agencies, statistical
organisations etc
In
previous editions of this newsletter we have already described instances
of channelling and the potential for abuse, driven by owners of medical
centres. Channelling prevents "leakages", and thus gives higher rental
returns to practice owners, since pharmacy rentals are generally based
on a percentage of total sales.
Technology companies, particularly those involved in the development
of prescription writing software for doctors, are anxious to see the
above processes evolve, and most have plans to roll out systems in the
online pharmacy area over the next twelve months.
The Guild is interested in seeing the paper component of NHS claims
disappear from community pharmacies and to extend this process, provided
it does not prevent patients from visiting the "bricks and mortar" pharmacy
to pick up their prescription and receive face-to-face counselling.
Recently,
the Guild entered into a relationship with an organisation called MedWeb,
to provide extended links between doctors and pharmacists, initially
in the area of Schedule 2 and Schedule 3 drug purchases online. In the
information published on the MedWeb site, the Guild is described as
a partner, along with the ANZ bank, and the initial purchasing model
will involve a patient ordering over the Internet with the pharmacy
physically delivering.
It is not clear how the philosophical problems, raised by Guild in its
various confrontations with Pharmacy Direct (no face-to-face counselling
etc), will be resolved. It may be seen as a method of addressing "information
asymmetry" as discussed in Rollo Manning's article. Whether the system
will be competitive on price, is also not obvious.
Clearly, there is a lot of ground to be made up in the loss of market
share to Pharmacy Direct, a process that has been highlighted in this
newsletter on a number of occasions. However, Peter Brown (Pharmacy
Direct owner) had a vision and the courage to see it through.
The result is a totally different model of pharmacy to the norm, which
is coincidentally, one of the recent CoAG recommendations. Pharmacy
Direct should be a welcome addition to pharmacy ranks, because it has
a lot of valuable experience that can be shared and it has proved successful.
Only competition to the Pharmacy Direct model will reduce market share
imbalances.
Congratulations Peter!
Consider that:
* Pharmacy Direct is now the largest single turnover pharmacy in Australia.
* It employs a total of 160 people distributed through its organisation,
which includes 5 pharmacists in the dispensary, 30 staff in its call
centre, and 25 staff involved in data entry.
* Peter Brown, is now canvassing for finance to invest in further business
expansion.
* Its advertised prices are up to 50% below other pharmacies.
* It has the support of all major consumer organisations
* Most importantly, it has an established "brand" image, and this single
fact will make it hard to dislodge Pharmacy Direct from your local marketplace.
It is like having a strong local competitor just around the corner.
The
MedWeb initial offer seems to be geared towards doctors, in that they
are initially offered their own practice website. Patients will be able
to access selected details from the site, which will include location,
after hours arrangements, areas of specialty, services offered and languages
spoken. Additional patient facilities will include access to an online
after hours appointment schedule, an e-mail communication to patients
with health news and a link to the Health and Wellbeing segment of the
site, which is claimed to provide credible general health and medical
information on a range of popular subjects, including complementary
therapies and medicines.
In an excerpt which appears on the MedWeb site, they say:
"The Health and Wellbeing Site content is being produced by MedWeb's editorial team of writers and medical journalists, and will be continually updated and validated by relevant Australian health organisations/professionals. The site is neither diagnostic nor prescriptive. Instead, the emphasis is on creating a resource of engaging and informative consumer health content to assist patients to take a preventative approach to managing their health. The site will also feature 'breaking' news stories in the health and medical fields - providing the latest in research, new treatments, trends and opinions. Additional content has been purchased from a leading US consumer health web site and will be localised and adapted for our Australian audiences."
A doctor search engine located on the parent MedWeb site will direct
potential patients to doctors registered with the organisation, based
on name, location, area of specialty, languages spoken and gender. Other
services on offer to the doctor include access to an online reference
library, connectivity and sharing to include a permanent Internet connection,
online peer discussion groups, and netcasting facilities for CME. Software
for practice management is also available, with other enhancements such
as voice recognition software for preparation of clinical notes, referral
letters and miscellaneous reports.
Practice supplies have been factored in with an online B2B procurement
system, which is designed to take advantage of group buying power.
Online personal services to include airline booking, financial information
and entertainment completes the package. The players behind the project
include Professor Branko Cesnik, the director of the Monash University
Centre of Medical Informatics, a range of medical practitioners, partners
(Pharmacy Guild and the ANZ Bank), plus a range of financial affiliates.
Some
questions arise out of all the above.
* Is this the only model that the Guild has considered, and what options
were placed before members for consideration?
* What is the partnership costing Guild members and what are the terms
of the partnership?
* Given the failure rate of e-commerce startups is there a formal business
plan and budget prepared? * Are the monies coming out of the $7.5 million
appropriation given to the Guild to administer the "Agreement Management
Committee" over 5 years, and if so, what happens (in dollar terms) at
the expiry of this time?
* To what extent is the PSA involved in this development, given that
they have a range of professional information and other resources available
for pharmacists?
* Will pharmacists simply be a service appendage to this site, or will
they be able to exercise equal rights under their partnership agreement.
Have they available, the same range of benefits as the doctors, including
customer/patient access to pharmacy type customised services?
* Has anyone considered the potential loss of pharmacy identity in such
a joint shared proposal?
* Have the new IT management and staff, recently appointed by the Guild,
sufficient time to evaluate the project, and could they do better internally.?
One of the more unusual aspects of the recent Guild/Government agreement
was that the Guild were given $7.5 million to disperse through an "Agreement
Management Committee" i.e they were to hold the purse strings for all
pharmacy organisations involved in the process.This gave the Guild an
extraordinary power. The expenditure of this money in the form of a
published budget, has never been publicly available, except in very
general terms. With proposed high expenditure in the IT area, it should
be a given that members be included in the decision making process,
because they will have to live with the results.
Where is the member consultation and where are the safeguards?
Because we have a basically illiterate IT pharmacy population, perhaps
some of this initial expenditure could have been directed towards member
education. How else can substantive debate occur and informed decisions
be made on these very important issues?
Control is essentially being imposed from the top down, when the reverse
needs to occur.
The right decisions here are definitely "life-important".
Perhaps the process could begin with those pharmacists who have already
invested in e-commerce, and have experiences to share in constructing
a good model. Also, consideration to be given to these pharmacists so
that their sites can be an integral part of the MedWeb site. This entire
process needs to be made transparent. It is not easy to make a pharmacy
site comfortable and intuitive for a pharmacy customer/patient, who
will definitely be seeking a different experience from that of a doctor
visit.
Has anyone asked the customers what they need?
As we stated earlier in this article, we applaud the Guild for taking
an initiative in the e-commerce area, because it is needed as a matter
of urgency. We are already in the global economy, even though most do
not realise it. The time may not be too far away before we are competing
head on with online pharmacies in America and elsewhere (we actually
are now, but nobody is able to state in dollar terms what the leakage
is).
Therefore, the power bestowed upon the Guild should be handled benevolently
by them, be inclusive, and be shared with all members, and all other
pharmacy organisations that have a legitimate claim to be involved in
the processes.
The
past twelve months have been hectic. We have had worries imposed through
the dreaded Y2K bug, Millennium celebrations, countdown and introduction
to GST.
We are now sorting our way through ABN and BAS.
Currently we have the distraction of the Olympic games.
Pharmacists have literally become chronically fatigued by these processes,
yet continue to cope with activities such as accreditation, and now
need to summon strength to cope with the Christmas rush. In all this
upheaval, most pharmacists have not considered that they are losing
ground in the Information Technology (IT) area, particularly e-commerce,
because a lot of the competition is still hidden.
Lead time to develop an IT strategy is lengthy, and there is a similar
lead time delay in having it take shape and form as a website.
It has been simply to hard to think about.
What is now apparent is that the concept of developing a website as
a part-time hobby activity now needs to be discarded, and be replaced
with a fully resourced IT division within your business.
The concept can be compared to say, a system of inventory management.
Pre-1960, someone (usually anyone) would whip around the shelves, look
for a gap, guess a product and a quantity. That was the system, and
it coped with the level of inventory and competition. Gradually, this
was replaced by organised written records until the early 1970's when
computers began to take over. From this time onwards, dedicated and
trained support staff have been utilised to manage inventory, a major
business asset and a survival necessity.
Similarly, IT is evolving, but at a much faster rate.
There is a need for a similar asset management strategy.
The last three years of pharmacy IT system timeframe can be equated
to the inventory system timeframe of 40 years. This is a thirteen fold
velocity, and it is increasing exponentially. Because of the long lead
time in developing strategy and infrastructure, most competitive IT
activity has not yet become obvious, but during the pre-Christmas period
and beyond, there will be a relentless rollout of IT systems coming
at pharmacists from all directions.
Competition will develop and intensify between pharmacists, between
pharmacists and other retailers, between pharmacists and other professions,
between cyberbusinesses and bricks and mortar businesses.
While this will initially be regional to your existing business, it
will expand rapidly to a national basis and then to an international
basis.
The notion of being just a neighbourhood operation will not be sustainable,
and the global village of pharmacy will probably take only the next
two years to achieve. Consumer organisations need have no fear that
real competition has not come to what they regard as the privileged
ranks of pharmacy. So prioritise those three letter acronyms (BAS, GST
etc) downwards, and go rapidly upwards to the two letter variety, in
particular, IT.
How do you rectify these problems of competition?
Well, the first step is to gather information, learn a bit about the
technical side, get some good advice from a qualified adviser, develop
a business plan for your entire business with a strong market plan component,
recruit suitably trained IT staff and then go for it.
As a precursor, you need individual focus and commitment, and a realistic
budget for investment.
Gathering information:
Talk to other businesses, particularly retail businesses, that have
evolved to e-commerce and ask them what problems they had getting to
their existing position, has it been successful and can they see potential
for improvement. Include any e-pharmacies you can find on the Internet,
and you may even see if you can talk to Peter Brown at Pharmacy Direct.
While this entity has been more mail order moving to e-commerce, he
would have all the answers to order fulfillment, one of the main problems
in e-commerce businesses.
Document all the good ideas for incorporation in your own business.
Technical
learning:
This does not have to be intense. Read up on website design, what HTML
means, attend a few basic lectures at a TAFE or similar setting, or
even retain an IT university student to give you an insight. Don't leave
yourself so totally blind that you must depend on others to interpret
what you need.
You do not need to know how to do every aspect of say, web design and
programming, but at least understand the principles behind the processes.
Once you feel confident about the basics, purchase an HTML program editor
(we would recommend Dreamweaver at around $300) and have a fiddle yourself.
There are a number of "hands on" prepackaged training courses that you
can purchase to assist in your learning.
Qualified
adviser:
This will be an essential at some point.
Selection of adviser is important, and will probably need to be someone
experienced in e-commerce marketing and pharmacy marketing. Pharmacy
is a difficult market for a non-pharmacist to interpret intuitively,
so if your adviser can be a pharmacist, this would help.
Advice in the format of business coaching would be more suitable than
straight management consulting, for it can be done by telephone and
by the Internet.
The writer of this article has a small business coaching practice, and
communicates by telephone for approximately one hour per client per
week, drawing down problems, client objectives and instructions.
A report summarising the conversation and solutions is posted to a website,
which is fully secured and only accessible by the client with a discrete
password.
A link to this site takes the client to a spreadsheet, where all account
details are posted on a progressive basis.
All other communication is by e-mail and in the case of website construction,
the sites are costed on a per item basis (so much per graphic, link
etc) so a client knows in advance what their cost is, and can basically
manufacture to their own budget.
Coaches need not be involved in your total IT activity and can be reserved
for special segments or overall strategy and tactics. Basically, a modular
and flexible approach is required.
For more information on business coaching contact neilj@computachem.com.au
giving some basic details regarding your needs.
Develop
a business plan:
You are about to commit valuable resources to an e-enterprise.
Do not do it without having some form of vision and how you wish to
achieve that vision. Identification of your target market is essential.
Your existing customers/patients you may think you know, may behave
in a totally different manner on the Internet.
The old story about the customer always being right, but the patient
is not necessarily right takes on a different complexion on the Internet.
Customer/patients assume a greater degree of control when they enter
the Internet environment. Most importantly, identify your resources,
both financial and human.
Draw up a budget for finances and leave a reasonable $value for unplanned
contingencies.
Believe me, you will utilise this particular segment.
Identify which staff you are going to give extra training to and begin
to appoint basic management and supervisory positions to your IT division.
Decide whether you are going to market all services, your entire inventory,
or only those items that you know a fully competitive.
Plan new markets for provided you have a reliable supplier, you can
enter areas on the Internet not previously possible, and with minimal
stock holdings e.g computers, exercise equipment etc
Recruiting
staff:
There will be a need to recruit trained IT people outside of your existing
staff. This can be part-time or full-time, depending on the scale of
your planned operations. IT university students are a good resource
during vacations and between lectures.
Here is an opportunity to balance out all those male-unfriendly pharmacies
that Leigh Kibby has been writing about in this newsletter.
Recruit male IT graduates and have them double up as male-interested
shop assistants, say in photographic departments, exercise and fitness
departments, computer software, men's toiletries, men's health, etc.
Note that in most Australian households at the moment, men usually are
the computer literate persons. This is rapidly changing, but as we have
pointed out before, there is a need to initiate a program to service
male needs.
Communicating via the Internet may be just the answer, and a profitable
market expansion as well
.
Go for it:
Once you have made the commitment to set up you own IT division, don't
hold back.
You will never experience a comfort zone where you feel you are totally
in control at any stage of the experience, and most actions will be
done on blind faith, qualified by your own research.
Is this any different to setting up a normal pharmacy business?
Not a lot, except that pharmacy business has evolved over many centuries
and has a defined pattern. Internet business can only be measured in
the last decade and is a different environment. There are no easy answers.
Basically, you must pioneer your own solutions.
If you hold back until someone has done this work so you can emulate
it, forget about it.
In the flicker of an eyelid (or a mouse click), you will have lost your
market.
It will be that quick.
One word of caution.
Many promoters will endeavour to lead you into a storefront site controlled
by them, to save you individual development costs. This will be a site
that you will have difficulty personalising and to be able to stand
out from the crowd. Customers will require more key strokes to access
the goods and services they require and may become frustrated.
While it may be a cheaper entry point, you must eventually evolve your
own personality through your own site and make the storefront a subsidiary.
Merchandise and services promotion should be your own province, provision
of updated information linked and integrated with your own site can
be the province of others (in designated areas).
As we have previously stressed, you must evolve with tools of control,
to ensure your own success.
A BRIEFING PAPER ON MEN'S HEALTH
AND ORGANISATIONAL HEALTH
By Leigh Kibby and Rick Hayes
The
North East Health Promotion Centre's research into Men's Health Promotion
covers four local government areas (Whittlesea, Darebin, Banyule and
Nillumbik) and focuses on issues relating to mental health, employment
status, class, language facility, and cultural and social origins.
It has discovered a number of key issues to date:
* one size does not fit all; men vary in their outlooks on life
and their needs: for instance, many male factory workers we interviewed
knew what they should do for good health and complied with the information
very well; the most pressing issue for working-class males under age
44 is not cancer, stroke or heart disease--it is stress, accident, injury
or violence in the workplace or community
* there is a tendency to pathologise men's health and focus on illness as just a personal issue: illness is seen to be the result of genetic make-up or lifestyle issues even though these only account for forty percent of the factors influencing heart disease for instance; even among professionals stress levels increase as they find they have less control over and support in their work situation, but their illness is seen as a personal inability to cope; this can be especially troubling for men who can find it difficult to ask for help because it might be interpreted as personal failure or weakness
* there is a wide spread failure to recognise the structural and cultural determinates of health: the incidence of male suicide has grown dramatically over the last thirty years with the broader changes in society and the workplace; literacy rates among males are falling and violence is increasing at earlier ages; un- and underemployment significantly impact health for all males under 25 and over 45; young males are finding it difficult to socialise and entertain themselves unless they have the money to pay for commodities or access to so called "public" space; male middle-class workers are increasingly finding that the processes and pressures of work are precluding their significance as people--their frustrations often spill over into their home lives
* organisational policies are often unhealthy in their consequences: restructuring without redeploying middle-managers to the front lines has created a "survivor syndrome" situation where remaining employees have become more stressed and less willing to take the risks necessary to develop and implement creative solutions and innovative possibilities; this can be especially debilitating for many men as they often still see themselves as the key source of income provision--many take failure personally
* attempts to address men's health issues should capitalise on and enhance networks and processes men presently utilise through work, sport and schooling: approaches should be strategic, collaborative, intersectoral, self-sustaining and involve the men in solving problems and taking advantage of new opportunities; at present there is a systematic failure to adequately address these issues in the business and public sectors
These
findings correlate with the broader research in Australia and overseas.
According to the ABS Australian Social Trends 1996, male professionals
and other workers are twice as likely to take sick leave as are managers.
However, the reporting of certain long-term ill-health conditions by
managers was considerably higher than other occupational classifications
in Victoria.
In absolute terms, only clerks and labourers reported mental disorders
more often.
However, per capita, managers were only slightly behind clerks in reporting
mental disorders. Compared to others, managers had significant reporting
rates for diseases of the:
* nervous system and sense organs
* circulatory system
* respiratory system
* digestive system
* musculoskeletal system and connective tissue
Professionals
also had difficulties with diseases of the:
* nervous system and sense organs
* respiratory system
* skin and subcutaneous tissue
Basically,
managers have significant health concerns often related to stress. However,
they are less likely to seek time off from work to recuperate.
At the VicHealth auspiced workplace stress conference held at the end
of August 1998, the seriousness of the emotional stress was emphasised.
VicHealth, which funds the Men's Health Promotion Strategic Framework
Project of the North East Health Promotion Centre (NEHPC), reports that
the most common causes of stress include the pace and rate of change,
poor organisational communication and a failure to communicate the reasons
for the necessity of change to employees.
The 1995 Australian Workplace Industrial Relations Survey had similar
findings. That same year, Britain's Chief Medical Officer estimated
that thirty percent of employees were suffering from stress at work.
In October of 1997, the UK Manufacturing, Science and Finance Union
survey of 423 workplaces found that the situation had worsened. Eight
out of ten employees reported stress as a serious workplace problem.
Seventy-two percent said that the situation had worsened since the previous
year and 74% said that the situation was worse that five years earlier.
The Director of the National Institute of Occupational Health and Safety
in the United States forecasts that stress will be among the most important
problems affecting workers and organisations well into the next century.
On one estimate work related stress is the primary cause of 54% of workplace
absences.
The World Health Organisation estimates that depression among males
will become a significant health issue early in the next century.
A recent study by Drake International of more than 3500 businesses found
that nearly nine out of ten indicated that their Australian workplaces
were stressful.
Mr.
Glenn Thompson lists the following causes of stress that need to be
addressed by managers:
* lack of an agreed set of expectations between managers and subordinates
* failure to indicate how performance levels are to be monitored
* failure to listen to employee concerns
* failure to adequately provide for career development and advancement
* poor communication channels
* aloofness of managers
These
findings are similar to those of the 1997 ACTU National Survey on Stress
at Work which also identified lack of control over work, job insecurity
and long working hours as key sources of stress. A research project
into men's health and welfare needs recently identified similar concerns
among both working-class and middle-class male workers.
This project also identified another significant area of concern--fathers
wanting to be good parents, but who find themselves working more hours
to keep up with the fast pace of change so as to avoid the effects of
restructuring.
In 1991, Caroline Milburn reported in the Melbourne Age that both men
and women in Australia were experiencing increased strain trying to
juggle the demands of work and family life. She was referring to the
findings of a survey of 1500 people aged between 27 and 44 carried out
by the Australian Institute of Family Studies in 1990.
Sixty percent of the men surveyed said that work interfered with time
spent with their children. Twenty-five percent said that they lacked
sufficient energy to be a good parent. Half said that work demands outside
left little energy for work at home.
The survey showed that men who had low levels of satisfaction with their
work, who worked long hours and were financially vulnerable had higher
levels of stress both at home and at work. Significantly, high status
workers also had similar levels of stress due to their greater focus
on work responsibilities at the expense of their families.
In June 1997, Milburn who was covering a VicHealth funded seminar on
workplace health again reported in the Age that men had failed to come
to terms with the heavy demands of work and family responsibilities.
Dr. Daniel Lewis of the Monash Medical Centre is reported to have said
at the seminar that "most male health problems were caused by stress
and men were not educated properly to make the right choices about diet,
exercise and lifestyle."
Steve Biddulph commented that the degree of male unhappiness can be
determined by looking at their high suicide rates. During the last four
years, suicide has surpassed car accidents as the leading cause of death
among men aged 25-55 in Australia.
The North East Health Promotion Centre's study is discovering the importance
of social capital for men's health.
Contrary to many myths, men do care about their health and the health
of those whom they love. However, they often find it difficult to seek
help for themselves and others unless an environment supportive of health
is available to them. This means more than providing gyms and fitness
centres and helping men make good choices regarding diet and lifestyle,
as important as these are.
It means increasing corporate social capital (CSC).
Social capital in corporations allows for the positive social cohesion
that precludes politicking, collusive behaviour and low morale that
eventuate in higher turnover, absenteeism and lower productivity.
Without adequate social capital, the spiral of workplace stress and
its negative effects will only accelerate in an organisation.
Social capital is comprised of:
* norms such as company visions and values that allow employees the
opportunity to experience and express themselves as significant people
capable of creative engagement in the social, political and economic
realities that confront them
* networks of support and encouragement that provide access to the resources
required to resolve the problems and exploit the opportunities that
face them
* trust that allows each employee to influence the processes that shape
their own working and personal environments and those of others for
whom they are accountable
Low
CSC is indicative of low organisational health which, in turn, is indicative
of low health for those in the organisation. The indicators of low CSC
can be seen in workplace performance, absenteeism, anti-organisational
behaviours and SOS (Satisfaction Out-Sourcing) behaviours by those in
the organisation.
Conversely, it is now possible to measure CSC (previously hard to determine)
and then make direct changes to increase CSC which can be a significant
long term cost saving – treating the cause not the effect – one step
beyond the band-aid solution.
This is the approach used by leading organisations although, albeit
the have been wrestling with cultural change which is an effect rather
than a cause and more difficult to shift than is increasing CSC. The
costs of low CSC can be seen and/or measured as can the cost which is
high. In the case of turnover, it ranges between 100% to 150% of the
gross salary.
In some organisations, this averages at $50 000 per year whereas in
service based organisations based around professional and academic qualifications,
the cost can be as much as $100 000. With turnover ranging between 20%
- 30%, the overall losses are significant.
Additionally, the impact of disgruntled alumni is not added into this
equation.
Measuring
CSC has proved a challenging task and has involved analysing:
* organisational DNA
* organisational health and self-esteem and
* organisational commitment to A+ like strategies.
Our
research is suggesting a powerful link between health at both the group
and organisational level and that strategies to improve each can be
cost-effective. In particular, increasing CSC can decrease other costs
both to the organisation’s bottom line and to the individual in terms
of health and well-being.
The comments and views expressed in the above
article are those of the author and no other. The author(s) welcomes
any comment and interaction that may result from this and future articles,
and can be contacted directly by e-mail at
kinematic@bigpond.com . Alternatively, the editor would be pleased
to publish any responses directed to neilj@computachem.com.au
.
ROUNDUP
A regular column devoted to Rural and Isolated Health Issues
The
practice in remote health of allowing nurses and Aboriginal health workers
to give medicines to clients may have lessons to be learnt in the "mainstream"
health care system.
The debate about "nurse practitioners" being able to prescribe has drawn
harsh criticism from other sectors of the health professions, in particular
the medicos.
The practice of being able to treat minor illnesses with certain Schedule
4 medicines without recourse to a medical practitioner has certainly
proved its value in remote practice.
While there are ways it could be improved with more educational opportunities,
the system does alleviate the need for further expensive medical intervention.
The problem is that while the practice is not recognised nationally
it is difficult to convince the Health Insurance Commission that Medicare
should pay the bill.
Imagine nurses or pharmacists in the suburbs being able to "prescribe"
antibiotics.
The savings to the Federal health bill could be enormous.
Payment from Medicare for the work of remote health professionals would
assist to correct the per capita imbalance of money spent per head on
remote residents compared with those in the suburbs. Surely a good practice
in "the bush" could be picked up in the suburbs and put all Australians
equal access to Medicare funding.
THE NATIONAL RURAL HEALTH ALLIANCE
Want
to subscribe to another interesting newsletter?
The National Rural Health Alliance has a publication dedicated to news
and reviews of all aspects of rural health. You can subscribe on the
website at http://www.ruralhealth.org.au
or you can contact the independent editor, Jim Groves, at grovesc@winshop.com.au
Back
to Top
Article
Index
Home
*
Don't forget to advise of any change in your e-mail address so that
your subscription may be continued without interruption.
* Letters to the editor are encouraged, or if you have material you
would like published, please forward to the editor.
* You are invited to visit the Computachem web site at http://www.computachem.com.au
.
* Any interested persons who would like to receive this free newsletter
on their desktop each fortnight, please send a single word e-mail "Subscribe"
to neilj@computachem.com.au
.
* Looking for an organised reference site for medical or other references?
Why not try (and bookmark) the Computachem
Interweb Directory , for an easily accessed range of medical and
pharmacy links, plus a host of pharmacy relevant links.
The directory also contains a very fast search engine for Internet enquiries