It may be too late for employee wellness professionals to adjust their plans for holiday-season programs this year, but now is an ideal time to rethink the holiday stress programs we typically offer.
Every December, wellness program managers promote programs about managing “holiday stress.” These commonly take the form of lunch-and-learns or communication campaigns. They have the usual catchy titles like Holiday Stress Less and Take the Hassle Out of the Holidays.
The holiday season is stressful for many employees — no doubt about it. And it’s distinct from other sources of stress in the workplace in that the conditions that cause holiday stress can, indeed, be modified with behavioral approaches.
But I suspect that our holiday stress programs add to employee stress. They contribute to a culture that considers stress the primary mental state in which we experience the holidays and, as such, comprise a self-fulfilling prophecy.
May I suggest a new approach to promoting mental health during the holidays, even if some of the content may be the same? Let’s offer programs that promote happiness and joy, rather than just trying to remediate stress. Next year, instead of teaching people to manage holiday stress, why not teach them how to nurture their holiday happiness? Why not publish newsletter articles like “How to Share Holiday Joy”?
Instead of “5 Tips for Managing Your Holiday To-Do List,” how about “101 Reasons to Enjoy a Holiday Vacation”? Rather than “Balancing the Burdens of Work/Life During the Holidays,” how about “Focus on Family this Holiday Season!”
[Originally posted by Bob Merberg in May 2010 on the In TEWN blog.]
Summer’s here, and it’s time to unstrap the Fitbit and track some physical inactivity — the kind, for example, that takes place while reading. Pictured here is a pile of books that I’d recommend, or almost recommend, to wonky wellness professionals who have been at it for a while and are still searching.
You may think it weird that some of these books are old or even out-of-print. What good does an out-of-print book recommendation do you? Well, sometimes the story of a book is worth telling just as much as the story inside it.
Starting at the bottom of the pile…
Making Health Communication Programs Work.
Can you imagine there was a time — from 1989-2004, to be exact — when the US government gave this health communication book away for free? All you had to do was call and ask. This was the authoritative source on health communication — with more of a public health bent rather than employee wellness — affectionately known to health communicators as “The Pink Book.”
The good news is that you can get the final version of the book as a pdf. Who cares if it doesn’t include the last 13 years of developments? Who cares if the last entry in the glossary is a definition of “World Wide Web”? The book still covers an evidence-based approach to health communication theory and practice, with some behavioral change theory thrown in to boot. Get on it.
I’ve been studying the Hawthorne experiments for the last couple of years, and have assembled quite the collection of yellowed, musty, out-of-print books, this being one of the most important and, published in 1993, the most recent. At the heart of the matter is the field study of workers, supplemented with detailed interviews of 23,000 workers, under different conditions at Western Electric’s Hawthorne plant outside Chicago, in the 1920s and early 1930s. It stands as one of the most important studies of workers, management, and productivity ever.
While the Hawthorne researchers weren’t committed to worker wellbeing as we think of it, they did recognize wellbeing as relevant to productivity. And much of what we believe today about management styles, leadership, employee engagement, and teamwork was rooted in the Hawthorne research. Forget the fact that it started as a study of lighting, or that it had an entire category of bias named after it. Most experts today believe that if there is such a thing as the Hawthorne effect — in which research subjects change their behavior simply as a response to being observed — it didn’t occur at Hawthorne.
Let’s get real… You’re not going to read an old book about a 90-year-old study. So take 9 minutes to listen to this peppy BBC podcast on the topic. Regardless of the Freakonomics interviewee drawing an unfounded explanation of the Hawthorne findings, the podcast may start to give you a sense of how important the Hawthorne experiments are to our understanding of work, motivation, and even research design.
Yup, out-of-print — I don’t know why, as this is a seminal classic about the relationship between work and health, in which Robert Karasek, one of the most important worker health researchers of our time, lays out the case for the demand/control model of job strain.
Healthy Work may be too technical for a lot of people, but if you can get your hands on a copy, it’s great to keep around and skim through whenever you have a chance. Healthy Work changed how managers, health agencies, and labor organizations around the globe think about worker health.
Health Behavior and Health Education.
Get the 2015 version (5th edition), which is called Health Behavior: Theory, Research, and Practice. Health behaviors aren’t the foundation of employee wellbeing. (Exposures are.) But whether you agree with me or are convinced that, like people always say, “it all comes down to behavior,” isn’t it important to understand what makes health behavior tick?
This book was published in 2000 predominantly for clinicians and other wonks. It gets highly technical — so it’s not something you’ll want to read at the beach. But I keep it handy on my desk. It’s a collection of evidence documenting the relationship between work, psychosocial job stressors, and health, and suggesting a causal relationship — that is, bad jobs lead to poor health. The rigor of the studies contrasts with the vendor- and employer-fueled quasi-science to which wellness professionals are customarily subjected.
Amazon usually sells The Workplace and Cardiovascular Disease, used, for less than 10 bucks. If you want something cheaper and more current, you can try to access the article, “Globalization, Work, and Cardiovascular Disease,” published in 2016 in the International Journal of Health Services. Two of the article’s authors, distinguished researchers Peter Schnall and Paul Landsbergis, were among the editors of the book.
The only thing I find more painful than hearing our industry called the “ignorati” is noticing that we often do ignore criticism. Sure, we’ve all been paying the price for Al Lewis’s book ever since it was published, but we can be thankful that someone cast skepticism on the claims of the wellness industry. I don’t know if this is Al’s goal, but it is mine: To get better at supporting the wellbeing of the American workforce. In order to achieve this, we need to be able to assess our practices critically, and this book rallies us to do just that.
Former Washington Post reporter turned work-life balance hunter, Brigid Schulte, endeavors to wake up America to the mess we’ve gotten ourselves into by putting obsessive “busyness” and profits ahead of our kids, our spouses, and ourselves. Schulte deconstructs an American culture driven by a destructive sense of individualism and machismo that puts us on a never-ending treadmill — the unhealthy kind — as well as the policies and gender inequality that keep us there. She draws upon the experience of her own work and family life, and visits Denmark where the possibility of a better way reveals itself to her.
Health is influenced by social status — specifically, our position in the spectrum of autonomy and of full participation in society. The workplace is a microcosm for this “social gradient.” Epidemiologist and author Sir Michael Marmot, who has devoted his career to spotlighting the social determinants of health, led the Whitehall studies — investigations into the work lives and the health of thousands of British civil service workers. Whitehall II is among the most important studies of worker health, but — as with much of the excellent research from Europe and other countries around the globe — is noncommercial and, consequently, infrequently discussed at American wellness conferences. Sir Michael once wrote in Lancet,
Healthy behaviors should be encouraged across the whole of society. More attention should be paid to the social environments, job design, and the consequences of income inequality.
Of all the books in my pile, this is the one I most enjoyed reading. If it’s nothing else to you, it’s a heart-wrenching story well told. Triangle also is filled with historical detail about working life that, for many, will continue to resonate today. The importance of the Triangle Factory fire — along with the events that preceded it and those that ensued — remind us of the context for worker wellbeing, and how it represents something more profound than lower health care costs or even improved morale.
Worthwhile reading, but not in my pile:
Workplace Wellness That Works, by Laura Putnam. At this point in my career, I learn most by delving into topics that are unrelated or only somewhat related to wellness. I don’t own Laura’s book, but I flipped through a co-worker’s copy and found it to be thorough and well-researched. This is the book I’d recommend to someone who’s looking for wellness ideas or trying to assess the evidence basis for employee wellness.
Quiet: The Power of Introverts in a World That Can’t Stop Talking, by Susan Cain. Quiet raises consciousness about what life is like for the large segment — perhaps the majority — of employees who consider themselves introverts. This is relevant as we plan our wellness programs and events and target our communications. Quiet isn’t on my pile because I lent it to someone and never got it back. I’d like to think that’s some sort of endorsement.
Any text on occupational health psychology. I like The Handbook of Work and Health Psychology, but others will do. Just as we should understand health behavior if we want to influence employees’ exercise and eating habits, we need to learn the science behind stress, burnout, adjustment to change, resilience, depression, motivation, and engagement.
Even if we don’t always understand the science of worker health, we benefit from recognizing that there is science to worker health.
For those interested in evidence-based approaches to wellness, reading these or similar books will be a breeze this summer.
Congratulate me! This week, I celebrated ten wonderful years at my current job.
Yes, I started in the thick of the holiday season. I remember my first day, a co-worker came over to my cubicle to offer me a gooey chocolate confection she was serving off a piled-high tray. “Wow, what a classy holiday treat!” I thought.
Another co-worker left a tray of Italian cookies on the long credenza down the aisle. Then a couple of gifts came in from vendors — caramel-dipped popcorn from one, mixed nuts from the other — and they also were put on the credenza to share.
Then we had a big meeting where I was introduced, and a giant bowl of candy was passed around, for reasons unknown to me. It reminded me of my orientation the day prior, when the facilitator did an ice-breaker by asking us trivia questions about the company, and if you answered correctly he threw you — threw you! — a packet of M&Ms.
Anyhow, after the candy-bowl meeting, I was taken to lunch at the company cafeteria, where I enjoyed a good-sized serving of pork tenderloin with a side of fries. For a beverage, I stuck with water — you know, to keep it all healthy.
Holiday feasting and food-sharing are wonderful and important social traditions. Little did I know back in those days that the feasting had little to do with the holidays, and would ebb and flow — but mostly flow — for the next 10 years.
It surprised and saddened me back then that, as I was introduced to co-workers as the new wellness manager, they sometimes felt the need to make an awkward joke about whatever food they had around at the time, assuming I was judging them for the muffin on their desk or the McDonald’s bag they were carrying.
But I wasn’t judging, and never have. I’ve observed an unbridled abundance of edible goodies pervasive in the workplace — my workplace and others — and I believe it’s a force in wellbeing that employees quietly contend with daily. But, indeed, it’s a force that challenges me — I like food, too — so far be it from me to judge anyone else.
Here are some of my observations and thoughts — optimistic, skeptical, and neutral — about the promise of this new player on the employee wellness scene:
Giving a keynote presentation at a small conference last April, I speculated that burnout will be the next employee wellness trend — on the heels of mindfulness, sleep, and financial wellness.Thrive Global positions “burnout” front and center. Their announcement states,
Thrive Global’s mission is to change the way we work and live by ending the collective delusion that burnout is a necessary price for success
Thrive Global currently has seven employees. In light of recent consolidation in the wellness industry, we may expect that the company’s plans include significant partnership (possibly including acquisition or merger) with an existing wellness vendor.
Thrive Global already is partnering with basketball players Kobe Bryant and Andre Iguodala, and football coach Pete Carroll… (…because, when employees struggle with their physical and mental vitality as a result of working multiple jobs, being torn between the demands of their family and their employer, enduring long commutes to a workplace where they’re overwhelmed with responsibilities that aren’t clear or meaningful to them, being subjected to unfair or hostile environments where their efforts aren’t rewarded, feeling alienated, and/or being anxious about the possibility of losing their job altogether — the variables known to be drivers of employee wellbeing and burnout — who better to help than a pro basketball player and a football coach?)
A seat on Thrive’s Board of Directors is held by Aetna CEO Mark Bertolini, de facto czar of the mindfulness-industrial complex. Time will tell whether this relationship leads to Thrive Global having ready access to Aetna’s 23 million members or its 50,000 employees (who often serve as test subjects for the insurer’s innovations).
The announcement states that Thrive Global will partner with “thought leaders including Adam Grant… to measure the impact of its services on employee retention, wellbeing, and productivity, as well as organizational culture.” Grant is an organizational psychologist — a field conspicuously absent from the US wellness scene — with a track record of insightful research and a knack for contributing to marketable content. Possibly to Mark Bertolini’s chagrin, Grant authored the New York Times article “Can We Stop the Meditation Madness?“
On the consumer side, Thrive Global is planning an e-commerce strategy that includes products like “sleep kits,” pillows, beds, candles, supplements, “food products” and “lines of product and subscription boxes specially curated by celebrities and athletes.” This is one of the biggest red flags. Is Thrive Global a serious company “aimed at changing the way we work and live’’ as they say in their announcement? Or a celebrity-fueled new-age bazaar “capitalizing on this growing market opportunity” (as the investor pitch explains)? Or both?
Arianna Huffington is a former feminist-bashing “Republican Revolutionary” metamorphized into a liberal self-help guru. The investor pitch says Thrive Global “leverages the brand and success of Arianna Huffington as the face of the platform to drive adoption.” For more about how the brand was built and about the twists and turns of Huffington’s activism, check out the 2008 New Yorker article, The Oracle: The Many Lives of AriannaHuffington
We’ve had one of our [startup] partners say to us: ‘Everyone here does three jobs.’ There has been this hero mentality and sometimes in that culture companies want to change that so they can do right by their employees…
Levy has described Thrive Global’s corporate offering as a consultancy. The investor pitch envisions, “Organizational Design consulting to establish structures and systems that support Thrivers, eg. workspace design, (including nap and quiet rooms), healthy snack offerings, team communications design and more — all within an educational framework that encourages healthy choices.”
In an interview conducted by Benz Communications, published last week, I called for the convergence of independent wellness research with wellness product. Though it may be agonizing to see employee wellness take a turn toward celebrity-worship, health fads, and opportunism, Thrive Global may be just what this convergence inevitably looks like in real life.
What do you think? Visit the LinkedIn version of this post and chime in with your opinion.
Like many industries, we in the wellness biz tend to run with the herd. A few years ago, all we could talk about was mindfulness. Then we veered toward resilience. Last year, financial wellness was the buzzword. This year, the herd must be getting tired, as we switch direction toward…sleep.
New sleep program providers are cropping up, and existing wellness vendors are waking up to the opportunity to hop on the bandwagon.
Don’t get me wrong. Mindfulness, resilience, financial wellness, and sleep are important.
And I’m not saying that none of us have run against the herd by addressing these topics before they got trendy or supporting employee wellbeing in innovative ways. But, in general, our industry flits from one topic to another, from one tactic to another, falling in line with our herd’s stampede. The risk is that workers get trampled in the process.
One key to sustaining established wellness efforts, rather than letting the sun set on last year’s program as dawn breaks on this year’s, is to strategically scale up the size of the team that operationalizes these efforts. In other words — to use the term HR has eerily adapted from cattle ranchers — “add headcount.” Expand resources in proportion to demands? What a concept.
Despite my earlier acknowledgment that our herd mentality is comparable to other industries’, there is a difference: Other industries — especially those that are consumer-oriented — respond to changes in demand: Cold-pressed juice with chia one day, probiotics the next. Fuel-efficient cars one year, technology packages the next.
What drives our wellness herd?
As our newfound devotion to employee sleep takes hold this year, I suspect our herders may be revealed to us if we keep an eye on who is sponsoring the events, the publications, and the research that promotes it. There, the presence of vendors and pharmaceutical companies, for example, wouldn’t invalidate sleep as an important issue for employees, but it seems unlikely to serve as a sustainable driver of a successful long-term employee wellbeing strategy.
In 2013 the LA Times quoted Dr. Anup Kanodia serving up the catchphrase, “Sitting is the new smoking.” Ever since, you’d have to be an epidemiologist to separate the fact from hype. And you and I are no epidemiologists.
Personally, I’ve resisted the phrase “sitting is the new smoking,” except to use it mockingly. In equating sitting and smoking we diminish the 50 years of investigation, social change, and sacrifice committed to understanding and addressing an insidious chemical dependency — tobacco use — that remains the world’s leading preventable cause of death.
But I get it. Prolonged sitting puts us at risk for future disease and premature death, inducing harm that can’t be undone even by regular exercise. The research suggests that interrupting prolonged periods of sitting is essential to health.
No one is surprised to hear that lack of physical activity is a health risk factor. The unique finding in the sitting research is that there is something deadly specifically in the act of prolonged sitting — the position itself — and that standing (or breaking up periods of sitting with standing) has health benefits. The recommendation from a landmark study in 2010 was:
Public health messages should include both being physically active and reducing time spent sitting.
seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks.
For starters, the panel advised sedentary workers to accumulate two hours of standing or light activity (such as the type of low-speed walking you do on treadmill workstations, which usually have top speeds of 2.0 mph).
The 2010 study and others like it catapulted the popularity of standing workstations, which already were on the rise as a potential solution to ergonomic back pain. In my experience, however, enthusiasm for standing workstations was quickly eclipsed by a preference for sit-stand workstations, which offer workers the option to change position at will.
“Sitting Is No Worse Than Standing”
In recent weeks, however, we’ve seen a slew of studies that offered new perspectives — some refuting previous research about standing, some expanding on it:
be cautious about placing emphasis on sitting behaviour as a risk factor for mortality
Next… Hold the phone. Acknowledging that there’s “insufficient evidence specifically focusing on the public health and medical implications of increasing daily standing,” researchers set out to identify the relationship between standing, metabolic syndrome (a cluster of risk factors), and obesity. They found that people who spend 25% of their day standing are less likely to be obese compared to more sedentary counterparts.
The plot thickens: Much of the earlier research was based on subjects’ total time spent standing or sitting. An employer may well question why they should invest in a sit-stand workstation if Joe-The-Knowledge-Worker goes home and spends hours on the couch at home. Why not encourage people to stand while watching TV or eating? Is the idea of a standing dining room table or a raised counter in front of the TV really so far-fetched?
Sitting at Home Is the New Sitting at Work
Along comes a small study that evaluated the outcomes of workers outfitted with sit-stand workstations. Data was collected via self-report and via instruments that monitored the workers’ position. The conclusion: Workers using sit-stand workstations spent significantly less time sitting at work…but significantly more time sitting while they were home. (Interestingly, previous work showed that workers with sit-stand workstations spend more time standing at work, but was not able to correlate this difference to health outcomes.)
That employees with sit-stands spend more time sitting at home is entirely plausible. Consider our tendency to overcompensate for a workout by overeating afterward. Another explanation may be that people standing more during the day experience fatigue that leads them to sit more at home.
Speaking of fatigue from standing, read on…
Standing Is Linked to Problems with Pain, Cardio Health, Pregnancy
For me, an irony of our newfound penchant for standing is the long and hard-fought battle workers previously waged to sit more. This came to my attention when I researched my blog post about the workers who ultimately perished in the Triangle factory fire. Seamstress jobs at the Triangle factory were considered cushy at the time, because the workers sat all day, in contrast to the more common manufacturing jobs in which workers toiled on their feet for hours on end.
Prolonged standing was identified as an epidemic health risk long before cigarette packages even existed to put warnings on. In the 17th century, Bernardino Ramazzini, the “father of occupational medicine,” called for shorter periods of standing and more frequent breaks during work.
A recent analysis confirmed that prolonged standing at work increases risk of low back pain, fatigue, cardiovascular problems, and adverse pregnancy outcomes. Most modern-day experts favor a mix of sitting and standing rather than prolonged periods of either.
At this point, the body of evidence remains a labyrinth, with important variables — sitting at work vs. away from work; the role of standing vs. physical activity — not fully teased out. In the interim, we need to be wary of the “sitting is the new smoking” hype and learn more about the problem and the solutions.
In my opinion, pending further research, sit-stand workstations are a reasonable solution to attenuate problems associated with prolonged sitting at workstation desks. They give the worker more control over the work, which, all things being equal, is always a good thing for employee well-being.
I also have come around to supporting treadmill workstations, though I sacrifice a piece of my soul in doing so. Some physical activity is better than no physical activity, just as shifting positions is better than prolonged sitting or standing. But treadmill workstations seem just a step away from succumbing entirely to absurdity and putting workers in a hamster wheel.
There’s another approach that may be more sensible, well articulated in the quasi-satirical New Republic piece, “Screw Your Standing Desk!”
Of course the long, stationary workdays of most Americans are unhealthy. The solution should not be to sit less, but to work less. If sitting is as bad as the doctors say—and I’m sure it is!—then why not prescribe longer lunch breaks, shorter hours, and more vacation? You can still be chained to a standing desk.
Last summer, I offered up my family as guinea pigs for a local Community Supported Agriculture program (CSA). As the leader of an employee wellness program, I was considering creating a partnership with the CSA to have shares of their harvest delivered to employees directly at work, and I wanted to check it out myself, first. If you’re not familiar with how CSAs bring together residents and farmers to support local agriculture and promote fresh food, find out more about them here.
My family started getting our weekly deliveries of vegetables and fruit — eagerly checking-in with the earthy young workers at the local pick-up spot and collecting our garlic scapes, bok choy, berries, broccoli, peas, greens, corn, chard, melon, and so forth.
My epiphany occurred around week two of the 14-week summer season. We’d received a bunch of green peas in that week’s harvest. The pods were plump and firm and seemed ready to burst. Like I said, I’m no foodie, and I wasn’t sure whether to eat the pods. So I did. Raw. I had about six or seven, and soon felt like I was digesting an electric sander. The next night, we cooked them, which I thought might soften them up but instead just seemed to toughen the fibers. So I went to the CSA’s Facebook page and asked whether the pods were edible.
“All that hot weather,” they wrote back, “followed by the thunderstorms made those peas really GROW in the last week. So, although typically delicious and tender. if you don’t enjoy the shells a bit more fibrous, the peas themselves are still delicious…”
That muggy weather. Those storms! I remembered them from just five or six days earlier. As I held a plump pea pod in my hand, I was thunderstruck by how it had been affected by the same storm clouds that had flash flooded the roads during my commute and overflowed the roof gutters of my house. There was a direct line from the weather into the ground through the pea and into my body. We were connected.
Of course, this realization isn’t that novel — even for a city kid like me. After all, I’d planted gardens that were influenced by the environment. But something about this direct experience of it in my core food supply brought it home and made it real. And I related to those pea pods, and all the veggies that came after, in a way that I’d never related to food before.
At work, we went on to pilot delivery from the CSA to employees at four worksites. One hundred co-workers out of about 2500 participated. That may not sound like a lot, but we chose not to set participation goals and didn’t push the pilot aggressively. We weren’t trying to change anyone; we were providing employees with a convenience they’d been asking for.
I considered subsidizing employees’ purchases. In today’s world of wellness, however, a subsidy functions like an incentive — and health incentives are deadly to the success of employee wellness programs. But I may rethink this.
The primary objectives of the program were:
To support employees who seek convenient access to whole, fresh food.
To support local agriculture.
But what I hope may be a bonus, and the reason this small program might be the most important wellness program I’ve ever offered, is because it has the potential to help employees experience their relationship with food in a whole new way — just like I did with the peas (Caution, however: n=1!).
Most healthy eating promotions used today — calorie labeling and nutrition education, merchandising tactics like those promoted by the Cornell Food and Brand Lab, and behavioral interventions like Weight Watchers— haven’t been a match for the proliferation of unhealthful food, oversized portions, and appetites that, for whatever reason, are insatiable. Conventional approaches have their place, but none have achieved good results on their own. And, with the possible exception of mindful eating strategies, none get to the root of the matter by a change in folks’ relationship to food, potential that exists with a CSA partnership.
I believe we also experienced an unintended consequence: A social effect that stands to bolster an employee community that rallies around well-being. Not only do some participants choose to split their shares, teaming up to divvy their bounty and exchange recipes, but on the day the large boxes filled with each week’s share were delivered, there was a heightened level of energy, curiosity, and camaraderie amongst co-workers.
We expect participation to double this year. Our next step is to source some of our employee cafeteria menu items from the CSA. This will, of course, support local agriculture in an even bigger way. More importantly, it will make high quality food available to a larger population, and it will integrate with our CSA purchase program — cross promoting and allowing prospective participants to experience how local crops can be transformed into delicious meals.
And a little transformation can go a long way.
(My wellness colleagues needn’t fret about the usual… ROI, outcomes, and definitions of terms. We’re helping get fresh veggies onto the tables of employees and their families. No vendors, no registration, no incentives, no behavior change, no contracts. The simplicity makes it sublime.)
Only about half of employers evaluate their employee wellness program’s effectiveness, so it may be time to own up to the possibility that you have no idea whether your program is helping or hurting, or whether anyone even knows you have a program. Or whether your company even knows it has you. That’s okay. You’re okay.
Here are 15 Do’s and Don’ts to help you rise out of the abyss of employee wellness mediocrity:
Don’t:Expect your program to reduce health care costs. Most likely, it won’t. Do: Strive to support your employees’ wellness aspirations. Positive outcomes originate with your good intentions.
Don’t: Encourage your employees to get annual screenings. Screenings are probably one of the least cost-effective components of your program. Do:Offer your employees paid time off and good health insurance so they can get the care they need, when they need it.
Don’t: Get caught up in language: “Wellness” vs. “well-being”; “return-on-investment” vs. “value-on-investment”; “health risk appraisal” vs. “health assessment.” Not only are these sideshows, but in most of these debates, the wellness industry is settling for the less specific — hence, less measurable — option. That said… Do: Distinguish between “participation” and “engagement.” To use them synonymously is downright fraudulent. Especially: If you have incentives, you have unengaged participation.
Don’t:Call your health surveillance program an “outcomes-based wellness program.” It gives a bad name to those of us, and those employers, who truly care about worker wellness. Do: Speak out — in professional networks, on social media, at conferences, in journals, and in your company — against the scourge of “outcomes-based wellness.” If you don’t stand up to protect employees from mercenaries trying to pass off discriminatory tactics as “wellness,” who will?
Don’t: Try to address all the dimensions of wellness. Do: Pursue those dimensions of wellness that employees want addressed, that they will respond to, and that are actionable by and meaningful to your organization. (The dimensions of wellness — physical health, emotional health, spiritual health, financial health, occupational health, environmental health, relationship health, and so forth — are interdependent. When you influence one, you’ll influence others.)
Don’t: Rely on wellness committees to do the work. You don’t use committees to run your other employee benefits or your total rewards programs, do you? Do: Hire qualified professionals to do the work.
Don’t: Do something just because you heard about it at a conference. Do: Avoid insularity by attending wellness conferences and conferences focusing on unrelated industries.
Don’t: Obsess over obesity in the absence of population-based solutions. Do: Provide employees with delicious, fresh, whole food, when it’s necessary to provide food, and with opportunities to move.
Don’t: Get preoccupied with employees’ families. They don’t want you messing in their business. Do: Get preoccupied with the health of the community you are in. They do want you messing in their business, and you’ll stand to affect employees and their families in the process.
Don’t: Take it from me… Do: Seek diverse sources of evidence and opinion, and draw your own conclusions.
[15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Palooza was originally published on the InTEWN blog, April 2015. Some of the links have been updated]
Recently, I chatted with the Human Resources director from an employer known for encouraging “fun at work.” The company had the usual symbols of a fun workplace: foosball tables, slides, Xbox, pie-eating contests, and parties for every occasion. The HR director boasted about parades, in which employees construct floats, dress up in costumes, and march around the office to mark company milestones. I asked, “What if you don’t want to join the parade?” No problem. If you’re not the parading type, you can work on building a float. “Everyone is expected to participate in some way,” she told me. “Our employees know what kind of place this is when they accept a job.”
Fair enough. But count me out. When the data reconciles, when I have that eureka moment of identifying a creative solution to a work-related problem, when a team member rises to a new challenge or lights up when recognized for a job well done… That’s what I call fun. Some employees enjoy the fun of work, and don’t depend on adding fun to work.
Much of what passes for “fun at work” — parties, games, playground apparatus, contests, dress-up, etc. — represents little more than workplace tyranny of extroverts over introverts. And studies show, according to author Susan Cain, that one third to 50% of employees are introverts. So consider that half of your workforce may experience fun by setting their minds to their work, and they may be put off by someone else’s brightly colored and boisterous version of fun.
Lately, the social web has shone a light on “surface acting” in the workplace and the body of research, albeit thin, which suggests that being compelled to demonstrate positive emotions — like when service workers are required to smile and chirp to customers, regardless of what they are actually feeling — leads to emotional exhaustion, stress, and reduced productivity.
While most research demonstrating the negative effects of surface acting is based on studies of frontline workers such as customer support reps, food servers, hair stylists, clinicians, and first responders, blogger Mike Pearce — in a post called Surface Acting: Bad for Business and Your Health — points to a study suggesting that expressing inauthentic emotion in meetings is linked to employee burnout and turnover. Indeed, it’s not unheard of for supervisors to warn office workers — even those who have no exposure to customers — to smile more, a directive that serves no purpose other than allowing the supervisor to perpetuate their own delusion of leading an energized team.
In a LinkedIn post called The High Cost of Acting Happy, Time magazine contributing writer Annie Murphy Paul proposed well-founded alternatives to forced happiness:
Train workers well, so that they satisfy their customers with good service. Offer them congenial working conditions, so that they’re glad to be at work. Allow them more personal control over how they do their jobs (research shows this can buffer the stress imposed by surface acting). And provide them with opportunities to develop genuinely warm relationships with managers, coworkers, and customers—so that employees have something real to smile about, and so that when they tell someone to “be well,” they mean it.
Paul’s advice is rooted in evidence that maps how employee well-being is a product of healthy organizations and job design rather than employee behavioral change.
Do employers’ attempts to foster fun at work actually promote surface acting and its unwelcome outcomes? Do employees really want fun at work? Does contrived fun serve any purpose whatsoever? We’ll need more evidence to know for sure. In the interim, here are six tips for keeping the fun fun, and for keeping the surface acting at bay:
Genuine fun arises effortlessly. It may come organically to some workplaces whose culture is well suited for it. If you try to have fun, you’re not likely to.
Allowing people to bring their individual authentic personalities to the workplace, to express them freely, and to socialize according to their own desires, may be more fun than so-called fun-at-work events, campaigns, or games.
Not all employees seek fun in the workplace, and not every organization needs it. Tune in to employee demographics and organizational culture.
Fun in the workplace efforts may not be the only employer contrivances that promote a culture of surface acting. Be on the lookout for unintended consequences of the increasingly popular resilience and positive psychology initiatives so that stress, sadness, depression and even everyday introversion are not stigmatized.
What employees and employers sometimes perceive as a need for more fun may actually be a need for something else — gratification, camaraderie, satisfaction, purpose, hope, inspiration, or self-expression.
Based on studies of surface acting, expecting employees to act like they are having fun may lead to burnout, job dissatisfaction, turnover, and absenteeism. And that’s no fun for anyone.
I’ve previously mentioned that Scandinavia has pioneered research about job-related stress. Now, we learn that Scandinavian countries — specifically, Norway, Sweden, and Denmark — are the only ones that have a word for “happiness at work.” The word is arbejdsglaede. And, no, that’s not a typo.
Below is a video about arbejdsglaede.
The video is oodles of fun, but I have one beef with it: It advances the conventional American notion that employers are not responsible for employee happiness, and that your happiness is entirely in your hands.
Certainly, you have some accountability for your own state-of-mind. But Scandinavian research has shown repeatedly that organizational structure and job design are the primary drivers of employee well-being. So go ahead and grab yourself some arbejdsglaede — happiness at work — if you can find it. But don’t be too hard on yourself if you can’t.
[This post was first published back when analog pedometers were more common than accelerometer-based trackers like Fitbits. Most of the information about effectiveness and step counts still holds true.]
I don’t advise pedometer program participants to strive for 10,000 steps per day.
Having each individual aspire to an identical goal flies in the face of everything I’ve learned — or is it assumed?– about behavioral change. But participants have heard the 10,000-step mantra, and sometimes adopt it as a goal. Ultimately, many report getting discouraged when they clip on their pedometers and realize they only walk a baseline of 2,000 or 3,000 steps per day, at which point a 10,000-step goal can be a real motivation crusher.
Where did this 10,000-step goal come from? What are the alternatives? And what’s been shown to work? Pedometer programs are reasonably effective, but solving these mysteries may lead toeven greater effectiveness and may even influence how we think about goal-setting and self-tracking.
Back in the 1960s, a Japanese pedometer manufacturer dubbed one of its products manpo-kei, which translates to “ten thousand steps meter.” There was no known reason the company settled on 10,000 for its product name, but shortly thereafter, Japanese researchers did determine that habitually active walkers typically accumulate something in the neighborhood of 10,000 steps per day.
Since then, evidence has shown that it takes approximately 3,000 steps over and above the average steps taken by typical sedentary people to meet the standard recommendation for physical activity — namely, getting at least 30 minutes of moderate-intensity activity each day. Anything less than 5,000 steps a day is considered sedentary. So a daily recommendation for physical activity — 3,000 steps over and above a baseline of 5,000 — would be 8,000 steps.
The Institutes of Medicine, however, advises that 60 minutes of daily activity is necessary to maintain a healthy weight. This would be equivalent to 6,000 steps, which, when added to the baseline 5,000, means participants should accumulate 11,000 or so steps per day to prevent weight gain.
This establishes that 8,000 to 11,000 steps, a guideline subject to individual variation, is equivalent to the minimum amount of physical activity people should get to maintain good health. The question remains: How do you motivate sedentary employees to achieve this level?
An alternate to the 10,000-steps-per-day goal has been popularized by one of the first widescale pedometer programs, America On the Move, founded by obesity researchers James Hill and John Peters. AOM encouraged participants to wear their pedometers for three days prior to the program, then to set a goal 2,000 steps above their average for these three days. When they achieve this goal, they can set a goal 2,000 steps higher. It’s individualized and incremental.
But research has not shown individualized, incremental step goals to be more effective.
One randomized, controlled study compared participants who had 10,000-step goals to participants who had individualized goals. It found that, although previously sedentary participants rarely reached their goal of 10,000 steps per day, they increased their steps as much as those with the more modest, individualized goal.
Referring to this study, the authors of a 2007 meta-analysis concluded, “Given the relatively similar increases in physical activity among those pedometer users given the 10,000-step goal and users given other goals, we conclude that the relative benefits of setting different goals remains unclear.”
The specific goal didn’t make a difference. What about people who didn’t have any goal whatsoever? The authors of the meta-analysis reported:
“Pedometer users who were given a goal, whether the 10,000-step goal or an alternative personalized step goal, significantly increased their physical activity over baseline, whereas pedometer users who were not given a goal did not increase their physical activity.”
“…It may be premature to make firm conclusions about the efficacy, effectiveness, or appropriateness of any specific step-based goal in terms of behaviour change…Regardless of the number of steps per day, effective programs, informed by the best research on critical moderators and mediators of behaviour change (i.e., what works best for whom under what conditions and at what cost) remain implicitly necessary in terms of increasing individual and population levels of ambulatory activity.”
In the end, it may not be the ambitiousness of the goal, but the existence of the goal — any goal — and a behaviorally sound program, that make the difference.
The significance of this conclusion may go beyond employee pedometer programs. For example: with all the talk these days about the quantified self movement — and people strapping on accelerometers, body sensors, and all sorts of biometric devices — we should not assume that tracking organically leads to improved behavior.
We all know that goals don’t amount to much without measurement. Now we also know that measurement — in this case, step tracking — may not amount to much without goals.
[This post was first published back when analog pedometers were more common than accelerometer-based trackers like Fitbits. Most of the information about effectiveness and step counts still holds true.]
With all the chatter these days about whiz-bang innovations in employee wellness — mobile apps, body sensors, social media, and such — overshadowed is the lowly pedometer program. But why? I’d venture to guess that most employers running robust wellness programs, and even smaller employers just getting started, are offering some sort of pedometer-based program.
What are we to make of these programs, in which employees — usually in teams — wear a pedometer for several weeks and record the total number of steps they take each day? Are they little more than the minor league of more hi-tech solutions?
Given my penchant for evidence-based approaches, you may assume I’d balk at pedometer programs. Not so.
The great challenge of implementing evidence-based employee wellness solutions is that there aren’t many of them. After reviewing the evidence, we frequently have to go with where it is strongest — even if it’s not very strong —as we factor in what’s most feasible and the best fit for our purposes. The “best fit” analysis may include employees’ needs, employees’ wants, resource availability, occupational factors (Do employees have internet access? Are they working on a manufacturing line? Are they in vehicles all day? What’s their educational level?), our organization’s goals and, of course, cultural fit.
I categorize pedometer programs as low-resource/modest-impact. As such, I believe they have a place in many, if not most, employee wellness programs, certainly compared to many of the high-resource/low-impact programs that have grown popular.
Here are some things we know:
Evidence is mixed regarding the effectiveness of pedometer programs. A limited meta-analyses of programs conducted in various settings — published in the Journal of the American Medical Association (JAMA) — found “significant increases in physical activity and significant decreases in body mass index and blood pressure.” (A 2012 Finnish study concluded that a pedometer intervention “was able to affect only modestly some of the outcomes of walking,” but acknowledged, “The intervention seemed safe, inexpensive and highly adoptable in worksite setting.”)
Pedometers can be crude instruments. Their accuracy depends on the quality of the unit. It can vary based on participant age, weight, and walking speed. But, generally, they are sufficiently accurate to be effective in promoting physical activity.
Employees enjoy pedometer programs, and team-based challenges using pedometers may help foster camaraderie and a culture of health at the workplace.
Pedometer programs are affordable, scalable, well received by participants, and work about as well as anything else.
One of the more interesting, unresolved questions, about pedometer programs has to do with the goal — number of steps — recommended to participants. Employee wellness programs commonly implore participants to strive for 10,000 steps a day. Is this based on evidence? Does it work as a motivational strategy?
The question of pedometer programs’ “step goal” goes to the heart of our understanding of motivation and behavior change. We’ll get to some answers in my next blog post.
Much to my surprise, these little devices were shown to increase physical activity by just over 2,000 steps, or about 1 mile of walking, per day.
— Dena Bravada, MD, lead researcher of a Stanford meta-analysis
There may be some employees whose health has benefited based on some feedback they got on an HRA, but not enough to warrant the investment you are making in the HRA (that investment includes your organization’s money; your time; and, perhaps most importantly, your participants’ time, energy, and goodwill). But don’t listen to me. Your employees will also tell you that your HRA doesn’t make much difference to their health. That’s why some employers pay employees up to $500 just to complete an HRA.You wouldn’t have to pay employees to complete a simple form if they actually saw any value in it to begin with.
A series of blog posts about HRAs has deconstructed HRAs with an eye toward better understanding their value or lack of value. Here are the cliff notes:
The conventional framework of employee wellness programs is predicated on the principle that improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.
HRAs are techniques or processes of gathering information to develop health profiles, using the profiles to estimate future risks of adverse health outcomes.
HRAs are dependent on self-reported data, which is valid for effective use in population health management intervention, although its value at the individual level is questionable.
Importing clinical screening values — such as blood pressure and cholesterol — to an HRA does not add much validity to the HRA on an individual basis, but, like the self-reported data, should be sufficient to measure the health risk of a population.
HRAs may help steer individuals towards more intensive programs based on the position of the individual in the strata of the population’s health risk and predicted health care costs.
These findings point to the same thing: Health risk assessment is a population health tool. HRAs’ primary utility is in helping employers identify the health risks that deserve the most attention in order to achieve positive health and financial outcomes. The same tool can then be used to measure a program’s success in shifting the health risk of the population.
Unfortunately, employers have been using HRAs, a population health measurement instrument, as a behavioral intervention. No wonder you are disappointed. Be honest with yourself and with your employees: The HRA is for you — a potentially useful tool in the administration of your program. It’s not an employee benefit, and your employees know it.
Part of the reason employers have mistaken HRAs with a full-fledged health intervention is that vendors have marketed them as such. As a measurement tool, you should reassess whether your HRA is worth what you are paying.
But don’t rush to throw the baby out with the bath water. If you decide that your HRA’s capacity to measure risk in your employee population justifies its use, your next step is to reconsider whether you truly need to have all your program participants complete an HRA every year. Your vendor doesn’t want to hear it, but you may be able to realize the measurement potential of your HRA more cost effectively by having a sample of your employee population complete it every two or three years.
I’m not making a case for or against health risk assessments, just encouraging you to make a well informed and critical decision. What do you want your HRA to do? What does your HRA do? Is your organization getting its money’s worth?
[This article was originally posted on the InTEWN blog July 11, 2012].
Are health risk assessments effective? Three systematic reviews have sought to answer this question.
One of the most rigorous and most recent analyses, Health Risk Assessment: Technology Report, conducted by McMaster University Evidence-based Practice Center for Agency for the Healthcare Research and Quality, examined 118 studies of health outcomes associated with HRAs. The report concluded:
Many HRA programs demonstrated improvements on intermediate health outcomes such as blood pressure, cholesterol, physical activity, or fat intake. However, only one article considered hard health outcomes (i.e., freedom from any of the following after 24-month followup: death, myocardial infarction, stroke, Class II-IV angina, or severe asymptomatic ischemia ). Also, followup periods were often shorter than 24 months. Therefore, we were unable to assess whether HRA programs produced health benefits over the medium to long term.
A previous, similarly comprehensive, review was conducted by RAND Corporation. RAND’s study endeavored to evaluate the effectiveness of HRAs for Medicare populations, but in order to do that their study focused on the evidence of HRAs’ effectiveness in any setting, especially worksites. Rand’s conclusions foreshadowed the AHRQ study, stating, “Interventions that combine HRA feedback with health promotion programs are most likely to show beneficial effects… It is not known if these effects persist over the long term.” But Rand also examined cost-effectiveness — importantly for corporate wellness programs — and added:
Current literature is insufficient to accurately estimate the cost effectiveness of programs using HRA. Limited evidence suggests that a carefully designed program that uses a systematic approach to implement HRA and subsequent disease prevention/health promotion interventions has the potential to be cost-beneficial. Considerable effort is needed to optimize program design, implementation, and evaluation.
Yet another study, conducted by the Task Force on Community Preventive Services and published in the American Journal of Preventive Medicine in 2010, suggested more positive outcomes for HRAs, but still with qualifications. The study concluded that HRAs with feedback “has utility as a gateway intervention to a broader worksite health promotion program that includes health education lasting at least one hour or being repeated multiple times during one year….Results of this review suggest that this intervention may be more effective for some outcomes (e.g., smoking behavior or cholesterol) than for others (e.g., change in body composition).”
(These three reviews, in addition to trying to measure the value of HRAs, also provide comprehensive background information about HRAs — their history, their intended purpose, their modes of delivery, their strengths and weaknesses. If you haven’t studied HRA methodology, I strongly recommend that you read at least one of these reviews. Any of these three reviews will provide much-needed context. The AHQR review is the best place to start.)
Each of these reviews suggests that there is or may be some potential for HRAs in evoking positive health outcomes for individuals, but none of them are a ringing endorsement. In an upcoming post, I’ll offer my own opinion on why employers may want to hang in there with their HRAs.
[This post was originally published on the InTEWN blog on July 6, 2012]
For starters, here’s the prevailing rationale that serves as the framework of most employee wellness programs today:
Most health problems, and their associated costs, are preventable.
Modifiable health risk factors — such as tobacco use, sedentary lifestyle, and unhealthful eating habits — are precursors to many of these health problems.
Many modifiable health risks are predictive of higher healthcare costs and decreased worker productivity.
Employer sponsored wellness programs can reduce modifiable health risks.
Improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.
Important to this understanding of employee wellness are a few other learnings about health risks and their impact on health and productivity:
The number of health risks an individual has may have greater impact on financial outcomes than the severity of any one health risk. This is especially true for clusters of health risks related to heart disease, stroke, or psychosocial disorders (such as depression and anxiety).
Keeping low-risk employees low-risk may be a more direct route to health care cost containment compared to trying to improve the risk profile of high-risk employees. This focus on the low-risk, advocated by Dee Edington, is counter to a commonly accepted approach in which high-risk employees are targeted — based on the theoretical efficiency of targeting the 20% highest risk individuals believed to incur 80% of health care costs.
While it is unsurprising that risk is an indicator of future health problems, risk also is correlated — via mechanisms not fully understood — to near-term health care costs. In other words, one might expect that someone with cardiac risk factors is likely to incur higher health care expenses when they have, say, a heart attack, studies by Goetzel, Anderson, et al have shown that risk factors are associated with higher health care costs even in the near term, before the emergence of full-blown disease.
In employee wellness, absenteeism and presenteeism are the most common productivity metrics.
The model described by Goetzel and Ozminkowski is not the only rationale for conducting employee wellness programs. It may not even be the best rationale. But as we move forward in the next few posts to understand health risk appraisals — what they do, what they don’t do, and how they are perceived by wellness managers — it is essential to understand modifiable health risk and its role in the proliferation of employee wellness programs.
This post originally was published on Bob Merberg’s InTewn blog on May 27, 2012.
A recent Robert Wood Johnson Foundation study of workplace clinics included this:
“When it’s just a disembodied voice on a phone line in place of a face-to-face session, it’s not nearly as likely that [the employee] will form a connection with the health coach, or that the coach can figure out what makes [the employee] tick and what will drive behavior change that’s meaningful and lasting,” a benefits consultant said.
Certainly, when I’m seeking advice about human behavior, who better to ask than “a benefits consultant”?
What’s more, I’ve often heard decision-makers rush to judgement in favor of face-to-face coaching. One benefits director, telling me about her new coaching vendor, gushed, “They only do in-person coaching, which we all know is the best!”
Well, we may all think it’s the best. It’s hard to argue with what appears to be a high-touch approach. But argue I will.
Here are 4 reasons why telephonic coaching may be at least as good as face-to-face coaching:
Telephonic coaching overcomes one of the primary barriers to participation. Employees have limited time, and convenience is everything. With telephonic coaching, they can participate whenever and wherever they want.
Telephone conversations are not “disembodied voices.” If you don’t believe people can communicate effectively via the phone, will you also stand in the way of work-from-home arrangements, mhealth and telemedicine, and even conference calls? To take full advantage of the technologies of the present and future, we’ll need to let go of our old ways of looking at them.
Face-to-face coaching can be woefully expensive and inefficient. In most cases, face-to-face coaching simply is not feasible for employers that have employees dispersed over large geographical regions.
Employees demand and deserve privacy. If you’re an employer with a lot of extra configurable space, you may be able to devise the level of privacy employees demand, in which they cannot be overheard by co-workers, nor will coworkers even see them enter or exit the coach’s workspace. But can you match the level of employees can establish when they call a coach from the comfort of their home or office?
I don’t want to go overboard and try to claim that telephonic coaching is better than face-to-face. Most likely, the situation differs depending on the organization and the individual employee, and the ideal is to offer multiple options to each. But, as employee wellness continues to drive most of its initiatives based on intuition and pseudoscience, I simply want tocaution against assuming that telephonic coaching is in some way inferior to face-to-face coaching.
If you’re still not convinced, here are some studies that support the case:
When was the last time someone asked an insurer or an employer what their return-on-investment is for covering Viagra? Or back surgery? Prostatectomy? Probably never.
Yet we’re repeatedly asked to prove the ROI of wellness — partly because the role of wellness is misunderstood, and partly because we’ve oversold the ROI of wellness, as I outlined in a previous post.
Wellness is as much or more a part of health as those expensive medical procedures. It’s a double-standard to expect that wellness delivers a positive ROI when the same standard is not upheld for much more costly health expenditures.
Some may make the argument that CFOs will always demand ROI because their interests ultimately lie in the bottom line. But CFOs frequently approve expenditures that don’t have a documented ROI, including community service programs, facility maintenance, diversity initiatives, and go-green initiatives, not to mention numerous expenses more directly tied to business goals, such as those associated with creating a brand. All these activities, including wellness, may generate a positive ROI, but it hasn’t been well documented, in many cases because much of the “return” in “return on investment” is difficult or impossible to measure.
When your organization breaks free from what may be a misguided need to generate a numerical value — whether it’s 3:1 or 12:1 — to your wellness program, it will more readily see the full benefits of wellness, beyond the control of health care costs. These include:
Helping to keep employees healthy is the right thing to do. In fact, public health is dependent on having all sectors of society — employers as well as governments, schools, faith-based organizations, and so forth — working toward health improvement. Smoking cessation, reduced littering, and civil rights are just a few examples of how major changes in society require the broadest possible efforts. Ultimately, employee health is a component of an employer’s social consciousness.
Wellness programs may promote job engagement. A recent Well-Being survey showed that 40 percent of employees believe wellness benefits encourage them to work harder and perform better. Another survey, conducted by the World Economic Forum and Right Management, found that employees are eight times more likely to be engaged in their work when employers actively promote health and well being.
Wellness programs may enhance retention. The Well-Being survey cited above found that nearly half of Americans would stay at their jobs longer because of employer-sponsored wellness programs. The Right Management survey found that employers perceived as pro-wellness are 3.5 times more likely to be seen as encouraging creativity and innovation, and their employees are 4 times less likely to report that they plan to leave within the coming year (compared to employees who do not perceive their organizations as actively promoting wellness).
The United States is the only country where health care cost containment is the primary goal of wellness. “Keeping employees healthy and working” is the primary reason cited by most employers outside the U.S. and, notably, “improving workforce morale” is the primary objective in Asian countries, according to a survey by Buck Consultants.
Just as we all need to work on health improvement, we all do also neeed to work on a solution for spiraling health care costs, which requires strategies based on credible data that may include employee wellness ROI. But ROI is not the be-all-and-end-all of employee wellness, and the sooner we peek out from under the cloud of our single-minded focus on ROI, the sooner we can give our full attention to creating great programs that bring to fruition the full potential of employee wellness.