Predictable Scheduling, Clopening, and Health

in Uncategorized, job design

StarbucksWellness experts emphasize the importance of sleep, and vendors promote sleep-tracking devices, apps, and programs. But little is said about the job conditions necessary to assure workers have the opportunity to get the sleep they need.

It’s hard to get eight hours of sleep if you’re only home for five or six hours between your evening shift and your morning shift. And that’s where “clopening” comes in. The term commonly applies to schedules in which part-time retail and fast food workers are required to close the store late in the evening and open early in the morning.

Clopening gained notoriety in a 2014 New York Times story about the life challenges a Starbucks employee faced as a result of “just in time” (last minute) scheduling that included clopening. In the minds of activists, unpredictable scheduling and insufficient rest periods between shifts have been linked ever since — appropriately so, as  both practices tend to coincide and threaten employee wellbeing.

These scheduling practices also go hand-in-hand with schedule fluctuation (like working eight hours one week and 40 hours the next) and inflexibility. According to a report by the University of Chicago, unpredictable, fluctuating, and inflexible scheduling undermine almost every dimension of workers’ wellbeing, including the physical, mental, family, occupational, and financial realms. The report’s author, Susan Lambert, was quoted in a follow-up Times article as saying:

This particular form of scheduling — not enough rest time between shifts — is particularly harmful.

The Economic Policy Institute has delineated how “irregular scheduling” influences employee stress, work/life balance, and financial health — all issues we in the wellness industry prattle on about ad nauseam.

In July 2016, Human Impact Partners published an analysis, Scheduling Away Our Health, concluding…

Through literature review, original data analysis, and focus groups, we find that the health and well-being of workers is undoubtedly compromised by unpredictable work schedules.

Even prior to the original New York Times exposé, and increasingly after it, municipalities have considered “secure scheduling” legislation to limit schedule unpredictability, fluctuation, and, yes, clopening.

Employers inevitably resist regulation. But if we are as committed to employee wellbeing as we say we are, we should evaluate and address scheduling practices proactively.

Leadership sometimes emerges where it’s least expected — in this case, Walmart. The mega-retailer recently phased in new processes — on the heels of improvements it made to compensation and occupational development — in order to make scheduling more flexible and predictable for workers. The Washington Post reported that, based on early results, workers with access to the new scheduling system experienced an 11% decline in absenteeism and a 14% drop in turnover, “which comports with what academic research has shown is possible with greater predictability and worker control.”

 

 

[This post is adapted from one originally posted by Bob Merberg on September 19, 2016 on the Healthshifting blog.]

“Health Shapes Work and Work Shapes Health”

in Uncategorized, Stress, job design
construction workers

Photo courtesy jaimebisbal

The Robert Wood Johnson Foundation, as well as the Harvard T.H. Chan School of Public Health and National Public Radio, may have given a boost last week to advocates of employee wellbeing. Here, I refer to what I consider authentic wellbeing — based on workers’ exposure to harmful job conditions and environments — not the store-bought imitation based on wellness websites, apps, incentives, and medicalized interventions.

To promote the findings of their Workplace Health poll of 1,601 workers, these sponsoring organizations waged a publicity blitz that brought the “healthy work” perspective to a broad new audience. A Health in the American Workplace panel, streamed live on the web, served as a centerpiece of the campaign.

Workers’ Views on Jobs and Health

Poll results, according to panelists, revealed that many workers view their jobs as impediments to their wellbeing.

  • 43% said their job has a negative impact on their stress level
  • 28% said their job undermines their eating habits
  • 27% reported that their job interfered with the ability to get a good night’s sleep
  • 22% said their job has a negative impact on their weight.

Panelist Marjorie Paloma, director of RWJF, explained how job stress and health are influenced by workplace policies:

If you think about the stress a person feels whether because of their day to day work routines, or the stress they feel because of caring for a loved one while working a full time job, or workers who feel as if they have to go into work despite being sick…These are all stressors that influence health.

Succinctly describing the relationship between behaviors and the environment, Paloma stated:

The choices we make are as good as the choices we have.

She summarized this position with the catchy phrase:

Health shapes work, and work shapes health.

“Human Resource Failures”

Harvard Business School professor John Quelch described how workforce management and the intensification of work have been shown to influence health. Quelch bemoaned…

…the sheer overload that comes from downsizing and outsourcing and asking someone to do two jobs when previously they had to do one.

He cited an often overlooked source of stress:

It can also come from job ambiguity — the requirements of the job are not being clearly articulated by supervisors.

Quelch characterized these workforce management patterns as “fundamental human resource failures.”

Gloria Sorensen, from Harvard Chan, cited her team’s studies of health care workers, whose job conditions have been linked to health problems:

Risk of injury or musculoskeletal pain or accidents on the job increase…when we look at harassment on the job, inadequate staffing, bullying at work, high job demands, lack of control, and poor supervisor support.

Sorensen went on to say that these job conditions also have been linked to fatigue, sleep problems, and risk of obesity. She concluded…

The point is these conditions of work are critical when we look at a range of health outcomes for workers.

The panelists’ remarks revealed mixed feelings about conventional worksite wellness programs that focus on behavior change. The poll results showed that only half of workers have access to wellness programs, which at times the panelists, such as Harvard’s Robert Blendon, seemed to cite as an indictment of employers:

Almost half of people who work are at a workplace that has no workplace health program.…People go to work every day, and this is something they read about in a magazine, but they don’t see in their own job.

On the other hand, Paloma remarked…

Worksite wellness is insufficient if it’s not going hand in hand with efforts to improve the health of communities.

Blendon, director of the poll, said that the findings changed his mind about stress. He led an uncomfortable laugh at the expense of conventional stress management strategies, and noted…

Employers should have some responsibility for lowering the level of stress.

NPR’s Joe Neel, the panel’s moderator, summarized…

It’s all about conditions of the workplace and stress.

Kudos to Harvard Chan’s Sorensen, who introduces the audience to the study of job stress in San Francisco transit operators, in which changing the work — such as modifying schedules, training, staffing changes, and equipment upgrades — succeeded in reducing worker stress, whereas, according to Sorensen, previous efforts to change the workers (for example, with stress management programs) failed. For the curious: The research Sorensen cited has been incorporated into an in-depth analysis of stress prevention for bus drivers, available from the International Labour Organization.

The disconnect between the “healthy work” approach and the behavior change emphasis in the panel’s videos, if anything, highlights the need for an acceleration of credible worker health research, which is exactly what NIOSH’s Total Worker Health initiative has set out to do .

In the interim, watch the full one-hour panel here:

 

Workplace Health, Injustice, and Your Mother

in Uncategorized

Be FairYour mother always told you life wasn’t fair. In few places did her words ring truer than workplaces where favoritism, bullying, discrimination, or broken promises rule the day.

But if life’s not fair, it may be no small consolation that, when facing an unjust and uncivil work environment day in and day out, life may not be very long either.

One study has shown that workers who felt they were treated unfairly at work — compared to well-treated workers — had a 55% greater risk of heart disease, even after controlling for other risk factors.

Organizational Injustice

Organizational unfairness, or injustice, refers to a pattern of exposure to inequitable conditions that undermine workers’ dignity and self-respect. It runs the gamut from being ignored… to being spoken to rudely… to being bullied… to being assaulted.

In addition to its link to heart disease, which includes documented cases of heart attack and angina — organizational injustice has been associated with a variety of physical and mental health problems.

In one study, 8% of workers reported being harassed within the previous 12 months. These workers were significantly more likely to be obese; sleep less; smoke more; and experience psychosocial distress, pain disorders, and lost work days.

Another study showed that men who felt their workplaces had a high level of justice had a 25% lower risk of developing metabolic syndrome than those working in unfair conditions.  And a review of several studies revealed a consistent association between organizational justice and mental health.

The exact definitions may differ depending on which expert you talk to, but generally workers experience unfairness via four categories of organizational injustice:

  • Procedural injustice — Processes for the employer to interact with employees aren’t created or conducted in an equitable manner. For example, effective systems are absent to assure that workers in comparable circumstances are treated equally when decisions are being made about job performance issues, schedules, promotions, and transfers.
  • Interactional injustice — Workers aren’t treated respectfully and their value isn’t recognized. Bullying and hostile work environments are examples of interactional (also called relational) injustice.
  • Distributive injustice — Benefits, compensation, and other rewards aren’t extended equally to employees doing comparable work, or generally aren’t appropriate for the demands and expectations of the job. Workers who earn less due to discrimination based on race, gender, or religion experience distributive injustice.
  • Psychological breach — Promises are broken. This includes the expectations the organization sets — including those related to pay, responsibilities, job demands, opportunity, and job security — when workers are hired or assume a new role. This category isn’t always included in classical definitions of organizational injustice, but is a process that may amplify the other categories.

Failure to communicate accurate, timely information to workers and to offer conduits for meaningful input are common denominators of organizational injustice.

Manage Fairness for Better Health

A 2011 meta-analysis confirmed that organizational injustice is associated with physical health problems and mental health problems, especially depression, anxiety, and burnout. Interestingly, the study also found that the strength of the association with specific kinds of health problems depended largely on the type of organizational injustice:

  • Workers experiencing procedural injustice were most likely to have physical health issues
  • Those encountering distributive injustice mostly reported mental health problems.
  • Psychological contract breach was associated with burnout.

Reviewing the meta-analysis, the online publication I/O At Work proposed strategies employers can consider if they genuinely want to promote worker health:

Organizations have a great deal of control managing fairness (and unfairness) perceptions. To increase feelings of distributive justice, organizations should strive to make policies with outcomes that are the same for all employees regardless of gender, race, and tenure. Increasing perceptions of procedural justice can be accomplished by insuring that decision-making processes treat all employees equally. Finally, to increase perceptions of a sturdy psychological contract, openly and clearly communicate to employees, provide them with information, direction, and support in times of change, and treat employees with respect.

Your mother may have been right: Life’s not fair. But that doesn’t mean the workplace can’t be.

Our society of hard knocks may scoff at the notion of fairness at work — dismissing it as the product of a self-entitled workforce. And it may be hard for traditionalists to believe that justice and other organizational strategies are an avenue toward improved workforce health.

But sometimes it’s the employer that feels entitled or plays the victim. And the observational evidence that connects the dots from fairness to health is no less solid than that cited by the wellness industry to sell behavioral change.

Ultimately, organizational change and individual change are likely to complement each other in cultivating a healthier workforce. Of the various solutions to choose from, a combination of organizational and behavioral strategies may be the fairest of them all.

Waking Up To How Sleep and Work REALLY Interact

in Uncategorized
Awake

Photo by Aaron Edwards

 

By this time, most of us are well-versed in how sleep — more accurately, the lack of it — affects work. Injuries, errors, accidents, and health care costs have all been linked to sleep loss and shown to affect business results.

What’s more, as reported by McKinsey in the article “The Organizational Cost of Insufficient Sleep,” there’s a host of psychosocial and cognitive problems that have been linked to sleep loss, including impaired attention, concentration, creativity, learning and memory, decision making, and relationship formation. Some studies have even shown that lack of sleep is associated with unethical behavior and have proposed specific pathways in the brain that may explain the connection.

Just as important, however, as how sleep affects work — maybe more important — is how work affects sleep, points out Canadian researcher Julian Barling, author of the forthcoming book Work and Sleep.

Chronic overtime, excessive workloads, shift work, expectations to be “always on,” and a culture that diminishes sleep all have been shown to contribute to the widespread problem of worker sleep loss.

Researchers from the University of Washington and University of Michigan recently published a whitepaper, Why it Pays to Ensure Adequate Sleep for Your Employees. The authors point to the prevalence of the problem:

The average person needs 7-9 hours of sleep per night. When surveyed, about 29.9% of Americans stated that they had gotten less than 6 hours of sleep the previous night.

Okay, we get it. Lack of sleep is widespread and undermines the wellbeing of workers and organizations. What can we do about it?

Typically, well-meaning employers wheel out their usual wellness strategies to get employees to change their sleep habits:

  • Education about sleep hygiene, with tips like
    • Don’t eat large meals before bed
    • Establish a consistent schedule for going to bed and getting up
    • Limit nighttime use of lit devices, like phones and computers
    • Use your bedroom exclusively for sleeping and sex
  • Apps and web-based modules, like the cognitive behavioral therapy-based Sleep.io
  • Behavioral change programs that include goal setting, tracking, and rewards

But employers should first look at themselves, and how they create or facilitate the conditions that lead to sleep loss. These are the factors the employer can control, and only once they’ve committed to organizational changes as a primary solution can the benefit of behavioral change strategies be fully realized.

What changes should employers consider? The McKinsey authors also published an article in Harvard Business Review, in which they suggest some ideas for starters:

Evaluate and rework company policies to ensure that they encourage — or at least don’t discourage — a good night’s sleep. Look at policies covering travel, email (e.g., blackout time on email, after which no emails can be sent), team working (creating tag teams that enable employees to hand work to each other across time zones), work-time limits (setting limits on hours or creating blackout periods), mandatory work-free vacations, predictable time off, napping rooms, and smart technology that improves sleep management.

Flexible schedules might seem like a slam-dunk solution, but University of Washington researcher Christopher Barnes found they often backfire, according to a BBC article. Due to cultural biases that favor early risers, flexible schedules prompt workers to start their days too early for their own natural sleep and wakefulness rhythms. One of the sources cited in the article estimates that 70% of workers typically wake up too early to achieve optimal performance during their work day.

Multiple studies, the BBC reported, have found “that workers who adjusted their work schedule to their individual biological clocks were more productive, healthier and less tired both at work and in their free time.”

Nominal, short-term sleep loss — like the kind many of us experience in the days following the switch to Daylight Savings Time — can lead to big problems. According to one study, for example, workers sleep on average 40 minutes less, compared to  other days, on the Monday after turning clocks an hour forward. An accompanying study found  3.6 more mining injuries each year on these Mondays, with absenteeism data indicating that these injuries tended to be especially severe.

How much sleep did you get last night? How alert and well rested do you feel right now?

Unemployment Makes Health Worse. Recession Makes It Better?

in Uncategorized

Arrows -- unemployment harms health, recession improves it

Getting laid off, job insecurity, and long-term unemployment are hazardous to your health. So why do health measures for statewide populations tend to improve during economic downturns?

Job loss is associated with a 73 percent increase in mortality risk — the equivalent of adding 10 years to a person’s age, according to a 2014 study from Drexel University. Yet the same study found that  each percentage-point increase in state unemployment rate reduced the mortality risk of a resident of that state by 9 percent, about the equivalent of being one year younger.

In other words…

Joblessness strongly increases the health risk for people who are jobless.

But…

Periods of higher unemployment rates, such as recessions, moderately decrease health risk among the entire population.

What at first seems paradoxical may not be. The significant increase in mortality risk for the jobless is limited to a relatively small population — say, 9% in a typical recession. The improvement in mortality for the population is based on a small improvement spread across a much larger population, which can easily be misinterpreted, if someone were to oversimplify it, to mean that everyone’s health is getting better. (In fact, there undoubtedly are other subpopulations for whom health deteriorates during economic downturns. These may include those living in poverty, people with less access to health care, senior citizens, and less educated people.)

The researchers did not investigate the question of why risk improves for employed people during economic downturns, but they offered a hypothesis:

During economic expansions, work is done at a faster pace, more employees are commuting, workers have less average sleep, and so on — all of which can be linked to higher risk of heart attacks, vehicle crashes, industrial injuries and enhanced circulation of germs. All of this reverses in recessions.

Of course, this leaves us with a damned-if-you-do-damned-if-you-don’t scenario. Joblessness is harmful to your health — but hard work is also harmful and less work is the cure? This wouldn’t even begin to explain the bi-directional changes in mortality risk for the employed and the unemployed. And it neglects to factor in how job insecurity — which presumably increases across a wide swath of the population when unemployment rates spike — factors into population health shifts.

We still have a lot to learn about where the sweet spot lies for employment, productivity, and worker health. Ultimately, we get on the right track by asking the right questions.

Getting Axed Is Hazardous To Your Health

in Uncategorized, Stress, job strain

You look to your job not only for income and benefits, but also for purpose, social interaction, and daily routine. These influence your health, and the loss of them — or the threat of losing them — can suck the life right out of you.

Every day, millions of Americans either look for work or go to work. Their success at finding and/or maintaining a decent job with good benefits will, to a large degree, determine their current and future health.

Robert Wood Johnson Foundation

Job loss, long periods of unemployment, and job insecurity have all been linked to deteriorating health. Yet, even companies that profess to support employee well-being have been known to contradict themselves by executing mass layoffs as a first line of financial defense rather than a last resort.

Netflix Do-or-Die Culture Deck

The Netflix exec who masterminded the vaunted slide deck about the company’s do-or-die culture boasted about the workers she’d laid off and fired. After being let go in 2015, she “doesn’t like to talk about it.”

As a business strategy, layoffs are a proven fail, a formulaic tactic executed by complacent executives in the absence of genuine leadership skills. Though frequently assumed to be a desperate measure, corporations often lay off workers when business is booming.

Of course, layoffs aren’t the only source of unemployment and job insecurity…

  • Workers get fired due to performance problems.
  • Businesses go belly-up.
  • Some employers foster job insecurity as an ill-fated method to drive productivity.

But mass layoffs — regardless of whether they are euphemistically called reductions-in-force, redundancies, right-sizing, down-sizing, or all-around-the-town-sizing — are responsible for the majority of job loss that is out of workers’ control.

Job Loss and Health

Compared to employed workers, people who have recently lost a job are…

Unemployment and Health

According to Gallup, Americans who have been unemployed for a year or more are more likely to be obese than those unemployed for a shorter time. The obesity rate rises from 22.8%, among those who have been jobless for less than three weeks, to 32.7% among those unemployed for a year or more. Those who have been jobless for more than 26 weeks are twice as likely to have high blood pressure and high cholesterol compared to people who have been unemployed for shorter periods.

Gallup also found that 20% of people unemployed for a year or more suffer from depression — about twice the prevalence compared to people unemployed for less than six weeks.

The Robert Wood Johnson Foundation points to several pathways from unemployment to deteriorating health:

  • Reduced income, which leads to inadequate nutrition, shelter, and health care.
  • Increased stress and limited access to the physical, mental, and social activity that are underpinnings of well-being.
  • Increased likelihood of engaging in unhealthy behaviors, like alcohol consumption, smoking, and drug use.

Job Insecurity and Health

The jury is still out on whether job insecurity — the threat of involuntary job loss — causes measurable declines in health status, but plenty of studies suggest a connection.

Job insecurity harms health, even more than unemployment.

The World Health Organization

One of the largest investigations of job insecurity and health analyzed data from more than 174,000 workers who were studied for nearly 10 years. It found that workers with job insecurity were 20% more likely to experience life-threatening heart disease compared to others who felt their jobs were a lock.

Research also has found that chronic job insecurity is a strong predictor of deteriorating health, even stronger than smoking or high blood pressure.

Job insecurity can lead to unhealthful behaviors like smoking, a Canadian analysis concluded, and avoidance of healthy behaviors like exercise and taking needed vacation and sick time off. It may even increase the risk of work-related injury and illness.

The relationship between job insecurity and health may depend on job type, economic conditions — how readily a laid off worker can land a new job — and workers’ attitudes about their employment and health. Case studies suggest that availability of social support and services for laid off workers may be differentiators for wellbeing.

Real Leaders Lead: Alternatives to Layoffs

Honeywell CEO Dave Cote doesn’t have a perfect record when it comes to worker well-being,  but his decision to favor furloughs over layoffs during the Great Recession serves as a Harvard Business School case study on how to maintain competitive edge during economic downturns and recoveries. Cote’s process should be required reading for execs who succumb to arguments that layoffs are inevitable.

The benefits of using layoffs to manage costs during a recession didn’t make economic sense…

Harvard Business School

The Wall Street Journal offers a tip sheet suggesting alternatives to layoffs.

Lessons about support for laid off workers also can be learned from the Unnatural Causes video comparing Electrolux layoffs in the US and Sweden and the Nokia Bridge program that granted seed money to laid off workers in Finland.

For workers in America, if you worked at a company like General Electric it’s more like you get a month’s salary and go. They lock the doors on the day you are fired. At Nokia there were people who knew they were going to be laid off in six months and  were able to stay at Nokia with a Nokia email address with the Nokia laptop and spend time applying for new things, and Nokia helped them.

— Ari Tulla, laid off Nokia employee, now co-founder and CEO of BetterDoctor (quoted by BBC)

In a separate post, we’ll explore what we know about the relationship of health and on-demand or “gig” economy jobs, like Uber drivers, Airbnb hosts, Postmates couriers, and TaskRabbit taskers.

 

[If you’d like to comment on this post, please head on over to the LinkedIn version.]

Job Stress Is In Your Head. Literally.

in Uncategorized, Stress, job strain

Or…

Half of What I Know About Employee Health
I Learned from Concussion

Concussion is a movie about employee health as much as it’s about anything.

In the movie, the National Football League goes to great lengths to cover up the harm it allows to be inflicted on its players. The league is motivated by fear of liability and its unquenchable thirst for ever-increasing revenue.

Medical examiner Bennett Omalu, MD, a trained neuropathologist played in the movie by Will Smith, determines that several ex-players who died of unnatural causes suffered from chronic traumatic encephalopathy — CTE. The disease is characterized by long-term damage to specific sections of the brain, where tau proteins surround and choke off brain cells. The damage affects memory, agitation, and anger, and leads to dementia and, reportedly, Alzheimer’s disease. Brain studies were conducted on numerous players who died, including several who committed suicide. Ann McKee, a neuropathologist at Boston University’s CTE Center, reported in 2013 that she’d examined the brains of 46 former football players and found CTE in 45 of them.

Professional football players are employees of their respective teams, and the NFL serves as a sort of trade association for its member teams. For years, the NFL deflected blame for CTE, sometimes onto the players themselves. They pointed their finger to substance abuse (including steroids and alcohol), past history of concussion, and genetics. They downplayed the role of concussion, insisting that “mild traumatic brain injuries are not serious” and that players could safely return to the same game after suffering a concussion.

Ultimately, the NFL agreed to pay $765 million dollars in a settlement with more than 4,500 retired players who sued the league for concealing the issue.  Speaking about the settlement, NFL Commissioner Roger Goodell said, “There was no admission of guilt. There was no recognition that anything was caused by football.”

The settlement included a provision that the NFL would never again compensate players or their families for CTE, which is why, as one example, the family of hall of famer Frank Gifford, diagnosed with CTE post-mortem in November 2015, cannot take action against the NFL.

Football players are an elite group. What does their plight have to do with your job stress?

In another post, Half of What I Know About Wellness I Learned in the First Six Minutes of Joe Vs. the Volcano, I recounted a dialog between Joe and his boss. Joe, it turns out, suffers from “a brain cloud” caused by a black mass running down the center of his brain. His boss insists that Joe stay in the game: “So what!” the boss shouts. “Do you think I feel good? Nobody feels good. I don’t let it interfere with my job!”

Joe’s brain cloud and black brain mass, which viewers are led to believe result from job strain, are the stuff of satire. But is there really a chance that average workers exposed to prolonged job stress suffer brain damage — structural changes in brain tissue with accompanying symptoms?

Yes, there is.

Occupational stress affects signals from the amygdala to the prefrontal cortex

Repetitive stimulation of the amygdala — a result of prolonged job stress — releases chemicals to the medial prefrontal cortex and may cause thinning of the cortex, enlargement of the amygdala and, consequently, a cycle of deteriorating stress modulation, cognitive symptoms, and impaired fine motor function.

In 2014, Ivanka Savic, MD, PhD of Sweden’s Karolinska Institute, published a study that used brain MRIs and showed that prolonged job stress — which included chronic overtime and a cycle of distorted perceptions regarding job demands, abilities, and control — leads to structural changes in the brain.

Compared to the MRIs of demographically matched control subjects, the patients who reported debilitating job stress — and exhibited burnout symptoms like impaired memory and concentration, sleeplessness, achiness, fatigue, and emotional exhaustion — showed abnormalities in the parts of the brain involved with the processing and perception of stress, specifically the prefrontal cortex and the cortex (which were abnormally thin) and the amygdala (abnormally large). These findings were consistent with Savic’s hypothesis that “repeated, chronic stress could lead to damage of the brain areas which modulate stress perception, leading to a vicious cycle with impaired ability to cope with stress.” The MRI findings were supported by documentation of reduced fine-motor skills and emotional regulation in the stressed group compared to the control subjects.

Finally, Dr. Savic concluded, “This condition needs to be considered as a stress illness, whose sufferers deserve proper and swift treatment.”

Dr. Savic summarized her study in her blog post Does Chronic Occupational Stress Cause Brain Damage? (The complete findings were published in the journal Cerebral Cortex.)

While a worker suffering from stress-related ailments may feel, as they go about their business, like they  metaphorically are banging their head against a wall, the analogy between job-stress and football concussions is somewhat tenuous. Here are some ways the two phenomena differ:

  • The research on job-stress-related brain damage is still preliminary.
  • CTE is a result of smashed brains. Job-stress-related brain damage is more subtle, resulting from interactions between an individual’s job and their perceptions, and the resulting chemical activity in the brain.
  • There is no “cover-up” of job-stress-related brain damage that we know of — if for no other reason than most employers don’t know about it.
  • Job-stress-related brain damage has not been linked to behaviors that are as aberrant as those linked to repeated football concussions, nor has it been linked to death (though job stress has been found to be a significant risk factor for cardiovascular disease and death).

But there are some similarities, too:

  • Football concussions cause brain damage. Prolonged job stress also appears — based on preliminary research — to cause brain damage.
  • Just as football’s CTE was originally blamed on players (their drug use, history of previous head injury, or genetics), job stress in the United States has commonly been accepted to be solely a consequence of employee perception and coping skills, with employers turning a blind eye to their own role in creating job conditions that cause stress. Instead of empowering you with more control over your workflow, your employer adds a resilience program to your to-do list. In the absence of a broader preventive strategy, resilience programs are for job stress what football helmets are for concussions: Tools to help you endure more pain.
  • NFL players and everyday workers — as well as the enterprises that employ them — will benefit from having these neurological conditions identified and treated as early and effectively as possible.

Ultimately, symptoms of job-stress-related brain damage may prove to be less severe than CTE. But its burden to society — in terms of economics, well-being, and productivity — may be far greater simply due to the vastly larger population at risk.

 


[In addition to the film Concussion, much of the data and quotes for the CTE section of this post were derived from the episode of PBS’s Frontline: League of Denial — The NFL’s Concussion Crisis.]


 

 

 

NICE! Good Work Is the Key to Good Employee Health

in Uncategorized, job design
Good Work Is Key to Good Employee Health

Photo courtesy @prospectunion

On June 19, 2015, while the U.S. federal government was determining how much employers should be allowed to fine workers for high blood pressure and cholesterol, the United Kingdom’s quasi-governmental National Institute for Health and Care Excellence (NICE) was doing something beneficial for employee wellness. NICE issued evidence-based guidelines for management practices and policies that support employee health.

In the U.S., where we lean on behavioral programs and medicalized approaches to try to manipulate worker health, NICE’s focus on workforce management and policy may seem…um…foreign. But as often mentioned in this blog, much of the rest of the economically advanced world long ago realized that management practices — especially those relating to job design and work environment —  are the foundation of employee health. Voluntary behavioral programs play a potentially important but supporting role.

In fact, a recent Stanford study, described in a previous post here, determined that low job control, unemployment, long work hours, and work-family conflict had a greater affect on mortality than second hand smoke. And more than 120,000 deaths per year and approximately 5% to 8% of annual healthcare costs may be attributable to how U.S. companies manage their workforce.

The NICE guidance includes recommendations like…

  • “Encourage employees to be involved in the design of their role to achieve a balance in the work demanded of them. Allow them to have a degree of control, appropriate to their role, over when and how work is completed.”
  • “Value and acknowledge employees’ contribution across the organisation. If practical, act on their input and explain why this action was taken.”
  • “Create a supportive environment that enables employees to be proactive to protect and enhance their own health and wellbeing.”
  • “Ensure any unfair treatment of employees is addressed as a matter of priority.”
  • “Proactively challenge behaviour and actions that may adversely affect employee health and wellbeing.”
  • “If possible and within the needs of the organisation be flexible about work scheduling, giving employees control and flexibility over their own time.”

These are just a few examples. Visit the NICE website to read the full Workplace Health: Management Practices guidance and the evidence upon which it’s based.

In the U.S., we seek “disruption” in the form of new wellness programs, gizmos, and websites. But these aren’t disruptive and in some cases they aren’t even improvements. They’re just new tricks for old dogs.

Even if behavior is the underpinning of health, as we insist on believing, employers have  little influence over it, and may do some damage in the process of trying.

Employers do influence the workplace and the work, and that’s where they can have the most impact on wellness. Hence the tagline of this Health Shifting blog…

Change the work. Not the worker.

Effort-Reward Imbalance Underpins Worker Stress

in total worker health, Uncategorized, Stress, job design, job strain, industrial organizational psychology

effort-reward balance scaleIt may be hard to get your brain around abstract models of stress, especially when they don’t line up with the usual fright-or-flight illustrations or seem remediable by the relaxation tips commonly sold as solutions. But if we care about workers, and how employers may be able to help them, we can’t ignore the harmful effects of effort-reward imbalance.

Think back to Psych 101 and you’ll remember that most human transactions are based on our expectation of an even exchange, or social reciprocity. It’s like an unwritten contract. We’re hard-wired for evenhandedness, and when we get — or believe we’ve gotten — a raw deal, we suffer from physical and emotional stress.

In the workplace, employees trade their currency — effort — for the employer’s currency, rewards, which include:

  • compensation
  • job security and prospects for promotion
  • respect and prestige within the organization

The balance — or imbalance — of effort and reward may be influenced by an employee’s motivational style, especially for employees who are intrinsically driven to overextend their effort independent of rewards, often to fulfill their underlying longing for approval. This surfaces as “overcommitment” in the effort-reward imbalance model.

When physical and or mental job effort outweigh the reward — or employees perceive the balance to be out of whack — the result is chronic stress and, over time, the physical and mental problems that stress can lead to.

This understanding of work stress was first conceptualized by medical sociologist Johannes Siegrist.

The model of effort rewards imbalance claims that lack of reciprocity between costs and gains (i.e., high-cost/low-gain conditions), define a state of emotional distress with special propensity to autonomic arousal and associated strain reactions.

— From Johannes Siegrist’s seminal paper, Adverse Health Effects of High-Effort/Low-Reward Conditions 

Siegrist’s theory was put to the test in Britain’s classic “Whitehall II Study,” which followed more than 10,000 civil service workers for 11 years. Results showed that effort-reward imbalance led to increased risk of cardiovascular disease, as well as declines in overall physical and mental health. Study subjects who were lower on the organizational chart and those with less workplace social support had the highest levels of risk among those with effort-reward imbalance. Since then, research has shown even more pronounced effects of effort-reward imbalance, especially on the risk of heart disease and depression — based on rigorous studies of employees in a wide range of occupations working in countries across the globe.

The Whitehall researchers, led by social determinants of health pioneer Sir Michael Marmot, felt their results showed that cardiovascular disease and other stress-related illnesses could be prevented by improving work conditions. Their work led to a campaign to encourage employers to:

  • Improve rewards by recognizing good job performance
  • Encourage job-skill and professional development
  • Increase salaries
  • Foster social support at the workplace
Siegrist has proposed additional solutions:

  • Leadership development among supervisors, emphasizing the importance of esteem, recognition and appropriate feedback.
  • Building upon non-monetary rewards, like flexible work options, more effectively matching job status to achievements, and fostering job security.

Effort-reward imbalance is one of the two most influential frameworks for understanding job stress, alongside the demand-control model of job strain. In fact — despite our preoccupation with other models that push accountability for stress solely on workers — regarding both demand-control and effort-reward imbalance, Siegrist wrote in 2014:

Empirical evidence on their health-adverse effects is far broader than is currently the case for any other stress-theoretical model related to work and employment.

Ultimately, most elements of the psychosocial work environment can be plugged into one or both of these models.

Whether effort-reward imbalance is a product of employee perception or actual work conditions remains a topic of debate. Most likely, both play a role. Certainly, job demands and job control have been validated as causes of cardiovascular disease and high blood pressure, in contrast to trendy notions that stress is a mindset or is a good thing and that employees are on their own to address it. The role of personal interventions is to help employees with problem-solving skills that can help them advocate for themselves, assess their level of effort as objectively as possible and, in some cases, moderate overcommitment. Stress management and resilience programs may play a supporting role.

Further Reading
  • For a good overview of effort-reward imbalance, and researching showing how it leads to cardiovascular disease, see Siegrist’s 2010 overview from the International Journal of Occupational Medicine and Environmental Health, Effort-Reward Imbalance at Work and Cardiovascular Diseases.
  • Siegrist’s overview of effort-reward imbalance and depression has not been translated into English, but you can read the abstract here.

Mapping Workplace Demons to Health, Costs, and Mortality

in Uncategorized, Stress, job design, job strain
Desk worker stressed with long working hours

Photo courtesy of Adam Foster. http://ow.ly/MKMke

The workplace demons that threaten employee health include long work hours, job insecurity, low job control, high job demands, shift work, effort/reward imbalances, role ambiguity, work-family conflict, inadequate workplace social support, and unfair treatment. These can be bucketed in various ways, but whatever you call them, they are the work conditions — controllable by employers — that research has consistently shown to influence employee health and well-being.

Now, along comes a study out of Stanford University that not only endeavors to quantify the burden — in terms of health outcomes, cost, and mortality — of these demons (what the researchers called “stressors” and I sometimes refer to as the workplace determinants of health), but also puts it into context relative to other, more commonly recognized, health issues.

Spoiler alert: More than 120,000 deaths per year and approximately 5% to 8% of annual healthcare costs may be attributable to how U.S. companies manage their workforce, according to this analysis. The mortality rate for these stressors, plus another the researchers found to have significant impact — lack of health insurance — was on par with the fourth and fifth largest causes of death in the U.S.: heart disease and accidents. It was greater than mortality resulting from diabetes, Alzheimer’s, or influenza.

Exposure to the following stressors was found to be more harmful than secondhand tobacco smoke:

  • Lack of health insurance
  • Low organizational justice (fairness)
  • High job demands
  • Shift work
  • Unemployment

And — again, using secondhand smoke as a benchmark — the conditions that had a greater affect on mortality are:

  • Low job control
  • Unemployment
  • Long work hours
  • Lack of health insurance
  • Work-family conflict

The Stanford researchers concluded,

Employers may not make appropriate decisions concerning workplace management if they are unaware of the link between management decisions and employee health and healthcare costs. Our analysis suggests that for such organizations, paying attention to the structure of the workplace and the associated job stressors experienced by their employees may be a fruitful way to reduce unnecessary healthcare costs.

But they acknowledge that employers may have limited motivation to address these issues if, indeed, they’re not on the hook for the costs of health care — for example, in the cases of employees who have been laid off or who are not offered health insurance. The study didn’t delve into associations between stress and productivity.

The analysis was conducted by Joel Goh, Jeffrey Pfeffer, and Stefanos A. Zenios and published in Management Science. Goh is now on the faculty of Harvard Business School.

The researchers are conservative yet insightful in their expectations regarding the implications of their work:

While we stop short of claiming that employer decisions have a definite effect on these outcomes and costs, denying the possibility of an effect is not prudent either. Analyzing how employers affect health outcomes and costs through the workplace decisions they make is incredibly important if we are to more fully understand the landscape of health and well-being.

And what of our current approach to employee well-being, with its slaphappy embrace of screenings, health risk assessments, health coaching, apps, wearables and incentives? How does it jibe with the real determinants of worker health? Not very well, according to study co-author Jeffrey Pfeffer. In his YouTube interview for the Stanford Graduate School of Business, he says,

Employers worry mostly about individual decisions: eating, exercise, smoking, drinking…things like that. Or about policy issues like how we pay for health care. A lot of their excess health care costs come from what happens to people every day in the work environment… Things that employers could fix, if they wanted to.

Read Dr. Pfeffer’s summary of this research in the Fortune article, “Is Your Employer Killing You?


[This post was originally published on Bob Merberg’s Health Shifting blog on May 12, 2015. Edited on March 21, 2018 — minor word changes — for clarity.]

Napo Lovably Spotlights the Causes of Worker Stress

in Uncategorized
Napo spotlights the causes of workplace stress

Napo raises awareness of the drivers of workplace stress.


The psychosocial and environmental interplay of stress at work are foregone conclusions among regulators, thought leaders, and many employers across the globe, especially in Europe. In the United States, with the exception of NIOSH’s Total Worker Health strategies, the drivers of stress at work remain largely ignored. In the US, we take the reactive viewpoint that an individual’s response to stress is more important than the causes of stress. In doing so, employers grant themselves license to put the onus for solutions on employees, too. Whereas the rest of the industrialized world endeavors to address stress by balancing employees’ job control and demands, offering scheduling flexibility, limiting overtime, addressing bullying, and so forth — even the most caring American employers take pride in addressing stress merely by offering stress management programs or uber-trendy resilience training. “Yes, we’ll stress you out,” we seem to be saying, “but we compensate by training you how to live with it.”

Reflecting their dedication to furthering employers’ understanding of workplace wellbeing and encouraging  action, a small group of European organizations commissioned French company Via Storia to develop a series of videos promoting employee health and safety. The result is a lighthearted collection of culturally non-specific, animated vignettes featuring an endearing main character, Napo. Consistent with the European viewpoint, these videos include — in addition to episodes about slips and falls, workplace transport safety, skin protection, noise control, and the rest — a full series about the psychosocial and environmental causes of stress at work.

The Napo videos aren’t intended to be scientific documentaries or instructional tools. They’e an intentionally simple means to raise awareness about worker health and safety and, in this case, the ingredients — like role ambiguity, untenable work schedules, and job strain — of workplace stress. I’ll share some of these Napo videos, as well as other invaluable resources readily available to European employers — here on the Health Shifting blog.

To complement my previous post, which addressed NIOSH research suggesting a connection between hostile work environments and obesity, I’m pleased to share the following Napo video — a segment from “When Stress Strikes.” In this 56-second video — probably the simplest of these episodes — Napo’s co-worker, Napette, is subject to repeated incidents of disrespect from a workplace bully. The Boss intervenes.

 

Unlocking the “Human Factor” in Employee Wellbeing

in Uncategorized
Asch building

The exterior of the Asch building remained intact after the fire (above). The Triangle Shirtwaist Factory occupied the top three floors. (Photo courtesy of the Kheel Center, Cornell University.)

Years ago, in lower Manhattan, flames burst through the windows of a skyscraper. Cornered by a fast-moving fire, employees clung to the window frames until the heat, the flames, and the terror became too much to bear. They leapt from the windows to their certain death, their burning hair and clothes leaving a smoky trail, and crashed smoldering to the ground with an unearthly thud.

This is not an account of a terrorist attack. This is the scene of what, for 90 years prior to 2001, had stood as the worst workplace disaster in New York City history.  Like 9/11, this tragedy changed the world — especially the world of work.

This is the story of the Triangle Shirtwaist factory fire, in which 146 employees — mostly young immigrant women — perished on March 25, 1911.

Shirtwaists were a kind of trendy women’s blouse, and the Triangle factory, which occupied the top three floors of the 10-story Asch building, could barely make them fast enough to keep up with demand. Each floor of the crowded Triangle factory had two exits. But the Greene Street exit, the one that workers were herded through at the end of each day so that bosses could search the workers’ handbags for stolen goods, was blocked by flames after the blaze exploded near the end of the workday that Saturday.

The only remaining exit, the Washington Place exit, was locked — a huddle of desperate workers burned to death trying to open it. Fire escapes led nowhere and eventually collapsed in a mangled mass of heat-compromised iron.  Workers jumped down the elevator shaft into a heap of corpses on top of the elevator, which had shuttled many panicked workers to safety until the heroic elevator operator, Joseph Zito, knew it could run no more.

The fire department responded quickly, but their ladders weren’t tall enough to reach any of the victims. The factory owners, Max Blanck and Isaac Harris, managed to escape the inferno. (Later, Blanck and Harris were found not-guilty of wrongdoing in a contrived court case, and had to escape the courthouse undercover as the families of the victims cried for justice. They went on to have additional scuffles with the law over suspicious fires and illegally locked factory doors).

Several days after the fire, a funeral procession of 120,000 workers marched in the pouring rain, as 300,000 grief stricken New Yorkers looked on in a demonstration of unity. Marchers pledged never to forget the fate of the young women and men of the Triangle Shirtwaist factory.

We need not sully the memory of this tragedy by comparing the plight of the Triangle workers to the work conditions that most Americans enjoy today. But nor should we dishonor the memory by neglecting to apply the lessons we can draw from it.

Bestowed with a broad charge and powers to investigate the Triangle fire and the work conditions of factory employees throughout the state, the New York Factory Investigating Commission in 1912 argued that the “human factor is practically neglected in our industrial system,” and reported that employers had “shown a terrible waste of human resources, of human health and life.”

Foreshadowing current events, in which government intercedes where employers fail to regulate themselves, the Commission spelled out the true significance of worker health:

Health is the principal asset of the working man and the working woman… Aside from the humanitarian aspect of the situation, economic considerations demand from the State the careful supervision and protection of its workers. Failure to perform this obligation will produce serious results in the workers of the future. It will affect the working capacity of the future generation.

The Commission recognized that worker health had implications for society as a whole, in the present and in years to come.

Indifference to these matters reflects grossly upon the present day civilization, and it is regrettable that our State and national legislation on the subject of industrial hygiene compares so unfavorably with that of other countries.

Other industrialized nations continue, more than 100 years later, to surpass the US in the protection of total worker health. They emphasize psychosocial health at the workplace, regulate limits on overtime, require paid sick time, and encourage workers to take needed leave to care for newborns and for ailing family members.

The work of the Commission set the tone for widespread changes in labor practices, without which the comfort many of us enjoy in today’s workplace likely would not exist. (Many of us enjoy comfort, but not all.)

And, yet, today, when employee health is discussed in journals, in lay media, and at conferences, we persistently neglect the “human factor,” which the Commission identified as the core of worker wellbeing.

The question, “Does employee wellness work?” is posed consistently with an assumption that “wellness working” is measured in employer cost savings or increased output. This commodification of human life stands in marked contrast to the social consciousness, the compassion, the empathy, and the vision that swept the nation after the Triangle fire.

Rosaria Maltese was 14 years old. Bettina Maiale and her sister, Frances, were 18 and 21, respectively. Ida Brodsky was 15. Fannie Rosen, an immigrant from Kiev who had worked at the Triangle factory for only two days and was one of the last six victims identified — a century later — was 21 years old. These girls were among the 146 employees who perished in the Triangle Shirtwaist factory fire on March 25, 1911.

Fannie Rosen, age 21

Fannie Rosen, age 21

With a unified voice, Americans pledged that we would never forget these girls and their courageous young coworkers who fought to be treated humanely, who suffered and endured, and left a legacy from which most of us now benefit every day of our lives. Just as we now pledge to always remember the victims of the 9/11 terrorist attacks, we once gave our word that we would remember the sacrifice represented by the charred remains of 146 Triangle factory workers.

But every time we argue, or simply assume, that the primary purpose of employee health is not the human factor but is, instead, simply to save an employer money…we harden ourselves against the memory of Rosaria, Bettina, Frances, Ida, Fannie, and the others.

As former Secretary of Labor Hilda L. Solis wrote in her commemoration of the 100-year anniversary of the Triangle Shirtwaist factory fire, “We must always be a nation that catches workers before they fall.”

Much of the information in this post was drawn from: Kheel Center, Cornell University. The 1911 Triangle Factory Fire, accessed January 15, 2015, http://trianglefire.ilr.cornell.edu/index.html.

How Unhealthy Is Job Strain?

in Uncategorized, Stress, job design, job strain

job strain is harmful to employee health and wellbeingJob strain is a particularly insidious form of stress that goes far beyond overflowing inboxes or tight deadlines. It is characterized primarily by organizational environments and job structure in which employees have high levels of demands placed on them and limited control over those demands (that is, low “decisional latitude”). This is the demand-control model that was originally described and measured by Robert Karasek. Other organizational and job-related factors that contribute to unhealthy job-related stress are effort-rewards imbalances, long work hours (sometimes including long commutes), job insecurity, and lack of social support on the job. Some researchers have categorized all of these stressors as job strain, others differentiate them. But most agree that these stressors — all related to organizations and job design and not to individual behavior — lead to negative health outcomes.

How unhealthy is job strain?

Job strain has been linked to hypertension and to heart disease. This is not a simple matter of people who have other risk factors, like pre-existing hypertension or what used to be called Type A personality, being drawn to stressful jobs. Research suggests a causal relationship between job strain and both hypertension and cardiovascular disease. (Some studies also have linked job strain to depression, musculoskeletal disorders, dyslipidemia, physical inactivity, obesity, and adverse birth outcomes.)

Blue collar workers are more prone to the effects of job strain compared to white collar workers, but no one is immune.

Not every study of job strain has confirmed this relationship, but most have. A 10-year prospective study of 22,086 female health professionals, published in 2012, revealed that women with active jobs (high demand, high control) and high levels of job strain (high demand, low control) were 38% more likely to experience a cardiovascular disease event (such as heart attack or diagnosis of atherosclerosis) compared to women reporting low job strain. During the study, there were 170 myocardial infarctions, 163 ischemic strokes, 440 coronary revascularizations, and 52 cardiovascular-disease-related deaths, reaffirming that cardiovascular disease is a major concern for employers and for public health.

A Finnish study of 812 employees, followed for more than 25 years, found that employees with high demands at work and low job control had a 2.2-fold increased cardiovascular mortality risk — independent of other risk factors — compared to their colleagues with low job strain.

Earlier this year, an Israeli study confirmed a link between job burnout and coronary heart disease. Job burnout was defined as physical, cognitive, and emotional exhaustion that results from stress at work. Factors contributing to burnout included most of those typically associated with job strain or job stress: heavy workload, lack of control over job situations, lack of emotional support, and long work hours. Over the course of the study, 8,838 male and female employees were followed for an average of 3.4 years. Each subject was measured for burnout, which, as it turned out, was associated with a 40% increased risk of developing heart disease. Of greatest concern, the 20% of participants with the highest burnout scores had a 79% increased risk of heart disease.

A British study of 6,014 workers, followed for an average of 11 years, found that three to four hours of overtime per day is associated with a 1.6-fold increase in coronary heart disease risk, independent of other risk factors. (More about overtime in a future post.)

Countless research studies have demonstrated the relationship between job strain and health.

Unlike many other countries (again…especially Scandinavian countries), American employers continue to insist on offering employees behaviorally based stress management programs, such as relaxation programs and time management seminars, rather than trying to address the program where the employer actually has the most control: the structure of the organization and the jobs within it.

Even the National Institute for Occupational Safety and Health declares, “Working conditions play a primary role in causing job stress” and it advises,

As a general rule, actions to reduce job stress should give top priority to organizational change to improve working conditions.

Check out the NIOSH page for some ideas about the type of organizational change that is needed.

Emphasis on the organization’s role, rather than the employee’s role, may have applications beyond stress. Fitness challenges, biggest loser contests, tobacco-free campuses, incentives, health risk assessments, coaching, health screenings, yoga classes, and even culture-of-health have limited potential to evoke meaningful population health improvement…as long as the roots of the problem persist.

[A version of this post was first published on Bob Merberg’s Health Shifting blog on December 20, 2014]