Presenteeism: Measuring Employee Productivity
Debra Lerner, MS, PhD
Director, Program in Health, Work & Productivity
Senior Scientist, Institute for Clinical Research & Health Policy Studies
Debra Lerner, MS, PhD is a Senior Scientist within the Tufts Medical Center Institute for Clinical Research and Health Policy Studies (ICRHPS), where she directs the Program on Health, Work and Productivity. She is also a Professor within the Departments of Medicine and Psychiatry within the Tufts University School of Medicine and the Sackler School of Biomedical Sciences.
Dr. Lerner is a leader in research concerning the work and productivity impact of health problems. Under her leadership, Dr. Lerner and her colleagues developed the Work Limitations Questionnaire (WLQ). The WLQ is used throughout the world and has become a standard of measurement. WLQ users include employers, insurers, pharmaceutical companies, health and wellness providers and academic researchers. Hundred of thousands of employees complete the WLQ annually as part of routine health assessment and corporate health strategy.
In addition, Dr. Lerner’s program team has developed a new program aimed at preventing productivity loss due to depression. The effectiveness and economic impact of this program is being tested in the United States in multiple companies. Sponsorship for this research has been provided by the National Institute on Aging, the National Institute of Mental Health and the Centers for Disease Control and Prevention.
Dr. Lerner’s program is involved in health and productivity improvement projects with employers and other high profile organizations such as Aetna, Mayo Clinic Health Care Solutions, Ortho-McNeil Janssen and many health and wellness firms.
The process of diagnosing product problems identified during design, manufacture or use brings many challenges. The presentation will discuss ways to alleviate these difficulties using a structured, troubleshooting-based approach, and being aware of some common errors and ways of dealing with them.
• How to analyze data for low frequency failures
• Using the information from RCA for improving both prevention and detection
• Understand why finding a product solution often isn’t enough
The document describes a knowledge management approach called KCT that was developed and implemented within NASA's Exploration Systems Mission Directorate. It discusses the four parts of the KCT approach: start-up, milestone-based, sustaining, and close-out activities. It also provides details on how knowledge is captured and transferred using various methods, including interviews, brainstorming sessions, videos, forums, and documentation. Finally, it outlines how knowledge cafes are an effective technique for innovation, detailing the process, requirements, documentation, and benefits of using knowledge cafes.
The document provides an overview of project management modules and topics, including:
- Module 1 defines a project as a "temporary endeavor undertaken to create a unique product or service."
- Module 2 outlines the nine knowledge areas of project management according to PMI: integration management, scope management, time management, cost management, quality management, human resource management, communications management, risk management, and procurement management.
- Module 3 discusses the triple constraint of project management involving balancing the constraints of time, cost, and quality/scope.
- Modules 4 and 5 cover risk management and project selection methods such as payback period, net present value, weighted and unweighted selection criteria, and forced pair comparisons for priorities
1. Six Sigma is a set of techniques and tools for process improvement. It was introduced by Motorola in 1986 and involves identifying and removing the causes of defects and minimizing variability in manufacturing and business processes.
2. The Six Sigma approach follows the DMAIC model which stands for Define, Measure, Analyze, Improve and Control phases of a project. DFSS or DMADV approach is used for new product or service design.
3. Six Sigma defines different levels of belts that people take on - Champions, Master Black Belts, Black Belts, Green Belts and Yellow Belts to lead Six Sigma projects and implement process improvements.
This document provides an overview of the United Launch Alliance (ULA) transition and the challenges faced by the Launch Services Program in overseeing the transition. It discusses the ULA transition management approach, key projects in the transition like business operations and production, and risk mitigation efforts. Some of the challenges highlighted include managing requirements from multiple sources, the complexity of the transition due to legal, procurement and technical factors, and ensuring skills retention. It concludes with the top 10 risk management lessons learned, emphasizing communication, collaboration, understanding changes, and maintaining focus on NASA's interests and mission success.
In Chuck Norris we trust - A3 thinking introHanno Jarvet
How to get rid of assumptions, egos and opinions and base your change initiatives on data instead. A3 thinking allows you to craft strategies for change and improvement. Here is a short overview of how to do it.
This document provides a checklist for evaluating applications of the output-process-input model and goal specification form. The checklist outlines key elements to define like outputs, inputs, goals, processes, resources and standards. It also provides rules for outlining systems using this model, focusing on defining the final output, identifying input resources and labeling production, distribution and research processes.
The process of diagnosing product problems identified during design, manufacture or use brings many challenges. The presentation will discuss ways to alleviate these difficulties using a structured, troubleshooting-based approach, and being aware of some common errors and ways of dealing with them.
• How to analyze data for low frequency failures
• Using the information from RCA for improving both prevention and detection
• Understand why finding a product solution often isn’t enough
The document describes a knowledge management approach called KCT that was developed and implemented within NASA's Exploration Systems Mission Directorate. It discusses the four parts of the KCT approach: start-up, milestone-based, sustaining, and close-out activities. It also provides details on how knowledge is captured and transferred using various methods, including interviews, brainstorming sessions, videos, forums, and documentation. Finally, it outlines how knowledge cafes are an effective technique for innovation, detailing the process, requirements, documentation, and benefits of using knowledge cafes.
The document provides an overview of project management modules and topics, including:
- Module 1 defines a project as a "temporary endeavor undertaken to create a unique product or service."
- Module 2 outlines the nine knowledge areas of project management according to PMI: integration management, scope management, time management, cost management, quality management, human resource management, communications management, risk management, and procurement management.
- Module 3 discusses the triple constraint of project management involving balancing the constraints of time, cost, and quality/scope.
- Modules 4 and 5 cover risk management and project selection methods such as payback period, net present value, weighted and unweighted selection criteria, and forced pair comparisons for priorities
1. Six Sigma is a set of techniques and tools for process improvement. It was introduced by Motorola in 1986 and involves identifying and removing the causes of defects and minimizing variability in manufacturing and business processes.
2. The Six Sigma approach follows the DMAIC model which stands for Define, Measure, Analyze, Improve and Control phases of a project. DFSS or DMADV approach is used for new product or service design.
3. Six Sigma defines different levels of belts that people take on - Champions, Master Black Belts, Black Belts, Green Belts and Yellow Belts to lead Six Sigma projects and implement process improvements.
This document provides an overview of the United Launch Alliance (ULA) transition and the challenges faced by the Launch Services Program in overseeing the transition. It discusses the ULA transition management approach, key projects in the transition like business operations and production, and risk mitigation efforts. Some of the challenges highlighted include managing requirements from multiple sources, the complexity of the transition due to legal, procurement and technical factors, and ensuring skills retention. It concludes with the top 10 risk management lessons learned, emphasizing communication, collaboration, understanding changes, and maintaining focus on NASA's interests and mission success.
In Chuck Norris we trust - A3 thinking introHanno Jarvet
How to get rid of assumptions, egos and opinions and base your change initiatives on data instead. A3 thinking allows you to craft strategies for change and improvement. Here is a short overview of how to do it.
This document provides a checklist for evaluating applications of the output-process-input model and goal specification form. The checklist outlines key elements to define like outputs, inputs, goals, processes, resources and standards. It also provides rules for outlining systems using this model, focusing on defining the final output, identifying input resources and labeling production, distribution and research processes.
Scaling a Global Support Team - Atlassian Summit 2012Atlassian
The document summarizes Atlassian's experiment using Kanban and GreenHopper to scale their global support team to handle 1,500 requests per week. They trialed the new approach with a team in Kuala Lumpur during a product launch. Key results included reduced response times, lower escalation rates, and engineers feeling less stressed. The approach is being rolled out globally as the new standard process.
The document discusses Agile methodology, an iterative approach to software development that emphasizes continuous improvement and adaptation to change over rigidly following a plan. It outlines the core principles and processes of Agile development, including short sprints, daily stand-up meetings, prioritizing tasks based on product owner feedback, and evaluating progress at the end of each sprint through demonstrations and retrospectives. The document argues that Agile is better suited than traditional waterfall models for software projects where requirements are uncertain and likely to change during development.
The document introduces the Theory of Constraints (TOC), which was developed by Eliyahu Goldratt. TOC defines that only a few factors govern the overall performance of a complex system. It explains inherent simplicity using examples of organizations and production systems. Running simulations of production systems, it is shown that dependencies and variability determine flow, work-in-progress determines lead time, and following TOC's five focusing steps leads to ongoing improvement. The five steps are identified as: 1) identify the constraint, 2) exploit the constraint, 3) subordinate everything else to the above decisions, 4) elevate the constraint, and 5) return to step 1. Common problems in service organizations are discussed and mapped to speculated causes
Agile Innovation - Product Management in Turbulent timesVasco Duarte
In today’s world we are constantly confronted with the message that the competition is breeding down our necks, that the market and environment are changing and we need to change with them. And most importantly, we are told that we need to listen to our customers to be able to provide the right products.
We as a Product Managers need to be able to see beyond the basic product decisions, e.g. do we add feature A or feature B? We need to think beyond the silo of our function.
This document discusses heuristic evaluation, a discount usability testing technique developed by Jacob Nielsen. Heuristic evaluation involves having a small group of 3-5 evaluators independently examine a user interface and identify any usability issues based on 10 design heuristics. Evaluators then aggregate their findings and assign severity ratings to identify the most critical problems. Heuristic evaluation is less costly than other usability testing methods but can still find several usability issues. The document outlines the phases of heuristic evaluation and describes the 10 design heuristics that evaluators use to examine a user interface, such as providing feedback on system status, using familiar language and metaphors, and enabling user control and freedom of use.
EuroSTAR Software Testing Conference 2009 presentation on Spend Wisely, Test Well by John fodeh. See more at conferences.eurostarsoftwaretesting.com/past-presentations/
Agile adoption tales from the coalfaceNish Mahanty
This talk discusses how to fail with an Agile change transformation, and lays out some practical tips for successfully adopting agile software delivery processes within your organisation. Presented at Telstra, Superpartners, and several Meetups.
This document provides an overview of fundamentals of testing, including:
1. It discusses why testing is necessary due to the likelihood of faults in software and the potential harms and costs of failures.
2. Key terms related to defects are defined, including the differences between errors, faults, bugs, failures, and mistakes.
3. Testing principles are outlined, such as the impossibility of exhaustive testing, the need to prioritize based on risk, and the fact that testing can only find defects but not prove their absence.
4. Factors related to quality, reliability, and debugging are addressed in the context of testing.
Program evaluation is a component of program design and implementation that is often considered after the program is in place and serving a population. Designing a program with measurable goals in mind creates stronger programming, gives grant proposals a competitive edge, and provides an agency with useful feedback to help achieve its mission. Most importantly, program evaluation allows for program tweaking to deliver the best service possible to the client.
- The document discusses the use and benefits of earned value management (EVM) for project management.
- EVM provides an early warning system to identify potential cost overruns or delays before they become problems. It helps determine a project's true health and likelihood of completing on time and on budget.
- Without EVM, it can be difficult to assess a project's status based solely on budget versus actual costs or a project being ahead or behind schedule. EVM provides a more comprehensive view of project performance.
From defect reporting to defect preventionBestBrains
The document discusses moving from a defect reporting approach in software testing to a defect prevention approach using lean principles. It notes that preventing defects from the beginning is more effective than finding faults later. The document encourages exploring testing earlier in the process, understanding the root causes of defects, and prioritizing removing those causes over manual regression testing. The overall message is that building quality into the software from the start leads to higher profitability than relying on later fault detection and fixing.
The 3-day Lean Practitioner Program Level 1 focuses on introducing lean principles and tools for office, administration and service processes. The agenda covers lean evolution, value definition, identifying waste, value stream mapping, flow, flexibility and perfection. Participants will learn through simulations, exercises and case studies. They will understand lean principles, be able to diagnose processes and identify improvement projects. Successful participants will receive a Lean Practitioner Level 1 certificate. The goal is to help organizations enhance productivity, quality and reduce costs through lean transformations.
Agile estimation and planning focuses on iterative development with short planning cycles. Teams work together in short iterations to deliver working software. Planning occurs through story mapping and estimation rather than detailed Gantt charts. Constant inspection and adaptation allows teams to respond to changes rather than rigidly following a predefined plan. Traditional waterfall planning fails because it relies on overly optimistic estimates far into the future and does not adapt to new information learned.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Evaluating impact of humanitarian action: a science or an art (Jo Puri, 3iE)ALNAP
This document discusses impact evaluations in humanitarian assistance. It notes that humanitarian interventions are complex to evaluate due to factors like selection bias, fragile states, concurrent interventions, and lack of baseline data. Some key points made include:
- Impact evaluations are needed to understand what works in humanitarian assistance and improve accountability.
- Methodologies must account for heterogeneity among affected populations and emergencies.
- The Pakistan 2005 earthquake response provides an example where impact evaluations could have better informed recovery efforts.
- Collecting baseline data immediately after emergencies and designing interventions for staged rollouts can help establish stronger counterfactuals for impact evaluations.
1. Software quality management models can help set defect removal targets and guide quality improvement strategies.
2. The Rayleigh model illustrates how earlier and lower defect removal can be achieved by reducing the error injection rate and increasing front-end defect removal.
3. Tracking actual defect removal against the model targets does not clearly indicate whether variance is due to differences in error injection rates or review/inspection effectiveness, so additional indicators are needed for proper interpretation.
The document provides an overview of Kanban and how it can be used to improve processes and outcomes. Some key points:
- Kanban is a method to enable evolutionary change, help implement Agile at scale, and establish a culture of ongoing improvement.
- It is based on Lean principles like limiting work-in-progress to improve flow and pull-based systems to pace work based on demand rather than estimates.
- A Kanban board is used to visualize work with limits on work-in-progress for each stage to highlight bottlenecks and encourage swarming to flow of work.
- Metrics like lead time, wait time and blocks are measured to manage flow and continue improving the process over time
PROBLEMS ARE THE GOLDEN EGGS
problems??? day by day in our proffessional life we faces so many problems, but didn't recognize about the problem. Because we are habituate to facing to problems, if we want to solve the problems, first we can feel YES am facing a problem then you have a chance to solve it... after that we should find is it REPEATATIVE problem or New problem, on the bases of the issue we can take further steps, how to break it. how to analyse, how to find countermeasure, how to check is it suitable or not, how to make standard.... if you want to know gothrough my presentations..
This is my first presentation posted in Slideshare
The Worksite Wellness Council of Massachusetts (WWCMA) presented our 2016 WorkWell MA Award Winners with their plaques at the Annual Conference during an awards ceremony.
More Related Content
Similar to Debra Lerner's Presentation at the WWCMA April Meeting
Scaling a Global Support Team - Atlassian Summit 2012Atlassian
The document summarizes Atlassian's experiment using Kanban and GreenHopper to scale their global support team to handle 1,500 requests per week. They trialed the new approach with a team in Kuala Lumpur during a product launch. Key results included reduced response times, lower escalation rates, and engineers feeling less stressed. The approach is being rolled out globally as the new standard process.
The document discusses Agile methodology, an iterative approach to software development that emphasizes continuous improvement and adaptation to change over rigidly following a plan. It outlines the core principles and processes of Agile development, including short sprints, daily stand-up meetings, prioritizing tasks based on product owner feedback, and evaluating progress at the end of each sprint through demonstrations and retrospectives. The document argues that Agile is better suited than traditional waterfall models for software projects where requirements are uncertain and likely to change during development.
The document introduces the Theory of Constraints (TOC), which was developed by Eliyahu Goldratt. TOC defines that only a few factors govern the overall performance of a complex system. It explains inherent simplicity using examples of organizations and production systems. Running simulations of production systems, it is shown that dependencies and variability determine flow, work-in-progress determines lead time, and following TOC's five focusing steps leads to ongoing improvement. The five steps are identified as: 1) identify the constraint, 2) exploit the constraint, 3) subordinate everything else to the above decisions, 4) elevate the constraint, and 5) return to step 1. Common problems in service organizations are discussed and mapped to speculated causes
Agile Innovation - Product Management in Turbulent timesVasco Duarte
In today’s world we are constantly confronted with the message that the competition is breeding down our necks, that the market and environment are changing and we need to change with them. And most importantly, we are told that we need to listen to our customers to be able to provide the right products.
We as a Product Managers need to be able to see beyond the basic product decisions, e.g. do we add feature A or feature B? We need to think beyond the silo of our function.
This document discusses heuristic evaluation, a discount usability testing technique developed by Jacob Nielsen. Heuristic evaluation involves having a small group of 3-5 evaluators independently examine a user interface and identify any usability issues based on 10 design heuristics. Evaluators then aggregate their findings and assign severity ratings to identify the most critical problems. Heuristic evaluation is less costly than other usability testing methods but can still find several usability issues. The document outlines the phases of heuristic evaluation and describes the 10 design heuristics that evaluators use to examine a user interface, such as providing feedback on system status, using familiar language and metaphors, and enabling user control and freedom of use.
EuroSTAR Software Testing Conference 2009 presentation on Spend Wisely, Test Well by John fodeh. See more at conferences.eurostarsoftwaretesting.com/past-presentations/
Agile adoption tales from the coalfaceNish Mahanty
This talk discusses how to fail with an Agile change transformation, and lays out some practical tips for successfully adopting agile software delivery processes within your organisation. Presented at Telstra, Superpartners, and several Meetups.
This document provides an overview of fundamentals of testing, including:
1. It discusses why testing is necessary due to the likelihood of faults in software and the potential harms and costs of failures.
2. Key terms related to defects are defined, including the differences between errors, faults, bugs, failures, and mistakes.
3. Testing principles are outlined, such as the impossibility of exhaustive testing, the need to prioritize based on risk, and the fact that testing can only find defects but not prove their absence.
4. Factors related to quality, reliability, and debugging are addressed in the context of testing.
Program evaluation is a component of program design and implementation that is often considered after the program is in place and serving a population. Designing a program with measurable goals in mind creates stronger programming, gives grant proposals a competitive edge, and provides an agency with useful feedback to help achieve its mission. Most importantly, program evaluation allows for program tweaking to deliver the best service possible to the client.
- The document discusses the use and benefits of earned value management (EVM) for project management.
- EVM provides an early warning system to identify potential cost overruns or delays before they become problems. It helps determine a project's true health and likelihood of completing on time and on budget.
- Without EVM, it can be difficult to assess a project's status based solely on budget versus actual costs or a project being ahead or behind schedule. EVM provides a more comprehensive view of project performance.
From defect reporting to defect preventionBestBrains
The document discusses moving from a defect reporting approach in software testing to a defect prevention approach using lean principles. It notes that preventing defects from the beginning is more effective than finding faults later. The document encourages exploring testing earlier in the process, understanding the root causes of defects, and prioritizing removing those causes over manual regression testing. The overall message is that building quality into the software from the start leads to higher profitability than relying on later fault detection and fixing.
The 3-day Lean Practitioner Program Level 1 focuses on introducing lean principles and tools for office, administration and service processes. The agenda covers lean evolution, value definition, identifying waste, value stream mapping, flow, flexibility and perfection. Participants will learn through simulations, exercises and case studies. They will understand lean principles, be able to diagnose processes and identify improvement projects. Successful participants will receive a Lean Practitioner Level 1 certificate. The goal is to help organizations enhance productivity, quality and reduce costs through lean transformations.
Agile estimation and planning focuses on iterative development with short planning cycles. Teams work together in short iterations to deliver working software. Planning occurs through story mapping and estimation rather than detailed Gantt charts. Constant inspection and adaptation allows teams to respond to changes rather than rigidly following a predefined plan. Traditional waterfall planning fails because it relies on overly optimistic estimates far into the future and does not adapt to new information learned.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Evaluating impact of humanitarian action: a science or an art (Jo Puri, 3iE)ALNAP
This document discusses impact evaluations in humanitarian assistance. It notes that humanitarian interventions are complex to evaluate due to factors like selection bias, fragile states, concurrent interventions, and lack of baseline data. Some key points made include:
- Impact evaluations are needed to understand what works in humanitarian assistance and improve accountability.
- Methodologies must account for heterogeneity among affected populations and emergencies.
- The Pakistan 2005 earthquake response provides an example where impact evaluations could have better informed recovery efforts.
- Collecting baseline data immediately after emergencies and designing interventions for staged rollouts can help establish stronger counterfactuals for impact evaluations.
1. Software quality management models can help set defect removal targets and guide quality improvement strategies.
2. The Rayleigh model illustrates how earlier and lower defect removal can be achieved by reducing the error injection rate and increasing front-end defect removal.
3. Tracking actual defect removal against the model targets does not clearly indicate whether variance is due to differences in error injection rates or review/inspection effectiveness, so additional indicators are needed for proper interpretation.
The document provides an overview of Kanban and how it can be used to improve processes and outcomes. Some key points:
- Kanban is a method to enable evolutionary change, help implement Agile at scale, and establish a culture of ongoing improvement.
- It is based on Lean principles like limiting work-in-progress to improve flow and pull-based systems to pace work based on demand rather than estimates.
- A Kanban board is used to visualize work with limits on work-in-progress for each stage to highlight bottlenecks and encourage swarming to flow of work.
- Metrics like lead time, wait time and blocks are measured to manage flow and continue improving the process over time
PROBLEMS ARE THE GOLDEN EGGS
problems??? day by day in our proffessional life we faces so many problems, but didn't recognize about the problem. Because we are habituate to facing to problems, if we want to solve the problems, first we can feel YES am facing a problem then you have a chance to solve it... after that we should find is it REPEATATIVE problem or New problem, on the bases of the issue we can take further steps, how to break it. how to analyse, how to find countermeasure, how to check is it suitable or not, how to make standard.... if you want to know gothrough my presentations..
This is my first presentation posted in Slideshare
Similar to Debra Lerner's Presentation at the WWCMA April Meeting (20)
The Worksite Wellness Council of Massachusetts (WWCMA) presented our 2016 WorkWell MA Award Winners with their plaques at the Annual Conference during an awards ceremony.
The 2016 WWCMA 5th Annual Conference - Shifting the Focus to Employee Well-being was a huge success with enriching educational sessions, networking opportunities and great vendors on a beautiful fall New England day.
WWCMA WorkWell Massachusetts 2015 Award Winners. The inaugural award program for the Worksite Wellness Council of Massachusetts. Winners include Berkshire Health Systems, Web Industries, athenahealth, Borislow Insurance, Cambridge Health Alliance, Celldex Therapeutics, Injured Workers Pharmacy (IWP), OMAM, Trip Advisor, A.I.M Mutual Insurance Companies, Babson College, Endurance International Group, Kronos, Incorporated. The 2016 program will open in April 2016.
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The document summarizes the agenda and history of the Worksite Wellness Council of Massachusetts (WWCMA). It discusses the council's vision, mission, goals, organizational structure, and history since its founding in 2009. Key events from 2013 are highlighted, including growth in membership, sponsorships, and its annual conference. The council's plans for 2014 include new board members, a redesigned website, educational programs, WellCert certification training, and its annual conference in September.
The document summarizes the agenda and history of the Worksite Wellness Council of Massachusetts (WWCMA). It discusses the council's vision, mission, goals, organizational structure, and history since its founding in 2009. Key events from 2013 are highlighted, including growth in membership, sponsorships, and its annual conference. The council's plans for 2014 include new board members, a redesigned website, educational programs, WellCert certification training, and its annual conference in September.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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1. Advancing the Evidence Base for Health and Productivity
Improvement: The Work Limitations Questionnaire
The Tufts Program in Health, Work and Productivity
Institute for Clinical Research and Health Policy Studies
Tufts Medical Center
Debra Lerner, MS, PhD
2. Today’s Topics
• Health and Productivity (H&P) Improvement as a Strategy
• Tools for H&P Improvement
• An H&P Improvement Intervention for Depression
3. H & P Improvement
Generally refers to strategies undertaken to prevent,
reduce or otherwise manage the adverse effects of a
population’s health problems on its work performance and
productivity.
4. Health and Productivity Improvement
Contributes to Value
Health and Productivity Improvement Contributes to Value
5. Why Focus on Productivity?
The Value Perspective
(Adapted from Peter Neumann, ScD, Medical Center, 2007)
Impact on cost
Cost-saving Cost-Neutral Cost-Increasing
Depends on
Higher Adopt Adopt
Willingness
Effectiveness (big winner) (winner)
To Pay
Impact on
outcome Similar Adopt Other factors may
Do not adopt (loser)
Effectiveness (winner) decide
Depends on
Lower Do not adopt (big
Willingness Do not adopt (loser)
Effectiveness loser)
To Pay
8. The US Food and Drug Administration Guidelines
Patient-Reported Outcome Measure Development Process
Cultural & Language Identify Concept & Establish
Adaptations Conceptual Framework
• Cultural adaptation • Intended population
• Linguistic validation • Intended application
• Psychometric validation • Concepts & domains measured
• How concepts relate to other
endpoints
Modify Instrument
• Concepts measured
• Population studied Develop Instrument
• Instrumentation • Item generation
• Application • Choice of response option
• Administration • Recall period
• Item reduction
• Scoring
• Relationship among concepts, items, domains
Assess • Instructions and format
• Respondent and administrative burden
Measurement Properties
• Reliability
• Validity
• Ability to detect change
• Minimum important difference
9. The Work Limitations Questionnaire (WLQ)
• Presenteeism measured in 25 or 8-item versions
• Questions cover 4 domains of work: time, physical,
mental-interpersonal, and output demands
• Scale scores range from 0 (Limited None of the Time)
to 100 (Limited All of the Time)
• Validated
• Available in multiple versions (mail, phone, web) and
40+ languages
• WLQ Absenteeism module available
10. The Work Limitations Questionnaire (WLQ)
Sample from 25 Q Version: Time Management Scale
In the past 2 weeks, how much of the time did your physical health or emotional problems
make it difficult for you to do the following?
(Mark one box on each line a. through e.)
All of Most of Some of A Slight None of Does
the Time the Time the Time Bit of the Time Not
(100%) (About the Time (0%) Apply to
50%) My Job
a. work the required number of
1 2 3 4 5 0
hours . . . . . . . . . . . . . . . .
b. get going easily at the
beginning of the 1 2 3 4 5 0
workday . . . . . . . . . . . . . .
c. start on your job as soon as
1 2 3 4 5 0
you arrived at work . . . . .
d. do your work without
stopping to take breaks or 1 2 3 4 5 0
rests . . . . . . . . . . . . . . . . .
e. stick to a routine or
1 2 3 4 5 0
schedule . . . . . . . . . . . . . .
Note: For permission to use the WLQ, contact WLQ@tuftmedicalcenter.org
11. The Work Limitations Questionnaire (WLQ)
Sample from 25 Q Version: Output Scale
In the past 2 weeks, how much of the time did your physical health or emotional
problems make it difficult for you to do the following?
(Mark one box on each line a. through e.)
All of Most of Some of the A Slight None of Does
the the Time Time (About Bit of the Time Not
Time 50%) the Time (0%) Apply to
(100%) My Job
a. handle the workload . 1 2 3 4 5 0
b. work fast enough . . . 1 2 3 4 5 0
c. finish work on time . . 1 2 3 4 5 0
d. do your work without
1 2 3 4 5 0
making mistakes. . . .
e. feel you’ve done what
1 2 3 4 5 0
you are capable of
doing. . . .
Note: For permission to use the WLQ, contact WLQ@tuftsmedicalcenter.org
12. How the WLQ is Used
• Employee health assessment
• Employer health improvement initiatives
• Clinical trials within the pharmaceutical industry
• Services research
13. Levels of WLQ Data
Summary Score Job Level Task Level
% Productivity Lost % Time with % Time with
Compared to Impaired Job Impaired Task
Benchmark Performance Performance
Time Physical Mental- Output 25 Items
Management Demands Interpersonal Demands
Demands
14. How is Presenteeism Impacting the Company?
Cathy Baase MD, Dow Chemical
Employee Medical (US)
14%
Global Presenteeism
Retiree Medical (US)
48%
19%
Other Admin
13%
Global Absenteeism
6%
15. The Impact of Different Medical Conditions on
Presenteeism at Bank One
Arthritis**
Back Pain**
Odds of Work Performance Limitation
3.0 Depression**
Diabetes*
Heart disease
2.5 Heartburn**
Irritable Bowel*
2.0
1.5
1.0
0.5
0.0
time>0 physical>0 mental>0 output>0
WLQ
Source: Burton et al., JOEM, 2004; 46 (6 Suppl): S38-S45
16. Burden of Pain on Performance at Work:
Difficulty in Meeting Job Demands
60
50
Type of Work Demand
Type of Work Demand
Extent of Limitation
Extent of Limitation
40
Time
(0-100)
(0-100)
30 Physical
Mental / Interpers
20
Output
10
0
Healthy Low Moderate High The Harris Allen Group
Pain Severity
Pain Severity
17. Making the Case for Change With the WLQ:
Impact of Chronic Conditions
% Per Person
Productivity Productivity
N (%) Loss TypeCost ($) Demand
of Work
Total Number of
Chronic Conditions
0 7037 (53.1) 1.2 1446
1 3184 (24.0) 1.5 1792
2 1647 (12.4) 1.9 2240
3 734 (5.5) 2.5 3020
4 349 (2.6) 3.0 3597
5+ 312 (2.4) 4.2 5044
Pain Severity
18. Making the Case for Change With the WLQ: Impact
of Risk Factors
Health Risk Factor Summary Profile - Means
WLQ Scale Scores
Mental-
Time Interpers
Manage Physical onal Output Per Person
N (%) ment Tasks Tasks Tasks % Productivity Loss Productivity Cost ($)
Total Risks
0 160 (1.2) 1.7 4.1 2.5 1.4 0.6 616
1 601 (4.5) 3.4 5.4 3.7 2.4 1.0 963
2 1573 (11.9) 3.7 6.0 3.8 2.5 1.0 1,018
3 2738 (20.6) 4.5 6.9 5.0 3.5 1.3 1,307
4 2853 (21.5) 6.3 7.6 5.7 4.8 1.6 1,619
5 2469 (18.6) 6.8 8.3 6.6 4.9 1.8 1,762
6 1619 (12.2) 8.8 8.6 7.7 6.3 2.1 2,116
7 840 (6.3) 10.2 9.7 8.8 6.9 2.4 2,386
8+ 410 (3.1) 12.3 9.8 10.1 8.4 2.8 2,764
19. Depression Viewed Through the H & P Improvement Lens
• Common chronic illness adversely effects how people
think, feel and behave
• Attacks motivation, self-confidence, energy, thought
processes and social skills many of which are essential
to good work performance
• Working-age adults with depression experience high
rates of job loss, turnover, premature retirement,
disability, absences and at-work performance deficits
with productivity losses in the billions of dollars annually
20. The Work Burden of Depression
• Between 10-20% of the population stricken at least once
during lifetime
• One of the top 5 leading sources of health-related
productivity loss
• The average depressed worker misses from 0.5-4
workdays per month
• The average depressed worker is limited in his or her
ability to work 35% of the time
21. What is Behind the Staggering Work and
Productivity Impact?
• Variability in treatment efficacy and effectiveness
• Persistent barriers to obtaining high quality
screening, diagnosis and treatment
• Limits of the biomedical approach for reducing
disability and productivity loss
• Slow progress in engaging key stakeholders
(employees, employers and healthcare
professionals) in solving the problem
22. The Health & Work Study 2000-2004
Depression’s Burden Persists
25.0
PHQ-9 Depression Severity
Depression
20.0 Groups:
MDD
Double
15.0
Dysthymia
All Depression
10.0 Control Group
RA Group
5.0
0.0
Baseline 6 Month 12 Month 18 Month
Months from Baseline
Source: Depression and Productive Work Activity Study, D. Lerner, Principal Investigator,
23. The Health & Work Study 2000-2004
The Work Productivity Gap
20
WLQ: Percentage Productivity Lost
18
16
Employees with Depression:
14
12 Improved or Remitted n=47
Same n=176
10
Worse n=63
8 Healthy Employee Controls n=193
6
4
2
0
Baseline 6 Months 12 Months 18 Months
Months after Baseline
Source: Depression and Productive Work Activity Study, D. Lerner, Principal Investigator, 2004.
24. The Health & Work Initiative (WHI)
A New Workplace Intervention
• Opportunity to detect depression in a community setting
• Uses an existing resource: Employee Assistance Program
(EAP)
• May encourage employer investment by demonstrating
“return on investment” (ROI)
25. The Work and Health Initiative (WHI)
Aeronautics Manufacturer and State Government Pilot Tests
• Web-Based Employee Health Screening with Feedback
• Depressed and Work-Impaired Employees Enrolled in
16-Week WHI Program
• Care Provided by EAP Counselors On the Phone
• Three Care Components
• Medical Care Coordination
• Self-Help using Cognitive Behavioral Therapy Strategies
• Work Coaching
(Lerner, Adler, Rogers and Hermann, 2004-7)
26. Pre-Intervention Presenteeism and Absenteeism
WHI Treatment and Usual Care Groups:
State Government RCT
100
90
Usual Care
80 WHI Group
70
Baseline Score
60
50 45.6
43.7
38.5 37.3 39.1 40.7
40
31.2
30 26.6
23.3
18.3
20
10.1 10.3
10
0
Time Physical Tasks Mental- Output Tasks Productivity Productivity
Management Interpersonal Lost Lost
Tasks (Presenteeism) (Absenteeism)
WLQ Scales, Productivity Lost and Absenteeism*
* No significant differences between groups on any baseline score
27. Percent of Post-Intervention Change from Baseline:
State Government RCT
100
80
60 46.8 47.1 42.8
39.7 41.2
31.6 34.9 34.0
40
Percent Change
20 10.9
2.1 4.2 3.0
0
-2.6 -4.9
-20
-40
-60
-80
-75.6
-100
-100.0
-120
Time Physical Tasks Mental- Output Tasks Productivity Lost Days Missed Absenteeism Depression
Management Interpersonal Severity
Tasks
Outcome Criteria
28. Summary of Results
• The WHI was superior to Usual Care on every metric
• The WHI resulted in an average reduction in at-work
productivity cost of $3,500 per employee vs. $300 per
employee in Usual Care
• The WHI resulted in an average 50% improvement
(reduction) in absences per employee vs. an average
100% increase in absences per employee in Usual Care