So, I'm Dr. Ben Hoffman, I'm the Chief Medical Officer of WorkSTEPPS and I have with me here the distinguished Dr. Rosalyn, or Sandra Day Walker, I always get her first name wrong, who's our Medical Director. And we're going to share this talk today, which is entitled Post-Offer Employment Testing as a Cornerstone for Total Worker Health. I'll let Ros introduce herself when she comes on, but I'm a prior Chief Medical Officer of a number of companies. I retired from GE during their downturn a few years ago and since then I joined this company WorkSTEPPS. I met WorkSTEPPS about 15, 20 years ago when I was at Waste Management, I was Chief Medical Officer there, and I came into a pretty horrific situation with 15,000 claims, workers' compensation claims a year at Waste and 70 deaths. We also had about 15,000 motor vehicle crashes, it was really a mess, arguably we put 40,000 trucks on the road every day and we had about 1,000 locations where we were managing all sorts of waste materials, some quite toxic. But I met WorkSTEPPS and I joined them when I left. And this is not a talk really about WorkSTEPPS, will this take me down, yeah. But I did join them and we're sort of a strategic consulting firm around occupational health, we also provide a lot of different services and we also have a fairly strong analytics capability and you'll see some of this in a moment. Okay, so this is really three talks in one. The first one is we're going to talk about total worker health, I'll introduce it very briefly and then Dr. Daywalker who's really a subject matter expert, and we can get you the slides by the way, it's no problem, I'll just send them to you. She's a subject matter expert on this, she's getting her Ph.D., actually her first Ph.D. that NIOSH is going to give out on total worker health at the University of Texas School of Public Health where I'm a professor, that's how the two of us met and we got together Then we're going to talk about a model program that really is a good example of total worker health which has to do with injury management or injury prevention, injury management, hopefully you'll get something out of it. Then lastly, how you use analytics to make the case for the type of work you're doing. Thank you, it's wonderful to have you here to help me. She is the best co-worker in the world, okay. That means a lot, right, in today's world. The very best, I mean it's unbelievable, I'm just so pleased that we met. At any rate, so I've worked in corporations for a long time and it's really hard sometimes to get the people that I'm trying to influence to understand what the role of health is in their enterprise. Health is really important, it's part of human capital. Companies have four different types of capital, they have financial capital which is money in the bank, they have physical capital which is plants and equipment, they have intellectual capital which is like their IP and their patents, and then lastly they have human capital, sort of a fancy word for people. But then trying to structure, well what's human capital all about, and I've split this into really three categories. One is that it has to do with your human capital has to have knowledge and skills, the second thing they need to have is motivation, and the third thing they need to have is health. And what we deal with in occupational health is health of the workers in the enterprise, whatever that enterprise be, they're large or be it small. And health is these days, there's a much broader concept that has been embraced by employers that's more than just the health of the individual when they're within the four walls, either literal or figuratively, of the enterprise or employer they work for, an interchanging enterprise and employer. It's more complicated, we've come to realize, and I think the pandemic really pointed out a lot of that, that a worker who came to work was very much, their productivity was very dependent upon what went on in the home, because they could get sick in the home from family members or whoever they cohabitate with, and in the community, if the community didn't enforce and have good public health measures in addition to having a good healthcare delivery system, those things influenced the employer. And I think that, you know, many of you who work for employers, suddenly you became very much closer, if not the best friend of senior management at the companies that you were doing work for. And I do understand not everybody here is working inside of a company, they're working as, you know, outside in the community, but as you know, occupational health professionals sort of took a jump up the ladder, rung up the ladder when the pandemic came around. And total worker health, which Dr. Daywalker is going to go over, really is a paradigm that acknowledges that worker health is more than just the health of that individual. And with that, I'm going to hand it over to her. We go back and forth during the presentation. So thank you so much for the introduction and for kicking off the presentation. And so I'm sure, raise your hand if you've heard of total worker health. Oh, oh my God, everybody. Oh my gosh. Okay, we can go home. Okay. I have the pleasure of serving, I was appointed recently as ACOM's representative to the inaugural advisory panel for the Society for Total Worker Health. And of course, as you can imagine, worker health is our scope, right? And so we have a lot to contribute, a very valuable amount to contribute to the future progression of this paradigm of this program, this initiative. And so just to reiterate, won't go too much in detail because it seems like we're all experts in here. And I'm really proud of that. I'm going to let the folks at NIOSH know that ACOM is on the ball. But essentially it refers to policies, programs, and practices that integrate protection from work-related safety and health hazards, what we know as our slips, falls, exposures to chemicals and more, with the more newer health promotion and injury and illness prevention efforts. Some people may try to refer to it as wellness, but it's a little bit more than wellness, as we know in this room. And the purpose of taking these policies, programs, and practices and integrating them is to truly advance worker well-being because work is a social determinant of health. When I come to work, I don't leave myself and my well-being and my health at home. And the things that happen to me at work definitely carry back into my home and my community. And so it's with this understanding that the CDC NIOSH is funding multiple centers of excellence around the country, as well as we have several dozens, maybe nearing 100 plus, affiliates, institutions, they're mainly going to be public institutions, universities, and some partnerships with statewide workers, comp insurance organizations such as in Oregon with their SAFE program. And so the basis of it all is that we understand more or less what works when it comes to traditional work-related safety, but a little bit less about what goes on when it comes to well-being and wellness. And so the purpose of this initiative is to actually fund that research, those programs and implementation research to really give us a good evidence base as to what really works in the workplace so that we can translate that. As many of you probably remember, some years ago, a really prestigious institution came out and said, workplace wellness programs don't work. You're smiling. Maybe you read that paper. And at first I was shocked. This was before I came to occupational medicine, but I was still sort of interested in wellness in the workplace. I said, oh, my God, that's terrible. Why are they saying this? And now being more mature and knowledgeable and understanding that if your programs don't have an evidence base and they're not sustainable and they don't have leadership buy-in, they're probably going to fail. If you don't actually ask the people what they want and need and you just put in what you think they want and need, it's probably going to fail. And so there's probably some truth, a lot of truth in that paper. And so hopefully Total Worker Health and the initiative that NIOSH has put forth is combating that and making it real and accessible for all of us. So I told you what it is. And again, I just want to reiterate what it is not. Because sometimes it is a trademark phrase, it might sound like a buzzword, and sometimes people take it and use it in different ways without truly understanding what it is. This is an old meme, not the captions I added, but the cartoon existed before and it was this gentle dog, gentle dog, in a burning house. And in the second box he actually says, everything is fine in the original. And so that reminded me of some things that I had personally experienced and probably a lot of you have experienced, which is being in an environment or a situation where systemic practices and the environment just isn't conducive to wellness. And sometimes it can be just downright toxic and dangerous, right? And a lot of workers still live in that today. And so some of those examples include things like abusive management, pay gap disparities, discrimination, hazardous exposures, precarious work, and at one point COVID-19 was a huge issue when I first made this cartoon, still is. And some well-meaning people in our institutions, in our organizations, in our communities said, have you considered self-care? Have you tried yoga? And I love yoga, but it's not going to solve the environmental issues, it's not going to solve leadership issues, it's not going to solve operational issues. And so what Total Worker Health says is that's where we have to start if we really want to see change and sustainability. So it's not simply putting a bunch of wellness activities in the workplace and then being surprised when it fails, but it's really understanding what the needs of your population is, having the right leadership buy-in, design, and more. So what does it look like in action? I think one of the easier ways for me to really explain how Total Worker Health works is by sharing with you the five defining elements of Total Worker Health, which are leadership, I've dubbed them, I have dubbed them as leadership, design, engage, confidentiality, and integrate. So leadership, the first aspect or element is leadership commitment or leadership buy-in to worker safety and health at all levels of the organization. It's critical to establish and publicly demonstrate that there is real leadership buy-in through acknowledgement, communication, through modeling behaviors, right? How many times have we had a situation where we were told, yes, we want you to do this, we want you to be well, but our supervisors and others weren't doing the same thing. And then we felt conflicted because we want to be good workers and we want to be good team players. But then how do we step out the box and take care of ourselves when that's not really rewarded and might actually make us look bad? So basically, leadership buy-in and the real thing that comes with leadership buy-in is the resources in terms of financial manpower, resources of financial manpower and time, right? To actually do the things. And this is what's going to ensure your quality and sustainability over time. The second one is design. And Nayash actually borrowed from a very well-known popular model, which is the hierarchy of controls, which many of you are more than familiar with, which refers to sort of how we approach safety and health hazards in the community, in the environment, or in the workplace. And thinking about starting at the top with that which we think will be most effective, which is elimination. Can we completely eliminate or remove the hazard? And sort of working our way down to some of the lower levels that while probably less effective still have a place, such as PPE, but as we know and I mean as we got a great lesson in over the last few years, PPE is only as good as the wearer or the PPE itself. And so we'd like to start at the top. And so Nayash took that same concept and said, this is what it looks like when you're thinking about total worker health. Eliminate those work conditions that threaten safety, health, and well-being. We're not going to keep toxic leadership, we're not going to keep hazards, and then tell people that they just need to be more resilient, right? And then working your way down, because sometimes there are hazards or psychosocial, physical that you just can't eliminate, right? For example, hospitals, shift work is a thing, and it's not going to go away because the hospital doesn't close. But how do we mitigate the health effects? How do we mitigate and make sure that we're applying it in such a way that it is equitable and doesn't have undue hardship on people and long-term health effects? And working your way down to encouraging personal change. And so essentially, total worker health, the second principle is design, design work. Design work conditions and be intentional. The third element, which, you know, sometimes I say, is this my favorite one? Which is worker engagement. Because this is where you go to the people. You get down on the ground, and you ask people what they actually want and need. Rather than assuming, because you might be wrong. So this comes in the form of surveys, questionnaires, needs assessment, focus groups, windshield surveys, you name it. But the point is, sometimes those of us in leadership or who might not be on the front lines anymore, maybe used to be, may not know exactly what's going on on the floor. And so it is imperative that we include our workers, the front line, and others, not just decision makers, but everyone have a voice and actually have a seat at the table at the time that these programs are being designed for safety or well-being, et cetera. And so when you give people, as you know, a voice and choice in the matter, probably going to see the effectiveness go up because you actually had them in mind and what they actually needed. And they feel a direct involvement and investment in the process. The fourth element, super important, is confidentiality. As we all know, those of us who work in any kind of practice where we're having to collect data related to health and safety, we have to be very careful that we don't unintentionally, inadvertently break confidentiality or expose privacy of workers, because that is not total worker health. I just want to emphasize that. Any workplace policies that discriminate against or penalize people for their individual health conditions or create disincentives for improving safety is completely inconsistent with total worker health. We're not going out there and saying, okay, we think we have an obesity problem. You, you, you, and you look obese. Oh, sorry. You, you, you, and look obese. You need to partake in our step challenge. That's not how that works. We create systems and policies and programs that everybody has access to and hopefully design it in such a way that the people who need it the most can participate. It reminds me of a story that a friend of mine shared with me one time about where she worked and they had some sort of counter on the wall high up for everyone to see, you know, this many days since we had injuries, okay? And she said she knew that it was just the worst place to be when they had the person who had just gotten injured go up in front of everyone and change that counter to reflect that he had gotten injured and he was the most recent one. That's not total worker health. It's something, but it's not total worker health. And so keeping that in mind, confidentiality. And so those were, I feel like I'm missing one. I am missing a slide, but that's okay because I know it off the top of my head. And that is integrate. So the final one is integrate. And integrate means bringing together all of the relevant disciplines and lines of business that also are working towards the same end we all are, which is ultimately worker health, safety, and well‑being, right? Those of us in occupational medicine, occupational health, we don't have the monopoly on worker safety, health, and well‑being. We know that. It's definitely a team sport. And so, of course, so many others such as ‑‑ name a few people who you would involve from your teams. Industrial hygiene maybe? Give me one. Preventative medicine, absolutely. Anybody else? HR. Thank you. HR benefits. One more? Safety. Safety. Safety. Exactly. Occupational health psychology, real estate, right? If we're trying to build or revamp certain physical locations. These are all especially important people to include on your team, to bring to the table. And that's one of the hugest tenets of total worker health is breaking down those silos, right? In most companies, safety was over here and wellness was over here. Do they not go together? And so making sure that we come together, you know, and talk to each other in ways that we understand, because you might find that you can actually streamline a lot of your efforts and find redundancy. You might be able to combine resources. I know a lot of organizations are stretched thin as it is when it comes to time, personnel, or even finances. So when you're bringing more experts or more teammates to the table, you stand to increase your chances of being successful. So that's integrate. So those five were leadership, design, confidentiality, worker engagement, and integrate. So with all of that being said, I'd like to turn it back over to Dr. Hoffman to give you sort of a very integrated total worker health aligned approach to injury prevention and management that he actually created probably 25 years ago before it was hot, but now it's relevant more than ever. And this is sort of his approach to injury prevention and management. Okay. Thank you. You know, when Dr. Day-Walker talks, I a lot, you know, the, well, I want to, sometimes these types of programs are not, people think, oh my gosh, this is going to be impossible to do in an organization. Organizations, enterprises are complex. They have a lot of stakeholders, a lot of different functions that impact the types of programs that we're talking about. But I can tell you, you can do this. You know, I've spent my career developing these types of programs. They weren't called total worker health. Total worker health, even though it's not new, has gotten a lot of cache and attention in recent years because it is the right way to do things. We did this at GE. I mean, the whole organization, you know, 350,000 people was focused on the, on, forget this for the moment, but on the total worker health paradigm. We had a different term for it. And it was a full court press. It wasn't something that was easy to do, but the entire organization understood the role of employee wellbeing and all of the aspects of employee wellbeing that made the company successful. Unfortunately, GE fell apart, not because of those reasons, but there are a lot of large, high quality employers are, have been doing this sort of thing for years. Now what I'm going to present now is not a new paradigm or framework. And most of us, day to day, spend a lot of our time managing injury related issues. How many people in the room have to deal with injury on a routine basis? All right. So it's the vast majority of the people in the room. In many regards, it's the, it's a core of what we do. It's not always the sexiest thing to do, but there's so much attention and the worker, you know, in the, in the employers that we work in, particularly as they become more and more dangerous in terms of the work that's done, our organization spends a lot of time in oil and gas, which is a very dangerous area in heavy, difficult manufacturing. And so over the years, this is the type of work that I've done. And I developed this paradigm for two reasons. The first reason was I was trying to structure it myself in my brain as to how you should approach injury in the workplace. So this was for me. But then it became a useful framework when I would go and I'd try to pitch things to the various groups within General Electric, whether it be in the U.S., Angola, Australia, whether it be to operations, human resources, risk, EHS, that there is a right way to prevent and to manage injury. And that framework is based upon traditional public health principles of primary, secondary, and tertiary prevention. And so what I did years ago, and I wrote this article for a peer-reviewed journal that seems to have disappeared from cyberspace called the Journal of Workers' Compensation. And in many regards, it's what, today, what total worker health is. I'm not trying to take credit for total worker health by any stretch of the imagination, but I tried to apply my training in public health to the field of injury prevention and management. Injury is a very big issue for people. You know, there's a lot of abuse that goes on in the workplace, and we all know that and how you have to manage problem employees, et cetera, et cetera. But some people really get injured, and it becomes a lifelong impact to them, their families, and to a certain extent, even the communities they live in. So the first ask, and I'm going to focus on one after, yeah, yeah, it's a little lower. I'm going to, so this is a classic, what I would consider to be a classic integrated total worker health program. It's quite comprehensive. It doesn't mean to say every organization needs to do the whole thing. But to understand a framework to prevent and manage injury, I think is essential for all of us as professionals. I'm going to focus on one specific program after I do a highlight of all these, which is post-offer employment testing, which I've come to realize is an extraordinarily valuable service for employers to provide for both themselves and also for prospective employees. So primary prevention, somebody give me an example of primary prevention, not in occupational health, but just in health in general. Yes, perfect. That is the, you know, that prevents, that's the quintessential, that prevents disease in the first place. Okay. So in the world of occupational health, what that really is, is making sure somebody is able to perform a job, which is post-offer employment testing. There's other aspects, because post-offer employment testing, which I'll spend a few minutes talking about, is really just one snapshot in time. Although it does tell you more than what's going on at that snapshot, things occur after that snapshot, in which it's very important to have a safe workplace, ergonomically, something that, you know, we go into workplaces at times where a gorilla couldn't do the job, let alone an 80-pound Cambodian woman can definitely not do the job. And also work conditioning and stretching and warm up. All those things are actually very important. I used to think that was, in the old days, you know, I didn't give it much thought, but I've come to realize this is very, very important, in part because as I age, I realize it's important before I exercise. So we'll get into post-offer employment testing in a minute. The second thing is secondary prevention. Can anybody give me an example of, in general health, secondary prevention? Okay. Well, secondary prevention is the identification of risk factors that lead to disease. So the classic one for that would be their cancer screening, like mammography, or even a PSA still has value. It would also be blood pressure screening. That's secondary prevention. It's finding things that are going to lead to a negative outcome with regards to disease. In the workplace, early intervention is very useful. And by the way, the concepts that I'm providing here today, when I said I didn't really make these up, these are really the classic principles that were contained in the OSHA ergonomic standard of 2005, or whatever it was, in which OSHA put out a beautifully written standard, but unfortunately the courts, I believe it was the Supreme Court or the Court of Appeals, put a stay on it. And they put a stay on it, not because it wasn't a quality document, but they put a stay on it because of jurisdiction purposes. A number of states did adopt it. California adopted parts of it. Washington State adopted it in whole. So the concepts I'm going over today, if you want to read a beautiful document that's really quite long, just go back and look at the entire standard, including what was in the federal register to justify it. So early intervention is really classic secondary prevention. People who become injured in the workplace, the majority of individuals, go through a phase pre-injury. And they can tell you they're going to be injured if you let them tell you. Now, that's not all injuries. And it's certainly not an accident. These are not accidents. These are injuries. And OSHA classifies some of these as illnesses, such as repetitive motion is, I believe, categorized as an illness. You can detect these as long as you have people put their arms up in the air and say, look, I have problems. In recent years, and that's very much having an employee talk to an early interventionist in the workplace, typically athletic trainers or people in the world of rehab. However, interestingly, the use of sensors and using the Internet of Things, and this is not on here, the Internet of Things and AI has been extremely useful in certain types of areas, functions, or tasks in which you can identify the employee doesn't even know that they could become injured. And this is really an area that's growing very, very quickly. We were heavily working on this at GE. But you can predict. Some of the things are as simple as heart rate variation in people doing lifting tests. And then the third component of this is tertiary prevention. And tertiary prevention is, can somebody give me an example of that in the world of general health? Come on, you folks have been through schools of public health, haven't you? I know some of you were just reluctant to raise your hand. But tertiary prevention is that diseases occur and what you can do to mitigate the impact of that disease on one's, in certain regards, well-being, but really functioning. So a good example of that would be stroke rehabilitation. Now in the world of the workplace, once somebody becomes injured, there are a series of components that are very, very useful. And that is rapid triage of that individual. The first person that contacts that individual, the first medical professional, has the greatest impact on being able to determine outcome. So it's very important whether or not you do this face-to-face or you can do it virtually these days, triage is important. And I believe very strongly that triage should be done by doctors and not done by nurses. Most of the organizations out there are using nurses and they just are not, it's not the same. And we've studied this extensively. Also, aggressive case management. You know, apply a sports medicine model to a worker. You know, somebody, you know, as soon as somebody gets injured on the field, they take them into the clubhouse and they do an MRI or a CT on them and they're right on their way to the, you know, best level of diagnosis, best medical care, and safe return to the field. In this case, safe return to work. And generally speaking, the service providers out there, the vendors that do this sort of work, you know, the third-party administrators and the various case management groups, in my opinion, not all that good. All right? And I believe that should be outsourced to somebody else who really is focused on it using a sports medicine model. And you can do that. Okay? So, you know, all of this together is, I think, a pretty classic integrated approach to injury prevention and management. And I think it's a very good way to look at, you can go to the next slide if you could, at looking at a total worker health program. Now, I wanted to spend a few minutes talking about POET. And the reason I'm talking about this is that in my career, I've had enormous success with this. You know, I do have a vested interest in the company that's the dominant player out there. But I joined them because I felt very strongly about the work they did, particularly in the days when I was at Waste Management. But POET is a non-medical screening test. And it tests function. It doesn't test medical parameters. And I'll go into exactly what I mean by that in a moment. However, the ADA and other documents that the federal government has published over the years, as have state governments, have made it very clear that medical tests in the workplace are not well supported by the law. Doesn't mean to say, you know, companies don't do them all the time. But your typical physical examination and checking, you know, vision and doing really medical tests, the ADA does not like them. And without going into all the details about that, just take it at face value. I can send you more information about it. What you want to do is you want to determine whether or not somebody is physically and mentally capable of performing the job. And I can't tell you how often I deal with a case in which somebody was hired in which they were autistic to do a job. Nobody ever tested to see whether or not they had the mental faculties. People who have been profoundly injured, who are suddenly showing up on an oil and gas rig, who couldn't lift ten pounds. You know, it's very important to assess one's physical and to a certain extent mental capacity prior to performing a job, because you can really injure them. And what a post-office employment test does is it assesses the risk of injuries, of the risk for injury prior. It's pretty straightforward, in fact. The way it works is there is a process, and it's defined by the federal government, and you have to know what a person does in order to test them. And having adequate job descriptions with the essential functions is really important. I can tell you many large organizations do not have adequate job descriptions, non-defensible job descriptions. So if they end up in court, nobody has actually ever validated that what's on that job description is really what the employee has to do. An essential function means that individual has to do it without help. A marginal function means they can get help. But most employers don't have these types of job descriptions. So in order to do a post-office employment test, you need to make sure that somebody, that the job, that you've assessed what it takes to perform a job, and you validate that with workers. The next thing is you translate that into a simulation. Most job tests, whether it be in manufacturing, transportation, oil and gas, warehousing, you know, the tough jobs that are out there, can be easily translated into a simulation with very limited amount of equipment that's typically in a rehab office. And then lastly, you test and you measure a prospective employee. Now on the next slide, there's really four components to that type of test. There's a cardiovascular measure. You use the old Harvard step test. The Harvard step test is a graded, sort of depending upon the height and the number of stairs, there are standard numbers that come out after doing it for two minutes. And you can tell a lot about deconditioning. And people with chronic diseases typically have deconditioning and their numbers fall outside the norms for age and size, et cetera. The second part is getting musculoskeletal assessments. And what is meant by that is doing joint range of motion and seeing where somebody has a limitation in the range of motion. In many states, those numbers can be used for what's called apportionment. And that is that if somebody came to work with the ability to only lift their arm this much and it's recorded, if the person is injured in that arm and the rehab person needs to know they only could lift it this high to begin with, but then when it comes to a permanency award, the permanency award is going to measure loss of entire function. Let's say, in this case, 90 degrees. Unless you knew they had lost that 90 degrees prior to the injury, you're going to pay for it. So there's another purpose in addition to the rehab and just knowing if somebody has the range of motion. The third part are measures of strength, which is sort of obvious. Can you lift 50 pounds overhead 20 times in a row? And then lastly, some simulation like climbing a ladder and getting onto a truck, three-point contact onto a truck, et cetera. So these are the basic components of post-offer employment testing. And it really does improve job match, and it reduces the risk that somebody can have a lifelong impact beyond being able to perform their job. So just to recap this piece before we go back over to Dr. Daywalker, this type of injury prevention and management paradigm is really essential for any workplace in which there's a risk of injury. Many companies will have one component, two components of it. And I don't think that the EHS and the ops people really understand there's a more comprehensive view of this. And I can tell you, if you do this comprehensive primary, secondary, tertiary prevention, you will put into place the best possible practices to reduce the number of injuries. And EHS loves that because you have fewer recordables, and they're so focused on recordables, as we all know, because it's a metric that they get measured in terms of success. But if you can think about this type of paradigm, when you're doing your work in a company or if you're already there or you're working in the community, I think you'll find this beneficial. And again, this is a classic total worker health approach to reducing injury impact. With that, I go back to my colleague. Thank you. So I learned about this post-offer pre-employment testing once I joined Dr. Hoffman at the company. Before that, I was just doing my total worker health PhD, and I was coming from a very sort of aspirational understanding of what health, safety, and worker well-being should be. And as I, again, matured and got more experience, you recognize that there's a lot of good wellness programs out there, but they tend to be focused on people who have pretty safe jobs to begin with. And in the real world, a lot of people don't have those kind of jobs. A lot of people are not sitting at a desk, don't have that kind of privilege. A lot of people are in heat, exposed to heat, exposed to a lot of dangerous elements, are required to go up heights and go into dark, small holes and lift heavy. It's hard work that people are doing out there. And while we understand that technology is changing rapidly, I mean, AI, robotics, you name it, the fact of the matter is we're not there yet. And all the jobs haven't been eliminated, as you see in the news. AI has gone a lot farther than robotics, even though we thought robotics would take over faster. But it turns out that the human body is a lot harder to replicate than we thought. And so we still have people doing these jobs. So how do we keep them safe? And it takes a multilevel approach. Some things can't be outsourced. Some things can't be eliminated. And so we have to think outside of the box and just do everything we can, throw the kitchen sink, if you will. But the ultimate desire is that we don't unnecessarily put people in danger or put them at risk for a lifelong dysfunction and injury. So I was tasked, you know, in the past with thinking, how does this align with what I understand total worker health to be? And it became quite apparent, because a lot of you are in situations where you need this kind of testing in order to make sure that you keep your workers safe. So I think that POET testing encourages, in terms of how it encourages or supports total worker health efforts, right, is that they both focus at the end of the day on workplace worker well-being and safety. Okay. And I didn't emphasize it so much before, but the underlying, the underlying foundation of your total worker health initiative program paradigm is safety. There is no total worker health without safety. I don't care if you give me a pizza party and I don't have proper PPE when I come to the hospital. Safety first. And so you want to start with where are my hazards and where are, where am I prone to injury and illness? And so this is obviously a way for those who have a high number of musculoskeletal injury or risk for it to sort of match. And there's also mental capacity testing as well. I'm not an expert for sure in that, but some people are also experimenting with mental capacity as well for more cognitive roles. And of course, how it sort of does this when it comes to safety is it achieves this by identifying, you have to identify what the essential duties are of a particular job and then match work, ensure that your workers are actually physically and mentally able to safely perform them. Okay. And like Dr. Hoffman mentioned, a lot of, there's a lot of situations where the job descriptions are either completely out of date or nonexistent. And so even if you stopped at that level, at least you have some sort of understanding of what the job actually entails. And you're going to go to your frontline workers to validate that and make sure that this is actually true. We might have an idea, right? I come from, again, I'm a physician by training. I come from healthcare. And I remember those days where we would be told to do certain things. And it was like, do the people upstairs have any idea what we actually do down here? And I'm sure that that is how a lot of workers feel a lot of the time. And so making sure that you actually understand and validate, there are systematic ways to do this. You can do it by hand, of course, if those are your resources. But there are also systematic ways to do this to ensure that you actually have an accurate description in place. And then earlier I talked to you about the five defining elements of total worker health. And I just wanted to draw some analogies. This is not an exhaustive list. But I just wanted to draw some analogies, again, about what we're looking for when we're talking about total worker health aligned programming. Some people are using total worker health to completely revamp their entire health and safety structure to give them a guiding star, a north star, so to speak. And others are using total worker health principles to address very singular issues, such as musculoskeletal injury or such as psychosocial hazards in the workplace, mental stress, burnout. And then there's people who are doing everything in between. The point is that it is a paradigm. It is a mindset. It's not a checklist. I check one, two, three. I am total worker health. It's not something I can sell you in a box. It's more about conversation, about the way you design your programming and who you bring to the table to make it happen. So in terms of POET, you can think of leadership. It requires your company or your leaders to invest, to invest whether financial or the time required to complete the testing. But it requires leadership to be bought in, to be involved and invested, to signal their commitment, design. Again, job analysis. We're doing job analysis as part of this process. And so it's going to reveal your outdated issues and help you to get to more updated, accurate descriptions of the job, which then also represents an opportunity to maybe redesign the job if it doesn't make sense anymore, right? So you can only fix what you know about. And so that is a huge opportunity, I think, that this protocol or this process presents to people. Engage. Again, as part of the job analysis process, it has to be validated. And they do that literally by going to the people doing the jobs, you know, taking a representative sample and saying, this is what we have identified as essential duties. Does this match what you actually do on a daily basis? Again, this can be done sort of informal, but there are companies that can do this in a formal systematic way as well if you want it to be super objective and be defensible when it comes to legal issues. Confidentiality. I really like this. I, you know, echoing what Dr. Hoffman was talking about, how sometimes workers get sent for pre-employment physicals that don't tell you much of anything. And aren't very related to the functional duties, which is what you really need to know about. So I think it's an excellent way to sort of protect their private medical information and keep it separate from what they're actually trying to do on the job if it literally has no relevance, right? And in addition, you know, you have an opportunity, of course, the PHI can be protected and handled by an external partner, but you're focusing on functionality at the end of the day. And for some folks in the room for some institutions or companies who are actually having a hard time finding workers because they're being unnecessarily disqualified due to other issues, this can maybe broaden your pool because then you might find that, okay, they might have X, Y, Z medically, but that's not relevant when it comes to them actually being able to do the job. And then finally, integrate. This kind of process brings together all your favorite people from the world of safety in your organization, of course, safety, HR, occupational health, and more. And then just to reemphasize more, when we're talking about health and safety, again, total worker health, when you hear it, when you first hear about it, it can seem really overwhelming. It can seem like we're trying to boil the ocean, like you're asking me to do what? I already don't have time. I'm doing the most as it is. And again, sometimes it's about starting where you can and taking that first step. And so for many of you in the room, especially who have a lot of injuries in the workplace or musculoskeletal risk, this can be a nice first step, a nice stepping stone into that world, a low-hanging fruit, especially, again, if safety is an issue, you probably want to start with safety issues first. And so you're going to be promoting workplace safety through safe and appropriate job placement and not putting people in unnecessary harms way, prevent burnout and promote well-being, because as we know from the job demands and resources model, that job demands need to match resources or else you're going to get burnout, okay? And then reducing absenteeism and turnover, pretty self-explanatory. Injured workers have to go out. And supporting employee development as well in relation to, again, job analysis and bringing your employees in to actually validate these things and in the process, if you're finding opportunities to update these roles, there may be employee development opportunities as well in re-skilling and retraining. And then finally, all of this added together stands to enhance overall productivity and organizational wellness. And so with that, I will turn it back over to Dr. Hoffman, who will actually highlight a recently published return on investment case study that was published in the Journal of Occupational and Environmental Medicine this year. Okay. So the purpose of this last section is that I'm heavily focused on analytics. Our field historically has not really focused on analytics, you know, trying to show financial value. The challenge here is that it's not easy to do. And most of what we do, we shouldn't have to have a, to prove a return on investment, because frankly, it's the right thing to do. It's the right value to create a safe workplace. But on the other hand, you work in organizations where everybody wants an ROI. It's almost like a buzz word. And it can be very irritating. On the other hand, I think it does make sense to do some of this. So over the years, my team built an integrated database. I started at waste management, and I brought it into GE, and now the University of Pittsburgh is doing the work with us on looking at the value of the types of things we do in occupational health. So an integrated, this is an integrated database. It's a little complicated in that you can see on the left hand side, you basically put everything that has to do with human capital into the stew pot. All right. And in the old days, which is up until the last couple of years, there were people like me and people smarter than me that would look at this data set and try to figure out where the connections were. Now with AI, it's becoming a little bit easier to find connections, some of which you never would have thought existed. But you throw everything in. It's a person-centric database. And out of it, what you find are some really interesting findings. And some of the findings are quite straightforward. So for instance, with most manufacturing companies, once you reach eight hours of overtime, workers' comp injuries just go like this, okay? Is that fatigue? Is it boredom? I don't know. But you find these associations that exist. In the case of this one, this was an assessment of post-offer employment testing. A post-offer employment test costs about 200-ish dollars, give or take a little bit. And so what we did was we, I was being challenged, this was actually back in my waste management days, to justify the $200 cost. Meanwhile, we have 15,000 injuries and 70 deaths. I mean, it's like anything you could do to reduce that has got to have value. But we basically split the company in half. And half the company, we had about 100,000 employees. And one half, they got the test. The other half, they didn't. And that data set has been refreshed multiple times, including this most recent data set. And what we found was something really interesting. I'm going to jump forward. Oh, here, do the next slide. You know, the one, yeah. So what we found was that workers' compensation costs and injury rates, which are on the left. And by the way, this is a little bit not totally accurate here, in that it says a 22% reduction in workers' comp. Well, it is true. It was a 22% reduction in workers' comp costs. But there was more than a 50% reduction in injury costs, because half of the costs were accidents. And accidents are things that you could argue were preventable. But you have to remove accidents when you look at this data. So when we looked at workers' compensation costs, what we found was it went down about 50% with regards to injuries. That's what we expected. So it paid for itself right then. If you go to the prior slide, the most amazing thing we found was that people who passed the post-offer employment test had a 35% reduction in their group health costs. Now, I don't know how many of you people are involved in group health costs in your company, but group health has been steadily going like this, as we all know. Those costs are being transferred over to, you know, employees disproportionately. And there's almost, there's very little you can do to blunt the trend. Like this year, I think we're looking at 8 to 10% increases. And these are huge amounts of money, well beyond GDP increases, that typically the CFOs and CEOs are focused on giving back to for the next year. I mean, that's like an enormous amount of money. Basically, people who passed the post-offer employment test spent less money in their group health and in their prescription charges. And you could say, well, it's sort of obvious. I mean, they're healthier people, right? And healthier people don't get injured as much. They don't get as sick as much. Plus, you know, it's a greater chance that they won't become injured and have some sort of catastrophic event in their life. So go on to the next slide. Also, lost time costs aside from workers' comp went down dramatically. This was another thing. This was a big deal at Waste Management. We saw a substantial decrease in motor vehicle crash. And motor vehicle crash is a huge problem for a lot of employers that are, you know, putting heavy rigs on the road. And probably because these guys are healthier. You know, they're not getting, you know, they don't have sleep apnea. They don't have various medical problems that are causing them to be impaired. A lot of it is medication related. And then, let's see, what's the next one? Oh, one of the really interesting things was turnover. A lot of employers don't want to do post-office employment testing because they say, well, we need every warm body that we can get. And therefore, we don't want to put any barriers in place. Plus, the recruiters in companies don't connect with what the back door costs are with regards to incidents and comp and whatever. They're paid to get a warm body on the line. And what we found was about a 7% reduction in turnover, which coincidentally, you know, just randomly turns out to be about the number of people who get turned away from a job out of 100 people that go through a post-office employment test, statistically across most businesses, you know, blended rate is about 7%. So there is no negative impact of this because you don't have, you reduce turnover. And the reason I bring all this up, the next slide, is that when you monetize these programs, if you have an integrated database and you can monetize and separate out, remove the confounders for what the value financially is of a program, you find that a lot of things we do are really, really valuable. And they do save money to the company aside from the fact that it's the right thing to do. In this case, you know, you can see that the average averaged out to $3,518 in savings per employee in the first year alone. The cost of the test is $200 plus, you know, whatever other impacts there are to having a healthier work site. And these are the types of analytics that we've been working on in the company to help employers. We have various calculators and various ways to take in these data sets to help employers actually be able to more strategically, objectively analyze what's going on in their workplace to see what the impact of specific programs are. This doesn't have to be post-office employment testing. It could be your wellness programs. It could be whatever, your medical surveillance programs, et cetera. So that's the end of the presentation. We still have six minutes left. I don't know if there's any questions from anybody, but we're happy not only to take questions but to hang around a little bit. So lady in red. Yes. Wait, wait. I think they're recording it, so if you could use the microphone. Oh, yeah. If you could use the mic. Sorry, I didn't see the mics there. Thank you. Hi. Thank you. Excellent presentation. Thanks. I just was, my company is doing, is at the embryonic stages of some of the stuff that you're doing, and one of the things that we're looking at was, I was looking at means to measure, but you mentioned STD and work steps were some of the areas that you mentioned. And I was wondering if you could talk a little bit more about that. Sure. I mean, I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. I think it's a really good question. 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