Located 25 miles southeast of Indianapolis in Shelbyville, one clinic decided not to become a pulley between the employer and the employee. The dedicated staff of the Major Affiliates Inc., HealthWorks wanted to establish themselves as a strictly medical concern. It was no easy task in the employer-directed state of Indiana.

During a telephone interview with the Tracker, Ms. Inez Dailey of HealthWorks said, "We are here to provide medical care and not employer leverage over employee. And it is not easy to achieve that."

What Ms. Dailey is referring to is a classic dilemma faced by the Occuptional Health industry. The companies expect the clinics to be accountable to them while the clinics struggle to establish themselves as ethical and legitimate medical institutions – ones that remain unbiased in the continuing drama of employer versus employee.

According to Ms. Dailey, the problem often rests with the perceptions of the companies. They often view the doctors in the Occupational Health arena to be "company doctors" and truant officers managing employee behavior. The issue is amplified in an employer-directed state, like Indiana, where the employers actively select the clinics which provide services to their employees. Naturally, any company would want to choose a clinic which seems to be more sympathetic to the company’s agenda.

Ms. Dailey feels that the companies want the clinics to see things their way. Sharing some of her experiences while managing the clinic, Ms. Dailey said, "We’ve had occasions when case managers call up and say that such and such person was seen at Wal-Mart even though he is on work restriction."

"Well, if we see a medical problem, we treat it. If a company feels that an employee is faking it (injury/illness), then it is the responsibility of the company and not the clinic. The clinic imposes work restrcitions. The company has to enforce them," she added.

One of the most serious challenges faced by the six-year-old clinic was to maintain focus on its goal of neutrality– a position that needs to be reinforced almost constantly even today. "The staff meets on a regular basis and discusses specific issues regarding the expectations and the demands of the companies. This way we can come up with a strategy to tackle the issue collectively and, in effect, send a more consistent message to the companies."

Emphasizing the importance of providing sufficient and effective tools to the staff, Dailey referenced the importance of their information management systems. "SYSTOCŪ is indispensable to us" said Ms. Dailey. "We would not survive without it. It allows us to put in information like Orders and so on. Essentially, it provides a better way to keep track of employees and maintain specific details about a case."

"This, in turn, helps us to present our point of view to the company – a point of view that is backed with facts and accurate data," she added.

The battle does not end there. The clinic has to function efficiently if it wants to earn a reputation of being a professional medical clinic and have the companies take it seriously. The staff of this clinic, under the direction of Ms. Dailey, has managed to put in place an extremely smooth patient flow.

Describing some of the methods the clinic employs, Ms. Dailey said, "Much planning went into designing how the patient gets processed through the system. We took numerous steps from color coding cases to organizing a sufficiently large space for discharge and dedicating one staff member solely to it. Also, everybody does data entry here. We try to enter as much data as possible because I feel our financial growth depends on it."

"We have nine staff members and 12 computers. Almost all of our staff have printers on their desks instead of the one common hallway printer. In the discharge room, there is a fax machine so we can fax the paperwork to the employer while the patient waits in the discharge waiting room. This has come in very handy. There have been times when the faxed copy did not match the copy presented to the company by the patient. Such a discrepancy is an immediate indication that the employee has manipulated the paperwork," she added.

The clinic emphasizes discharging the patient with the paperwork. "When the patient leaves we make sure the paperwork goes with him. There are a few exceptions. But mostly our patients are discharged with their paperwork. We found that if we take even 30 seconds to do this one little thing while the patient is here, it makes a big difference in productivity and revenue," said the manager.

So, the recipe for success is planning, mixed with adequate and effective resources and tossed with dedicated staff?