What Have We Learned? What Next? - Panel Discussion, Medical Directors with Audience Participation, April 28, 2000

Vincent Kerr, MD, Medical Director, Health Care Plans, General Electric Company

DR. KERR: Well, so much has been said, I think it would be difficult to talk without reiterating many of the lessons I've learned. But the thought that strikes me first is something I believe Gertrude Stein said: "A rose is a rose is a rose." Were she here, I think she would say: "A traveler is not a traveler is not a traveler."

And what I think I learned from this symposium on the very first day, as I listened to the research the World Bank presented, was: What is it with our people? Are they from another planet? Are they in a different demographic? Or are we missing something? Because they don't sound like the people described on the surveys that we heard at the beginning of the meeting.

I think, as I listened further, what I learned was that at one level we all share many of the same risks in terms of the environments we encounter when we travel, in terms of the physiologic stressors that we experience and the emotional stressors we feel. Those things present to us in very much the same way. But the risk may vary by destination, by length of trip, by frequency of travel, and individual responses vary. Physiologically, we saw we're not equal; emotionally, very different; and in our values and what we define as work-life balance, we differ greatly.

I know that because if you ask the CEO, or at the executive level of my organization, or anyone running one of the businesses what they think of as work-life balance, it will be very different from what someone else in the organization may think. And that needs to be taken into account as we think about remedies. Also, the context differs. Corporate cultures differ. The level of support given by the corporation or the organization differs. And the degree of choice differs. And those things all add up to an impact.

So what does this mean? I think as we go forward what I would love to see is research that is more finely tuned to getting the kinds of answers we need, and that we need to remember two things: that findings or physiologic effects do not equal disease, and that we must measure what people do, not just what they say. By that I mean, in our organization every year our CEO, Jack Welch, takes a survey of employees. It's a statistically valid sample, and he surveys all of the top people down to a certain level, as well as a sample of others. He asks a number of questions, 60 or 70 questions. He wants to know how the organization is working, and he wants to know what the gripes are and what things get in the way, what things irritate us.

But at the end of that survey, there are two questions that are really important, and they are: Overall, are you better off because of your employment with this company? And, overall, are you more satisfied with your life and your career as a result of working here?

You can do a multiple regression analysis and decide if all the things that were listed as negatives really correlate to negatives on any of those two questions, and amazingly, they most often don't. I think it's self-selection. People chose to be part of an organization for many reasons, but if they stay and excel, it is match in many other ways.

So as we look at research, I think we need to link the findings, the effects, to outcomes. The fact that you report stress and that it's at a high level or that 90 or 70 or 60 percent of the organization reports it, is there actually an increase in absence, for example? Is there, in fact, more turnover, less loyalty to the corporation or to the organization? Is there a decrease or a change in productivity as a result? Is there a measurable social impact?

I think these are important outcomes to understand and the questions we ask have to be tailored, and not lump travelers as one monolithic mass, but seek to understand them in terms of their variable risks and the uniqueness of the populations, so that whatever cure we're able to define actually fits the disease

That was my take-away from the meeting.

[APPLAUSE]

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