Author: mpew

Roger Federer won almost 80% of the 1,526 singles matches he played as a professional. He won only 54% of the points.

Let that sink in. A man with 20 Grand Slam titles and 310 weeks ranked number one in the world lost nearly half the points he played. (In baseball, failing 70% of the time at the plate can get you into the Hall of Fame.)

During his 2024 commencement address at Dartmouth College, Federer explained why that statistic matters. In tennis, you must give everything to the point you’re playing. Once that point is over, win or lose, you have to move on. Whether you hit an incredible winner or made an embarrassing mistake, neither should dictate how you approach the next point.

As he put it, “When you’re playing a point, it is the most important thing in the world. But the truth is, whatever game you play in life, sometimes you’re going to lose.”

His comments caused me to think about something much bigger than tennis.

How often do we allow yesterday to determine what we’re willing to attempt today?

We’ve all experienced failure. A bad decision, a missed opportunity, a relationship that didn’t work, or an effort that fell short of expectations.

Those experiences can teach us valuable lessons but can also convince us that trying again isn’t worth the risk. We begin anticipating failure before we’ve even started.

Failure whispers, “Don’t try that again.”

Interestingly, success can create a similar problem. When something has worked well in the past, we can become convinced it will always work. We stop questioning assumptions, resist new approaches, and gradually become complacent.

When I first started warning about dangerous opioid prescribing and the need for a biopsychosocial treatment model, I heard the whispers. “We’ve always done it this way.” Polypharmacy was routine. Claims were financial transactions.

Success whispers, “Don’t change anything.”

Now think about an injured worker who has had a terrible workers’ compensation experience, or watched a coworker go through one. Perhaps an adjuster didn’t return phone calls to explain why the indemnity check was late. Maybe a physician dismissed legitimate concerns. It’s possible the employee felt like everyone involved was more interested in closing the claim than helping them recover.

Now that employee suffers another workplace injury.

Before the first appointment or conversation with an adjuster, they’ve already decided what will happen. Nobody will listen to them or believe them. They know for certain (because of their past experience) that everyone is looking for a way to take advantage of them.

That isn’t necessarily an unreasonable reaction. Their distrust may have been earned. Psychologist Michael Sullivan’s research calls it perceived injustice, and it’s linked to longer work disability.

Their distrust may have been earned through painful experience that has created perceived injustice which research links to longer work disability. As I wrote recently, distrust doesn’t begin with the denial.

But what happened previously can become an obstacle to what might be possible today.

We cannot expect someone to trust us because we tell them this time will be different. We must demonstrate it.

That means returning phone calls, explaining decisions, listening without immediately becoming defensive, and treating the injured worker as a person rather than a claim number. Consistency builds credibility, which creates opportunities for trust, which can influence someone’s willingness to participate in recovery.

We increasingly recognize that social determinants of health – things like financial stability, housing, access to healthcare, medical literacy, and social support – can influence recovery.

The same is true of adverse childhood experiences, commonly called ACEs. The term came from a groundbreaking 1998 research paper, “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” Childhood abuse, neglect, household instability, and other traumatic experiences can have lasting effects on how people respond to stress, perceive threats, develop relationships, and manage adversity.

An injured worker doesn’t shed that history before entering the workplace. Someone who has experienced repeated betrayal may struggle to trust authority figures. Someone who grew up with instability may perceive uncertainty about benefits or employment as especially threatening. Those are responses shaped by experience, not character flaws.

Regardless of their source, risk factors are not destiny.

People demonstrate extraordinary resilience, especially when they have meaningful support, appropriate resources, and relationships that help restore a sense of safety and control.

Our responsibility isn’t to diagnose someone’s childhood or investigate their personal history. Instead, we need to recognize that every injured worker arrives with experiences we may know nothing about, but that will affect their resilience, recovery, and (for those who care about the bottom line) the total cost of a claim.

Federer’s point isn’t that yesterday doesn’t matter. It matters enormously.

His failures helped him improve. His victories demonstrated what was possible. But neither could win the next point for him.

I think there’s an important lesson here for everyone involved in work comp.

A difficult previous claim doesn’t guarantee another difficult experience for an injured worker. Recovery may still be possible, even when the path forward looks different from what they expected.

For claims professionals and clinicians, an injured worker who has been distrustful, angry, or disengaged isn’t necessarily destined to remain that way. Our next interaction may be an opportunity to change the relationship by proving that we are worthy of their trust.

None of this means ignoring legitimate trauma or pretending failure didn’t hurt. Positive thinking doesn’t overcome every obstacle. It simply means refusing to confuse a prediction with a certainty.

We can’t change what happened yesterday. However, we can learn from it, acknowledge its influence, and make better choices because of it.

Somewhere in your caseload today is an injured worker who already expects to be ignored. The next call you return is the next point.

Their past is a lesson. It doesn’t have to be a life sentence.

Your AI tool just turned a two-hour task into 20 minutes. Congratulations. Now, what happened to the other hour and 40 minutes?

New research from Wharton suggests many organizations aren’t asking. They’re counting the hours saved instead of what those hours produce.

Every technological transformation has promised to make us faster, more productive, and more efficient. Many have delivered (sometimes in ways that nobody originally envisioned).

Over four decades in technology, I’ve learned that just because technology makes a task easier doesn’t mean it makes the outcome better. That’s why every business leader, risk manager, and workers’ compensation professional should pay attention to Wharton’s latest study.

Wharton recently released its fourth annual study of enterprise AI adoption, The Adaptive Advantage: Who’s Winning with AI and How, conducted with GBK Collective. Researchers surveyed 1,416 people at large U.S. companies, from C-suite executives to entry-level employees. I’ll share my takeaways below, but I’d encourage every leadership team to read the full report.

The adoption numbers are impressive.

• 62% of managers report using AI daily
• 91% use AI more than weekly
• 73% say AI has significantly changed their workflows

We’re well beyond the days when AI was something interesting to experiment with during lunch. It’s becoming part of how organizations operate.

While 80% report positive returns from AI investments, only 28% report strongly positive returns. And just 7% of organizations demonstrate success across all three measures Wharton identified: proving value, transforming workflows, and aligning the organization.

Organizations are adopting AI at extraordinary speed. They’re spending money, changing processes, and introducing new tools. But relatively few are putting all the pieces together. Using AI and succeeding with AI are two very different things.

One statistic particularly deserves attention.

Forty percent of departments measure AI’s return on investment by hours saved, yet only 27% use net-new revenue as a measure.

Saving time is certainly valuable. I use AI daily for both professional and personal needs. From developing content to crafting meeting takeaways to simplifying research, I can attest to its power. And more than once, I’ve caught it being confidently wrong.

So, back to that hour and 40 minutes. Did the quality improve? Did the customer receive better service? Did the employee use that additional time to solve a more important problem? Or did we simply get the same result faster?

Wharton found that 35% of departments measuring at least one growth-related outcome reported strongly positive returns, compared with just 13% of those measuring efficiency alone.

Whether correlation or causation, that difference is hard to ignore.

There’s a difference between improving productivity and creating value. I suspect many organizations haven’t fully considered it.

Imagine a claims adjuster using AI to summarize medical records. Instead of spending an hour reviewing documents, the adjuster receives a summary in minutes. That’s a tangible efficiency improvement.

But did the summary accurately identify the important medical issues? Did it recognize conflicting information? Did the adjuster verify the output? Did that saved time translate into better communication with the injured worker, a more thoughtful claim strategy, or a faster return to work?

Now consider a risk manager using AI to identify emerging workplace safety trends. If technology helps recognize a pattern of injuries before another employee gets hurt, that’s not efficiency. That’s an employee who didn’t get hurt.

The same applies to identifying claims that are beginning to deteriorate, improving employee training, or helping smaller organizations access capabilities they previously couldn’t afford. The real opportunity isn’t simply automation, but using technology to improve decisions, prevent problems, and produce better human outcomes.

Then there’s the finding on agents.

Sixty-seven percent of departments report using AI agents in some form. These are systems that can go beyond answering questions to perform tasks or take actions, such as sending a denial letter or setting a reserve. Only 17% report allowing agents to operate without someone approving every step.

We’re moving from AI that recommends to AI that acts.

What happens when an AI system influences a medical treatment recommendation, a claim reserve, or a decision about an employee’s benefits? Who …

• verifies the information?
• recognizes an error?
• is accountable when something goes wrong?

Oh, and who keeps track of your vendors’ use of AI?

I’m not convinced most organizations are developing the knowledge, policies, oversight, and accountability necessary to use AI responsibly.

Wharton’s research reinforces that concern. The report found that organizational alignment requires at least four of five factors: adequate AI training, a clear long-term vision from leadership, meaningful employee choice over how and when to use AI, people and processes that don’t hold the department back, and little resistance among colleagues. Notice that none of them is about the software.

And there’s a telling gap on the first one: 78% of leaders believe employees receive adequate AI training. Only 56% of employees agree.

Successful implementation involves more than purchasing software. It requires changing workflows, educating employees, establishing expectations, and aligning leadership around a common purpose. That’s a management challenge, not simply an IT project.

Next week, I’ll be in Sacramento delivering the keynote at the California Alliance of Self-Insured Groups’ annual conference. My presentation is titled “AI Is Already in Your Organization. The Only Question Is Who’s Controlling It.”

I chose that title deliberately.

Whether you’re running a self-insured group, managing claims, operating a business, or providing services to employers, AI is probably influencing your operations already.

Every leader should be able to answer four questions: Where is AI being used? What is it allowed to do? How are we measuring its value? Who’s responsible for the results? In reality, every employee should be asking them too.

I’m an optimistic realist. There are certainly challenges and unknowns as AI becomes more powerful at an ever-increasing pace. However, I believe AI presents extraordinary opportunities.

But enthusiasm without discipline isn’t a strategy. Neither is measuring success exclusively by how many hours we’ve saved.

Here’s where I’ve landed: our goal for AI shouldn’t be to make people unnecessary. It should be to make people more capable.

So the next time someone tells you how much time AI is saving your organization, ask a follow-up question: What are we doing with that time, and how do we know the results are better?

Hours saved is a number. An injured worker who returns to work sooner is an outcome. Start measuring the second one.

Gerald-Mark (Jerry) Breen had an IQ of 146. He earned a PhD in Health and Public Affairs. He published 30 articles and three books by age 29, one of which was cited by Supreme Court Justice Samuel Alito. He was a co-author of Improving the Quality of Care in Nursing Homes (Johns Hopkins University Press). He was a teacher. He was an accomplished classical pianist.

By almost any measure society uses to define success, Jerry was extraordinary.

But there was something his intelligence couldn’t overcome: addiction.

I recently had a deeply personal conversation with Bonni Breen, a registered nurse with more than 30 years in workers’ compensation. Because I’ve spent more than two decades speaking out against inappropriate opioid prescribing, she asked me to help share her son’s story, in the hope that someone else might recognize the warning signs before it’s too late.

Jerry’s challenges began early. He struggled with ADHD as a child. At age 10, he lost his father, leaving Bonni to raise him and his two brothers. He also received treatment for obsessive-compulsive disorder. What the CDC calls ACEs (adverse childhood experiences) were part of his foundation.

But a résumé and a diagnosis don’t tell you who Jerry was. A close friend from his years in Hawaii remembers an energy that was “infectious.” At a local brewery, Jerry would walk over to a tarp-covered piano that was clearly off-limits, pull the tarp off, and start to play. He wrote so quickly and fluently that his friend teased him about a ghost whispering in his ear. His students loved how freely he gave his help. And he talked about home. “‘My mom’ figured often in his conversations,” his friend wrote, “and Skyler, his dog.”

His exposure to opioids began with something seemingly ordinary: an ingrown toenail. What followed was anything but ordinary.

Despite his remarkable intellectual abilities, Jerry developed an addiction that increasingly controlled his decisions. He sought prescriptions from multiple physicians and pharmacies with no objective underlying pain that would require opioids. He underwent medical procedures to obtain medications. He completed two rehabilitation programs and spent years in counseling.

His mother watched it unfold. Bonni understood medications. She understood healthcare. She understood the dangers. And she repeatedly warned her son. So did a physician in Wisconsin.

Jerry knew the dangers, too. One of his favorite quotes, Bonni recalls, now feels painfully ironic: “To neglect your health is to accept illness as a friend.”

But Jerry believed he was smarter than the drugs. No one is.

On March 28, 2010, Bonni lost her son.

Jerry’s story shows what happens when physicians and pharmacies operate in separate information silos. Multiple doctors and pharmacies. Multiple opportunities to recognize what was happening. And a mother who knew exactly what she was witnessing but couldn’t make it stop.

In 2010, nothing required Jerry’s doctors to check what the others were prescribing. Gaps like these are why I spent years advocating for drug formularies and prescription drug monitoring programs, including California’s SB 482, signed into law in 2016, which requires prescribers to check a patient’s controlled-substance history before prescribing opioids and other controlled substances. Laws like that exist because of stories like Jerry’s.

Jerry sometimes called Bonni 20 times a day. Imagine being that mother. Knowing your son is struggling, recognizing the danger, loving him desperately, warning him repeatedly that his addiction could kill him. And yet, despite all of that, unable to change the trajectory.

We sometimes underestimate how helpless families can feel when someone they love is trapped in addiction. We assume that if the person were smarter, stronger, more disciplined, or more aware of the consequences, they would simply stop.

Jerry’s life challenges every one of those assumptions:

• Intelligence wasn’t enough
• Education wasn’t enough
• Accomplishment wasn’t enough
• Even repeated warnings and rehabilitation weren’t enough

Addiction is not a contest of intellect. Recovery requires more than willpower. Addiction doesn’t care about your occupation, education, income, IQ, or who pays for it. It certainly doesn’t care how much your mother loves you.

Bonni cannot change what happened to Jerry. For years, she couldn’t tell Jerry’s story without breaking down. Today she can, and she’s telling it in the hope that another family can have a different ending.

Perhaps a parent will recognize the warning signs sooner. Perhaps someone struggling with addiction will acknowledge that they need help. Perhaps a physician will look more carefully at prescription history. Perhaps a claims professional will question whether continued opioid therapy is helping someone recover or creating another problem.

Every time Bonni hears Beethoven’s “Für Elise,” she believes Jerry is sending her a message from heaven.

Jerry was brilliant. He was accomplished. He was loved. He was somebody’s son.

Addiction didn’t care.

If someone you love is struggling, you don’t have to figure it out alone. SAMHSA’s National Helpline (1-800-662-4357) is free, confidential, and available 24/7.