By Ted R. Borgstadt
I recently had the honor of presenting at the 2022 National Association of Occupational Health Professionals (NAOHP) National Symposium in Charleston, SC. The title of my presentation was “Bridging Occupational Health and Population Health.” Everyone in the audience represented occupational health, while I represented population health. Bridging the two groups is not a hard concept to grasp. For example, if you are performing a DOT exam and the driver smokes 2 packs a day, a bridge would be you giving the driver the phone number of the health plan’s tobacco cessation program. If the driver has high blood pressure, you could tell them that their health plan offers health coaching. If a patient is obese, you could offer a brochure for a weight loss program.
If giving the right information to the right person at the right time constitutes a successful bridge being built, then absolutely, a job well done! The task is completed, the employee returns to work with clarity, and the occupational health professional pivots to the next exam room. Connection made. Easy. Done. Bridge built.
What I realized was the “bridge” between occupational health and population health seemed less like the Golden Gate and more like a rickety rope-swinging bridge over a 2,000-foot gorge, as you would see in a movie. The bridge metaphor may not be as robust as I had initially thought. My presentation title didn’t capture the full potential of the occupational health provider’s opportunity to influence and drive extraordinary engagement into effective population health programs for every at-risk employee they encounter. I realized I needed to change the title of my talk.
My youngest son, Cole, is a storyteller and filmmaker. During Covid, Cole created a healthy cooking video series for one of his clients that he called, “The Kitchen Table Series.” I love the imagery from Cole when he discusses the project.
- “Eating should be delightful.”
- “The goal is to bring joy and ease to home cooking.”
- “An excited kitchen is a great tool to bring the family together.”
- “The kitchen table is where friends and family engage, and relationships thrive.”
I liked Cole’s imagery of the kitchen table, “where you engage and relationships thrive.” Cole included a “front porch” element of his series. Cole saw the front porch as a place for casual conversation and connection with friends and family. The front porch…. a place to casually connect, and the kitchen table…. a place to engage deeply. A nice articulation of the differences between connecting and engaging. I found my revised presentation title, “Front Porch, Kitchen Table.”
When I think of a front porch, I envision a place where friends drop by, sit for a while to catch up, and then go on their way Just because someone comes up on the front porch, it doesn’t mean they are thinking about stepping inside the front door and into the house, or expecting that they will be asked to come inside.
It is not hard for me to imagine that the occupational health providers are on the front porch waiting for an employee to walk up onto the porch to connect and receive the required occupational health exam, test, or service. During the time on the porch, the occupational health provider gives efficient, competent, evidence-based medicine guideline-aligned care in a professional and caring manner. When the services are complete, the employee leaves the porch and is on their way. If the focus on this porch visit is solely on the occupational health services being delivered, then a golden opportunity to engage the patient more wholistically is missed. The patient is in front of you and is connected with you and most have additional health issues that need attention inside the house. It doesn’t have to stop here.
If the employee leaves the porch without an invitation or chance to enter the house, then their opportunity to take a seat at the kitchen table and to engage deeper in their own health is also lost. Approximately 18% of all healthcare services are classified as Occupational Health services that are performed on the front porch, while 82% of the healthcare services (and spend) are from the medical and population health side that is done inside the house, around the kitchen table.
Occupational Health has an extraordinary opportunity to engage more deeply when someone is on your porch. The power of presence is not to be taken for granted. For some of your patients, you may be the only health professional with whom they connect, even though they have comorbidities that need attention and care, such as diabetes, cancer, obesity, stress, depression, or hypertension. The patient is in front of you.
