December 18, 1998

By Rodrigo Muñoz, M.D.
APA President

"Business Driven" has come to represent two completely different and totally opposite ways of looking at the same events.

When People Are Not Assets

"Business Driven" is now an often used expression to represent "financially correct" or "mindful use of resources."

This was the case at a facility for chronic psychiatric patients that I visited recently. The contracting corporation had "business-driven" practices: group therapy and other activities were scheduled to the maximum extent allowed by the Medicare intermediary, busy clerks documented every therapeutic minute, and every penny that could be billed was lodged in the books. The plan permitted patients to be paraded through the mill with little psychiatric supervision. The "business-driven" plan was a gate to administrative and financial bliss, minimally encumbered by individual diagnostic and therapeutic considerations.

"Business-driven" plans are also used to remove psychiatric coverage from "health" plans when reimbursement is not adequate.

When People Are Assets

"Business-driven" programs as proposed by the Homewood Centre for Organizational Health in Guelph, Ontario, create and promote activities leading to protect the primary asset of the business community: human capital.

In the still prevailing but increasingly obsolete view in the United States, employees are regarded as a cost, not an investment. In actuality this may have ceased to be true in 1991, when the $107 billion spent for production technology dropped below the $112 billion spent for information technology. Such a development has given impetus to the movement toward viewing human assets as the main capital in the new industrial world. Knowledge-intensive companies now account for 28 percent of total U.S. employment and in the last five years generated 43 percent of new positions. When these companies have gone public, their worth has not been evaluated on the basis of physical assets but on human assets, which are often estimated often in the billions of dollars. A person who invests $100 in Microsoft buys fixed assets worth little more than one dollar.

Mary Jane England, M.D., president of the Washington Business Group on Health and a former APA president, has stimulated research suggesting that the strongest predictors of days lost to disability, absenteeism for minor illness, and on-the-job accidents are psychosocial. As stated by Maria Gonzalez, vice president of Strategic Initiatives at the Bank of Montreal, "people initiatives" will prepare the business community for the 21st century, because only a healthy organization-one that cares for its human capital-can be profitable.

Some of us see these developments as presenting an opportunity to develop a new relationship with business leaders: If they see employees as assets and not as costs, we can help them increase the value of their human assets and thus their profitability. Even if only the two psychiatric disorders of depression and chemical dependence were targeted for early detection and effective treatment in the workplace, the positive financial results for business would speak for themselves.

The Canadian Business and Economic Roundtable on Mental Health is rapidly developing plans for "business-driven" mental health programs. Bill Wilkerson and Tim Price, business leaders in Canada, have joined psychiatrist Edgardo Pérez, M.D., chief executive officer and medical chief of staff of the Homewood Health Centre and consultant to the APA Committee on Occupational Psychiatry, to launch multiple initiatives. We will welcome them with Len Sperry, a recognized leader on psychiatry in the workplace and chair of the APA Committee on Occupational Psychiatry, at a meeting with business leaders in Chicago in March 1999.