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Studying the Study: Different Kinds of Analysis Yield Contradictory Results For Illinois Wellness Studyin Uncategorized
This is Part II of a 2-part post. Check out Part I, Does The Illinois Workplace Wellness Study Say What Everyone Says It Says?.
A lot of questions remain about if and how these programs work. We have observed results for only the first year of our intervention. We are continuing to collect data to evaluate effects in the second and third years.
— Illinois Workplace Wellness Study website
The University of Illinois study rolls on as the researchers demonstrate they are eager to uncover the truth and not just confirm over-simplified pre-existing notions about whether wellness works or doesn’t work. Notice that they called their paper, “What Do Workplace Wellness Programs Do?” rather than using a title that declares the issue put to rest, like, say, “Workplace Wellness Doesn’t Work.”
Ultimately, they may very well find that the Illinois program doesn’t yield the desired outcomes (potentially a real kick in the pants for Aetna, one of the researchers’ “collaborators”). Or that it does. If we knew for sure, there’d be no point in the study.
Personally, I’ve never had any reason to believe a wellness program would reduce an employer’s health care costs. But, so far, there isn’t anything in this study I’d cite to support that opinion.
Randomized Controlled Trials vs. Observational Studies
One of the most interesting things about the study is its design. It’s a randomized controlled trial (RCT) — a rare sighting in the world of wellness — and the researchers compared their findings to what they would’ve concluded if their data came from a an observational study (the kind that almost all our healthy lifestyle guidance is based on — from “physical activity is good for you” to “don’t inhale too much asbestos”), potentially explaining, as Aaron Carroll argues in his column, why some wellness studies show that wellness does work. Or, as one of the Illinois study’s principal investigators wrote to me in a private correspondence, “Methodology matters.”
Even when methods are about as good as can be, we probably should never trust a single study with high confidence…Take, for example, the randomized controlled trial (RCT). It’s reasonably considered the gold standard of social science methods. When you read the results of a well-conducted RCT, does that mean you can take them and run with it? Not so fast. They may not apply outside the population studied.
– Austin Frakt, co-editor with Aaron Carroll of the Incidental Economist, in Limitations: The Achilles Heel of Single-Study Relevance
No Reason to Expect Improvement
The Illinois Wellness study is and will continue to be important. It has the potential to deliver actionable insights into the value of incentives; the profile of employees who tend to engage in wellness programs; the types of programs that are and aren’t effective; and, ultimately, the behavioral, health, financial, and productivity outcomes we can expect from comparable programs.
For the university, the iThrive program is a good start — more thoroughly thought-out than most new programs. (Thanks to the study’s transparency, a large employer seeking to launch a wellness program could use the study’s published material to develop a program template — though I’d recommend skipping the incentives and the screenings, and adding longer-range plans for a more comprehensive strategy.) But that’s what it is — a start.
In a non-study situation, smart leaders of a “comprehensive” program, seeing that Year 1 activities had no effect on anything, would undertake a quality improvement process and make adjustments accordingly. After all, if there aren’t any behavior changes in Year 1 — and environment, culture, and work design aren’t even on the radar — there’s no reason to expect health, financial, or productivity improvements in the following years.
I admire the researchers’ refraining from sensational conclusions based on their Year 1 data. Now, it’s up to thought leaders with a media platform, and up to us — those responsible for applying research findings to our programs — to exercise the same restraint.
Does The Illinois Workplace Wellness Study Say What Everyone Says It Says?in Employee Wellness Programs
Seems like every month, the University of Illinois workplace wellness study re-enters the limelight, and earlier this month Aaron Carroll, MD really shoved it center stage in his New York Times piece, Workplace Wellness Programs Don’t Work Well. Why Some Studies Show Otherwise.
This was a randomized controlled study of an employee wellness program. To date, the study results have shown no improvement in health behaviors, health care costs, or productivity. To date.
You can read the full study paper published on the Bureau of Economic Research website. But if you’re not one to wade through a swamp of statistics, check out the study’s very own website for info, updates, and bar charts galore.
Does Feeling Valued Count?
Rather than cherry-picking the facts, allow me to just suggest questions to consider as you learn more about this study:
What does “doesn’t work” mean, anyway? Work to do what?
The study found that the number of program participants who believed their employer was committed to their health and safety increased significantly as an effect of the intervention. Is this important?
In the study paper, how many times do the researchers make the claim that has captured the imagination of Dr. Carroll and many others in the business and health care media, that “wellness doesn’t work”? (You can cheat by using your browser’s “Find” function. Or take a guess. It’s somewhere between -1 and +1.)
Was the study published in a peer-reviewed journal?
“I heavily favor peer-reviewed work.”
— Aaron Carroll, in The Power (and Weakness) of Peer Review, 2011.
How many employers, and how many different kinds of wellness strategies, were included in this study of the University of Illinois wellness program (called iThrive)?
Let’s say you’re running a program for a global manufacturing company or a tech start-up. How comparable is your employee population to the employees at University of Illinois?
A Comprehensive Wellness Program
iThrive is said to be a “comprehensive” wellness program. In my mind, a comprehensive wellness program might include some behavioral programs, cultural strategies, environmental strategies, and, most importantly, organizational strategies that promote healthy work.
Is this a comprehensive program? You be the judge. The core activies and strategies of iThrive:
- Biometric health screenings
- Health risk assessments
- Participation incentives
- Participation in “one of several activities in the fall and then again in the spring.” Activities included classes on chronic disease management; weight management; tai chi; physical fitness; financial wellness; healthy workplace habits; a tobacco cessation hotline; and an online, self-paced wellness challenge.”
A “Post-Intervention” Time Warp?
- Screenings were conducted from August 15 to September 16, 2016.
- Health risk assessment was conducted from September 8 to October 4.
- Fall wellness activities were held October 10 to December 16.
- Spring wellness activities were held January 30 to April 25, 2017.
- “Post-intervention” healthcare utilization was measured for the period August 1, 2016 through July 31, 2017.
Thinking carefully about this timeline, what changes in healthcare utilization patterns would you expect during the first year of the program?
Keep these questions in mind. And I hope you’ll pose a lot more of your own when you read about future findings from this and other studies.
Check out Part II of this post, Studying the Study: Different Kinds of Analysis Yield Contradictory Results For Illinois Wellness Study.
We all need to educate ourselves and stretch our creative muscles regarding blockchain and, maybe, cryptocurrency. It’s a bummer blockchain is so hard to understand, but that’s no reason to dismiss it.
Blockchain will be used to store medical records and also to accelerate the advancement of medical research. Cryptocurrency could be incorporated into employees’ Total Rewards packages. And, if the will is there, it may be used to advance more participatory workplace practices — representing real progress for employee wellbeing.
Civil, an application of blockchain and cryptocurrency, is focused on democratizing journalism (not workplaces or employment — though they do say their own employees have “equity/token opportunity”). Still, Civil’s model, in which currency represents not nothing — the accusation commonly and rightly leveled against, say, Bitcoin — but influence.
Imagine influence issued as an employee benefit. At first blush, it may seem unlikely — but not if viewed as a future iteration of employee ownership, co-ops, or even stock options and other equity awards.
You’ve probably read dozens of Blockchain-for-Dummies explainers and still don’t get it. Here’s one I’ve found helpful:
And an employer’s unique application of blockchain to protect workers in non-US countries:
The Future of Workplace Wellbeing – As Seen by the “Redesigning Wellness” Podcastin Uncategorized, Employee Wellness Programs
There’s been a lot of talk lately about how to take wellness past well-being and into the future. Specifically, how can we expand beyond physical health and, as wellness professionals, deliver maximum value to our organizations.
Check out the milestone 100th episode of Jen Arnold‘s Redesigning Wellness podcast.
As a result of all the interviews she’s conducted, combined with her own experience and insight, Jen has her finger on the pulse of employee wellness more than just about anyone.
In this solo episode, Jen — with her characteristic candor — systematically lays out a case for a new vision of wellness and previews exciting opportunities she’s creating for wellness professionals who want to make good things happen.
Listen to “Celebrating 100 Episodes” on the Redesigning Wellness podcast wherever you usually get podcasts, or stream it here…
Organizational Culture Is Rooted in Organic Interactionin industrial organizational psychology, job crafting
“What Do Companies Mean by Culture?” is a fascinating article from Scientific American’s “Workplace Anthropology” series.
Right down to the way it uses the word “organic,” the article aligns with my recent post about the importance of a work environment that encourages employees to craft their own “fun at work,” rather than simply having fun activities prescribed:
And the best cultural markers are those that aren’t imposed on employees—mandatory game night or spin classes!—but are those that are formulated by employees. These create a shared sense of continuity, which creates the foundations for trust and support and strengthens the bonds between people. Organizational culture is rooted in the ways companies encourage these organic interactions but also in how they support their employees themselves.
Webinar: Wellness, Wellbeing, and Workforce Sustainability — 3 Routes to Employee Wellness and Optimal Performancein Uncategorized, Wellbeing, Employee Wellness Programs, Stress
Big thanks to the folks at Lumity, Inc. for inviting me to present the webinar “Wellness, Wellbeing, and Workforce Sustainability: 3 Routes to Employee Wellness and Optimal Performance.” If you missed it, check out the recording.
In this orderly mash-up, I present about 40 years of work in 33 minutes (plus Q&A). It has something for everyone — from the HR generalist who’s been assigned to wellness but may not know much about it, to veteran managers of comprehensive programs trying to figure out what does and doesn’t work. I cover
- the premise of health risk costs and risk reduction;
- the distinctions between wellness and wellbeing;
- ROI vs. VOI;
- typical wellness program components;
- work, stress, and health;
- job crafting.
Without being overly prescriptive, I offer my own interpretations of evidence and practices, some of which you’ll find immediately applicable and some of which will irk you to no end. This link, exclusively for my blog readers, takes you directly to the recording.
The Play’s the Thing: Two Brilliant Articles from Different Generations Shed Light on Fun and Workin job crafting
Viewed through the lens of job crafting, “Banana Time: Job Satisfaction and Informal Interaction,” a classic in the annals of organizational studies, offers clues about how to foster real “fun at work” that can boost employee wellbeing and, with any luck, improve business results.
If you were absent the day they assigned Banana Time in Industrial Sociology class, I highly recommend this unique article. Sociologist Donald Roy’s story, embedding himself in a small group of die press operators, was published in 1959 and is unlike anything else you’ve read in a journal. At times it’s humorous, sarcastic, and self-deprecating. And it’s always empathetic.
Roy didn’t set out specifically to explore fun at work. He primarily was studying how laborers coped with tedious work. He also sought to “penetrate the mysteries of the small group,” recognizing there might be a relationship between surviving monotony — and it’s “twin brother,” fatigue — and the human relations that take place among co-workers.
Roy describes the isolation he and his small cadre of co-workers experienced:
…This was truly a situation of laissez-faire management. There was no interference from staff experts, no hounding by time-study engineers or personnel men hot on the scent of efficiency or good human relations. Nor were there any signs of industrial democracy in the form of safety, recreational, or production committees.
Roy cites forerunners who described humans’ irrepressible impulse to engage in play, which can help “the worker find some meaning in any activity assigned to him.”
Short-Range Production Goals with Achievement Rewards
He shares his experience of this impulse, in the initial days before he interacted with the three other die press operators — “clicker operators,” as Roy called them — in his work area. He cognitively crafted what he called “the game of work”:
‘As soon as I finish a thousand of the green ones, I’ll click some brown ones.’ And, with success in attaining the objective of working with brown materials, a new goal of ‘I’ll get to do the white ones’ might be set. Or the new goal might involve switching dies.
“Thus,” Roy writes, “the game of work might be described as a continuous sequence of short-range production goals with achievement rewards in the form of activity change.”
Ultimately, he acknowledges, “These games were not as interesting in the experiencing as they might seem to be from the telling.”
After his first week, however, Roy realizes that another game — one played daily by his co-workers — is taking place.
Looking Forward to Banana Time
First, he notices a regular pattern of horseplay and teasing. In one example, one of the clicker operators, Ike, would steal a banana from the lunchbox of another, Sammy:
Ike would gulp it down by himself after surreptitiously extracting it from Sammy’s lunch box, kept on a shelf behind Sammy’s work station. Each morning, after making the snatch, Ike would call out, “Banana time!” and proceed to down his prize while Sammy made futile protests and denunciations. The banana was one which Sammy brought for his own consumption at lunch time; he never did get to eat his banana, but kept bringing one for his lunch. At first this daily theft startled and amazed me. Then I grew to look forward to the daily seizure and the verbal interaction which followed.
Roy describes a variety of “time” activities the workers wove into their daily work routine. Many revolved around refreshments, such as peach time, a daily mid-morning ritual in which Sammy shared two peaches with the other press operators. There were also coffee time, Coke time, and many other “times,” including, of course, quitting time.
(Sorry Family Guy fans… No peanut butter and jelly time!)
Team Job Crafting
These playful activities, initiated organically (that is, intrinsically) within the group, are a form of team job crafting. They met specific employee needs like social support and relief from monotony, and were enjoyed by everyone who chose to engage. Contrast organic, worker-crafted fun with activities planned by management or by a fun-at-work committee.
Banana Time and the other “times” are examples of relational (social) crafting. (For an overview of job crafting, including relational, cognitive, and task crafting, see my previous post: I Have Seen the Future of Employee Wellbeing. It’s Name Is Job Crafting.)
Roy observed other kinds of social interaction, as well, and the influence they all had on what we now call the employee experience:
The interaction was there, in constant flow. It captured attention and held interest to make the long day pass. The 12 hours of “click, —move die, click, — move die” became as easy to endure as 8 hours of varied activity. The “beast of boredom” was gentled to the harmlessness of a kitten.
Seven Lessons for Workplace Leaders
It may feel like a stretch, at first, to apply Roy’s 1959 die press operator experience to the modern workplace, but it suggests no less than seven insights relevant to most modern work situations:
- Workers engage in playfulness to remain stimulated.
- Fun delays or cloaks fatigue.
- Workers use gamification to find meaning in their work.
- Playful rituals during the workday are used to mark time and support short-term intrinsic motivation.
- Workplace fun often revolves around food and beverages.
- Playing with others is more meaningful than playing alone.
- Informal interaction between members of a work group is important for job satisfaction.
As for management goals, Roy posed one possibility: “Leavening the boredom of individualized work routines with a concurrent flow of group festivities had a negative effect on turnover.”
He observed that the more he played the less tired he felt, which may have positive implications for productivity, but Roy neither measured productivity nor speculated about it.
One of Roy’s most important observations, in my opinion, is that, given the opportunity, workers craft their own fun, especially via social interaction.
Job Crafting, Gamification, and Play
Arnold Bakker and Marianne van Woerkom, in last year’s article “Flow at Work: a Self-Determination Perspective,” posit that job crafting and “designing work to be playful” are two strategies workers use to satisfy basic needs, which leads to improved job performance. They cite (as Roy did) a well accepted theory that humans have a “natural tendency” for play. And they point to research suggesting that fun at work “leads to higher job satisfaction, morale, pride in work, creativity, service quality, as well as lower burnout and absenteeism.”
Echoing Roy’s experience of cognitive game-playing before he discovered Banana Time (Remember? “As soon as I finish a thousand green ones, I’ll click some brown ones”), Bakker and van Woerkom share testimonials from people who gamified their work, such as one HR manager who said:
When I need to work on a boring, bureaucratic task, I gamify it by building additional tasks into the boring task. One option is to fill out the form using the fewest words possible yet covering all the content that must be addressed. This makes it a writing challenge and so, more interesting.
Bakker and van Woerkom conclude,
Proactively creating conditions at work that foster play – to which we will refer to as “playful work design” could therefore be an effective strategy to increase flow at work.
(Flow at work, the author’s explain, is “a short-term peak experience characterized by absorption, work enjoyment, and intrinsic work motivation.”)
Beyond “Fun” Activities at Work
Bakker and van Woerkom focus on individual gamification, which Roy found to be “not as interesting in the experiencing as it might seem to be from the telling,” rather than socially interactive play. Nevertheless, their research affirms Roy’s finding 50 years ago: workers will find ways to craft fun into their work. And the authors encourage leaders to create conditions that encourage workers to do so.
For today’s manager, the lesson is clear: Ping-pong tables, office scooters, outings, office parades, and dress-up-as-whatever days in the office are all well-and-good, but more important is an environment that supports employees crafting their own fun. (The foremost benefit of social outings, office parties, and other gatherings — especially when accompanied by autonomy designed into the work — may be to provide opportunities to interact in ways that foster future fun and relational job crafting.)
When all is said and done, as we contemplate Roy’s insights, as well as the theories advanced by Bakker and van Woerkom, we may conclude that trying to provide fun at work needn’t be nearly as high a priority as enabling the fun of work.
Thank you to Dmitrijs Kravcenko and team, who introduced me to Donald Roy and Banana Time via their remarkable podcast “Talking About Organizations.” Check it out. Start with the first episode, or jump right in with their discussion of Banana Time.
It’s easy to imagine how a white collar employee like a project manager or a data scientist might engage in job crafting. But what about, say, a machine operator or a restaurant server? Do they have enough flexibility to refashion the tasks, relationships, and other building blocks of work to more effectively match their strengths and needs?
Crafting any job presents challenges. But it can be successful across the full spectrum of occupations. Research I’ve previously described, as a matter of fact, included a wide variety of jobs: Silicon Valley tech workers, teachers, hospital housekeepers, chemical plant workers, police officers, and nurses, to name a few.
Less Flexibility May Mean More Job Crafting
Job crafting pioneers Justin Berg, Jane Dutton, and Amy Wrzesniewski tell us — in Job Crafting and Meaningful Work — why it can be easier for employees in highly structured, lower-status jobs to engage in crafting compared to those with more flexibility:
Since their jobs included tasks that had clear means and ends established (e.g., “you should service this machine using the following steps,” or “you must enter these data in this way”), it was easier for them to see the “white space” in their jobs—i.e., where they could fit in new tasks or relationships or drop tasks and relationships that were not very important.
Berg and company go on to describe, in contrast, the challenges of crafting a flexible, typically white-collar, job:
Lack of structure, combined with the continuous pressure to pursue their end goals, seemed to make it more difficult for [“higher-rank employees”] to recognize opportunities to craft their jobs. In other words, to color outside the lines of a job, one needs lines there in the first place.
We talk a lot about the importance of autonomy for employee wellbeing — and for job crafting, specifically. But more autonomy or less, at either extreme, may be suboptimal. The sweet spot lies somewhere in between.
The 3-minute video below summarizes an article — Who Built Maslow’s Pyramid? A History of the Creation of Management Studies’ Most Famous Symbol and Its Implications for Management Education — to be published in the journal, Learning and Education.
The article argues that Maslow never conceptualized the pyramid commonly used to illustrate his Hierarchy of Needs. The figure was developed by a consultant seeking to simplify Maslow’s theory for corporate clients, and it distorted Maslow’s work in the process.
Maslow’s theory aside, we can find a broader learning here. The phrases “some consultant,” “distorted,” and “overly simplistic,” remind me that consultants and other practitioners do, indeed, habitually oversimplify and distort theories of employee wellbeing.
In the employee benefits and wellness spheres, a couple of examples of oversimplification come to mind:
- Consultants and other practitioners increasingly cite Self-Determination Theory, which says that autonomy, competence, and relatedness are prerequisites for human flourishing. But many present the theory as a simple explanation of behavioral motivation and are hard-pressed to explain what relatedness is or how it fits in.
- Behavioral economics is a trendy framework consistently misrepresented. Wellness consultants have described it as a theory of intrinsic motivation. Behavioral economists, however, will assert that there is no such thing as intrinsic motivation. If behavioral economics had to be bucketed as one or the other, it could only be considered — with its warm embrace of incentives and other manipulative techniques — a framework for extrinsic motivation.
Scholars resent such oversimplification. But I’d be cautious about one-sidedly indicting consultants.
Perhaps scholars should endeavor to communicate their theories and findings in a manner more accessible to lay practitioners. Were relatedness and competence really the best terms to communicate what’s intended in Self-Determination Theory? Indeed, delve into the details of Self-Determination Theory, and you’re likely to find it nearly incomprehensible to non-psychologists. The theory picked up steam outside psychology circles mostly after Daniel Pink simplified it in his bestseller, Drive.
Similarly, behavioral economics has repeatedly been distorted by TED-talk superstars who have little or no training in either behavior, economics, or any combination of the two.
We wellness professionals would benefit by reading fewer bestsellers and more journal articles. I might also suggest that scholars — in order to learn how to reach an audience of practitioners with minimal distortion before TED talkers and bestselling authors pull the rug out from under them — study fewer journal articles and more bestsellers.
Perhaps a consultant would not have created Maslow’s pyramid, and it would not have taken hold to the extent it has, if Maslow or another scholar had more effectively illustrated his ideas.
[Hat tip to Kuldeep Singh, who shared the “Who Built Maslow’s Pyramid” article on LinkedIn, and Rob Briner, who shared the video in the lively discussion that ensued. This blog post is adapted from comments I contributed to that discussion.]
In 2015, Japan passed a law requiring businesses with 50 or more employees to offer workers an annual assessment — the “Stress Check” — which measures risk of stress and other mental health concerns based on three domains:
- Psychosocial and other stressors in the work environment, including job demands, job control (autonomy), work intensity, and sense of purpose.
- Mental and physical symptoms of stress like irritability, exhaustion, difficulty concentrating, musculoskeletal discomfort, difficulty sleeping.
- Social support, including connection with supervisors, co-workers, and loved ones.
The Japanese government recommends their 57-question assessment tool, the Brief Job Stress Questionnaire (BJSQ). Take a look at the English version here. Employers can use alternative questionnaires, but they’re required to include the same domains — workplace stressors, symptoms, and support.
The law — designed to help prevent stress in response to an epidemic of stress-related death and disease — mandates that
- Employees are given the results of their Stress Check.
- Employees found to be at high-risk for potentially harmful stress are referred to a physician.
- Employers modify stressful work conditions (such as schedules, work location, or responsibilities) in collaboration with high-risk employees’ physicians.
The law encourages employers to improve the workplace environment based on analysis of their group’s data. Specific interventions aren’t prescribed, although models and case studies are available.
The law prohibits release of employees’ data to employers without the employee’s permission, and it prohibits discrimination based on Stress Check participation or results. Though employers are required to offer the Stress Check, workers aren’t required to participate.
No one’s advocating a program like this outside Japan, but it should evoke dialog among wellbeing professionals and enlighten how we view job stress.
- Japan — like much of Europe, Canada, and the US’s NIOSH — recognizes that job stress is rooted in workplace risk factors: lack of autonomy, role ambiguity, job insecurity, lack of social support, excessive demands, harsh environments, inadequate rewards, work/life conflict, and unfair treatment.
The Stress Check questionnaire draws on a growing body of evidence showing that it does, indeed, identify people who are at high risk of mental health-related disability.
As for intervention… There’s a lot of experimentation to be done before we can definitively say what works. To date, evidence supports organizational change more than personal interventions to prevent worker stress.
Recently, a small initial study failed to demonstrate positive outcomes for either the questionnaire alone or for workplace interventions alone. However, the researchers reported:
Combining the annual stress survey with improvement in the psychosocial work environment can effectively reduce psychological distress.
Like it or hate it, the Stress Check program is innovative. We’re reminded that innovation is not always technology driven. We need innovators to follow Japan’s example and take a fresh look at our job stress paradigms.
Oodles of studies that include workers with diverse jobs in various countries show that JD-R job crafting is an employee-forward way to improve person-job fit — a win-win for employees and employers. It leads to improved wellbeing, stronger work engagement, better adaptability to change, and more productive job performance.
But when it comes to pulling their job demands and resources into an ideal level of balance — ie. JD-R job crafting — workers often aren’t aware of the possibility, and some aren’t confident in their ability to do it. Then again, some employers haven’t yet come to appreciate job crafting or don’t know how to inspire it.
These are among the reasons we, especially those of us trained and experienced in operationalizing workplace wellbeing programs, want to know how to structure JD-R job crafting interventions and what kinds of interventions work.
In a previous post, I reported studies of what I dubbed “Job Crafting Classic,” the original model proposed by Wrzesniewski, Dutton, and Berg.
Here, let’s navigate the more rugged terrain of the JD-R job crafting landscape. The following are studies of JD-R job crafting interventions — almost every study I could find. Almost all are based on a “quasi-experimental” design, meaning that — consistent with most studies of workplace interventions — neither the participant group nor the control group was selected randomly. They’re mostly pre- and post-test study designs, meaning measurements — of things like job crafting behaviors, work engagement, levels of demands and resources, and job performance — were measured before the intervention and after.
This is a relatively detailed overview, with links to the original studies in case you want more detail. If you’re in a rush, there’s an abbreviated version on LinkedIn.
4-Week Job Crafting Intervention for Police District Employees
Van den Heuvel et al paved the way with phased intervention for employees of a police district. The first stage was a one-day workshop that taught participants about JD-R job crafting; had them assess the current state of their demands and resources; and raised their awareness of opportunities to find more meaning and satisfaction in their jobs via crafting. The workshop concluded with creation of a job crafting plan. This was followed by four weeks of independent work on their plan, which included two or three goals per week. At the end of the study period, a half-day “reflection session” was held.
The study included 39 employees in a Dutch police district and 47 employees in a control group.
Outcomes: Increased wellbeing; increased self-efficacy (confidence in one’s ability to effect their situation); greater access to developmental opportunities. (The same team recently published another study (in Dutch) of a similar intervention — with only one goal per week and more participant interaction between each other and with the trainers — with 83 civil servants. They found increases in job crafting behaviors, increases in access to job resources, and improved wellbeing, compared to controls).
The researchers found the findings of their police district study, generally, to be “not significant.” But they concluded,
The job crafting intervention seems to have potential to enable employees to proactively build a motivating work environment and to improve their own well‐being.
Van den Heuvel, Machteld, Evangelia Demerouti, and Maria CW Peeters. “The job crafting intervention: Effects on job resources, self‐efficacy, and affective well‐being.” Journal of Occupational and Organizational Psychology 88.3 (2015): 511-532. This pilot intervention was originally described with additional detail in Van den Heuvel, Machteld, Evangelia Demerouti, and Maria Peeters. “Succesvol job craften door middel van een groepstraining.” Scherp in werk 5 (2012): 27-49. [Dutch], worth noting because it may be the first published study of a JD-R job crafting intervention.
Simplified Job Crafting Intervention for Medical Specialists and Nurses
Intervention: Gordon et al tested a fine-tuned version of the 4-week intervention (above). They explained: “As the eﬀects found by Van den Heuvel and colleagues were rather weak, we modiﬁed their intervention in several respects. Adjustments were made to the intervention to increase individuals’ understanding and application of job crafting behaviors into their daily work…”
The intervention started with a three-hour workshop in which participants learned about JD-R job crafting — seeking resources, seeking challenges, and reducing demands. It encouraged participants to learn from their own or others’ real–life experiences by sharing stories of how their proactive behavior changed their thoughts, feelings, or relationships at work. The workshops were customized to support the employer and its workers during a period of organizational change. At the end of the workshop, participants created individual job crafting plans to follow for next three weeks.
The team conducted one study with 119 medical specialists and another with 58 nurses. The interventions were customized for each group based on the needs of the organization and the employees during a period of organizational change.
Outcomes: Overall, the participants experienced increases in their job crafting behaviors, improved wellbeing, and better performance compared to controls. The medical specialists improved adaptive performance — that is, their ability to effectively modify behavior in response to changes at work. Consistent with other JD-R research, reducing demands did not clearly lead to positive outcomes — a dynamic that’s not yet fully understood.
The interventions led to “medium to large” increases in job crafting behavior and wellbeing.
The researchers concluded that the intervention was…
…a promising job redesign intervention strategy that individual employees can use to improve their well-being and job performance… Individual and organizational interests … can be integrated by adopting the theoretical framework of the ‘job demands-resources model.’
Gordon, Heather J., et al. “Individual job redesign: job crafting interventions in healthcare.” Journal of Vocational Behavior 104 (2018): 98-114.
Blending The Job Crafting Exercise and JD-R Interventions for Healthcare Workers
Van Wingerden published several studies of job crafting interventions in recent years. She and her team published a relatively early study of a JD-R job crafting intervention, delivering a hybrid of the style of interventions described above and the Michigan Job Crafting Exercise™. The subjects were 67 healthcare workers who diagnose, identify, and treat hearing-impaired patients.
The intervention led to increased work engagement and improved job performance in the participants. Van Wingerden continued to use this “hybrid” (my word) intervention, weaving the JD-R model into the Job Crafting Exercise framework, in other studies.
Wingerden, Jessica van, Arnold B. Bakker, and Daantje Derks. “A test of a job demands-resources intervention.” Journal of Managerial Psychology 31.3 (2016): 686-701.
Comparing Resource Interventions and Job Crafting Interventions for Special Education Teachers
Van Wingerden et al compared different interventions for primary school special education teachers at multiple sites: 26 participants took part in an intervention geared exclusively to increasing personal resources (specifically, psychological capital… hope, optimism, self-efficacy, and resilience); 32 participated in a complete job crafting intervention; 26 participated in a combined personal resources and job crafting intervention. 18 study subjects were assigned to a control group.
The study found…
- The personal resources intervention improved work engagement
- Job crafting intervention can, in contrast to Van den Heuval’s study above, increase employees’ job crafting behavior.
- An intervention combining personal resources and job crafting leads to improved performance, but not increased work engagement.
The researchers concluded that job crafters probably should focus on increasing resources if they seek to boost work engagement. They suggested that, in addition to interventions, senior managers could do more to support employees’ balance of demands and resources, especially by expanding available resources.
Van Wingerden, Jessica, Daantje Derks, and Arnold B. Bakker. “The impact of personal resources and job crafting interventions on work engagement and performance.” Human Resource Management 56.1 (2017): 51-67. [first published in 2015]
Lasting Effects of Job Crafting in Teachers
Van Wingerden took it a step further in a study of 75 teachers, in which she and her team evaluated the sustainability of outcomes one year after completion of a JD-R job crafting intervention, in addition to the measurements they took shortly after the intervention’s conclusion.
They found that
- Participants exhibited significantly increased job crafting behaviors one week after the intervention was completed and 1 year later.
- Feedback, professional development, and self-efficacy resources had increased at the conclusion and one year after the job crafting intervention.
- Significant performance improvements weren’t found at the conclusion of the study, but were found one year after the intervention. The researchers explained this lag by suggesting that participants increased their challenge job demands during the intervention, which could result in a short-term suppression of performance improvement but long-term growth.
The job crafting intervention may be a promising tool to facilitate a resourceful work environment which enables employees to achieve their personal and organizational goals.
(This study, which focused on reducing hindering demands, did not lead to increased work engagement — a recurring finding in JD-R studies. A study Van Wingerden led and published in 2017, Fostering Employee Well-Being Via a Job Crafting Intervention, however, found that an intervention focused on increasing challenge demands did lead to increased work engagement.)
Van Wingerden, Jessica, Arnold B. Bakker, and Daantje Derks. “The longitudinal impact of a job crafting intervention.” European Journal of Work and Organizational Psychology 26.1 (2017): 107-119.
Broad Study on Effects of Job Crafting Opportunities
Finally, Van Wingerden and Poell published a study in 2017 that, based on questionnaire responses of 2,090 Dutch employees from various walks of life, supports the value of job crafting interventions: “Results indicated that individuals who experience a high level of opportunities to craft reported higher levels of job crafting behavior. In turn, perceived opportunities to craft and job crafting behavior related to higher levels of work engagement and subsequently performance.” [Emphasis added.] Interventions are one means of creating “opportunities” to craft jobs.
The research team advised:
Managers who positively influence employees’ perceived opportunities to craft before offering job crafting interventions, in the organization, can create optimal conditions that may in fact strengthen intervention effects.
Wingerden, Jessica Van, and Rob F. Poell. “Employees’ Perceived Opportunities to Craft and In-Role Performance: The Mediating Role of Job Crafting and Work Engagement.” Frontiers in psychology 8 (2017): 1876.
“Awareness” Intervention in Chemical Plant Workers
Tims et al surveyed chemical plant workers regarding their levels of demands, resources, work engagement, job satisfaction, and burnout. Surveys were sent at the outset and at the conclusion of a 2-month study period, with another survey specific to job crafting sent midway. All participants received standardized feedback that scored their levels of job demands and resources, with examples illustrating how demands and resources can be crafted by employees. 288 workers completed all three surveys and were, therefore, included in the analysis.
(This study generally isn’t described as an intervention, but it obviously is one — more of an “awareness” campaign rather than a behavioral intervention, but an intervention all the same. In health promotion terms, it’s comparable to, say, assessing someone’s level of physical activity and, if it’s low, providing boilerplate feedback on the risk of sedentary lifestyle and strategies people use to add physical activity into their life. The fact we aren’t telling them what they have to do or that they have to do anything at all doesn’t mean it’s not an intervention. In fact, it would be a fairly typical health intervention.)
Access to different types of resources had increased for respondents who reported, at the midway point, that they craft resources. This was positively related to increased engagement and job satisfaction, and decreased burnout. Those who said they craft job demands did not necessarily experience a change in job demands, but crafting challenge demands was linked to increases in wellbeing. This is consistent with findings in other studies that suggest, perhaps counter-intuitively, that positive outcomes may be rooted in the empowerment to engage in job crafting, if not with actual changes in resources and, especially, demands.
These researchers offered this caution:
Our results do not suggest that employees should be held responsible for their work environment and well-being. Rather, they suggest that management interventions should focus more on the effects of job demands on employee well-being because employees seem to change their job demands less often than their job resources.
These results obviously suggest that employees can optimize their own well-being when allowed to. Therefore, organizations should not only facilitate employee well-being by providing sufficient job resources and an optimal level of job demands, but they should also offer opportunities for employee job crafting.
Tims, Maria, Arnold B. Bakker, and Daantje Derks. “The impact of job crafting on job demands, job resources, and well-being.” Journal of occupational health psychology 18.2 (2013): 230.
Harvard Meta-Analysis: Job Crafting is Associated Positively with Work Engagement, but Interventions…
Harvard’s Frederick and VanderWeele conducted a meta-analysis on job crafting. A pre-print of the study is available on a limited basis. The researchers searched for studies of various outcomes, but only found enough studies of sufficient quality to examine work engagement as an outcome.
Their analysis showed that job crafting is positively associated with work engagement, but they weren’t able to say the same thing about interventions, specifically.
The studies of interventions, rather than just job crafting behaviors, that we did identify found no effect of the intervention (Van den Heuvel et al., 2015; Van Wingerden et al., 2015).
Presumably, they mean “no effect” on work engagement. Frederick and VanderWheele acknowledge that the intervention studies may not have had sufficiently large subject pools to demonstrate such an effect. Take note, however:
- The authors don’t mention Van Wingerden’s 2016 and 2017 studies (above) — perhaps they were published after the meta-analysis was conducted — that did demonstrate increased improvements in work engagement.
- The analysis didn’t include Tims et al’s “Impact of Job Crafting…” stealth intervention from 2012 (above), understandably since the authors didn’t describe it as an intervention. But it was an intervention and it did lead to greater work engagement.
If you’ve paid close attention, you may notice a few red flags about these studies: small populations (n), apparently homogenous demographics, limited number of studies, and a concentrated group of researchers. In a future post, I’ll offer my assessment of these studies — strictly from my perspective as an American employee-wellbeing practitioner — and (spoiler alert!) I’ll share why job crafting is, by far, the most exciting thing to happen to employee wellbeing in a long time.
We wellness professionals are an interventionist lot. Once we see that job crafting “in the wild” enhances wellbeing, reduces burnout, boosts performance, and eases adaptation to change, we want to know how we can make it happen.
And if we’re going to offer job crafting programs… We want to know what what works, based on evidence..
Let’s look at interventions based on two branches of job crafting:
- What I call Job Crafting Classic — as I described in I Have Seen the Future of Employee Wellbeing. It’s Name is Job Crafting — in which workers modify the tasks of their job, the personal interactions they have, and their perception of the job in order to experience a greater sense of meaning and purpose, and to increase work engagement, satisfaction, resilience, and thriving.
- What I call Job Demands-Resources Job Crafting — as described in my article The Good, the Bad, and the Crafty: Challenges and Hindrances in JD-R Job Crafting — in which workers seek resources, seek challenges, and ratchet down “hindering” demands in order to achieve much of what’s achieved in Job Crafting Classic, but with more emphasis on well-being and, theoretically, health.
Job Crafting Classic
In a controlled study at a large tech company, employees were happier and more effective in their jobs 6 weeks after completing the Job Crafting Exercise™. This quick video Job Crafting Classic intervention and some outcomes…
As far as I can tell, outcomes from this particular intervention, which was spearheaded by Amy Wrysznewksi, Jane Dutton, and Justin Berg, weren’t published in a peer-reviewed journal.
A Japanese study delivered a variation of The Job Crafting Exercise to 54 manufacturing managers and 25 psychiatric hospital workers. The intervention led to improved levels of work engagement, reduced stress, and an increase in job crafting behavior.
Increasing job crafting behavior — Wrzesniewski et al describe a job-crafting mindset — is important. The intention of these programs is not to have participants modify their jobs at the intervention workshop and then go about their merry way; it’s to have them re-envision their jobs as malleable and to develop their skills and their sense of empowerment…so they can establish and continuously improve their person-job fit.
Interventions and evidence for JD-R Job Crafting are a different story — one that will be told in Part II.
See what different kinds of job crafting look like in the real world of work:
- Job Demands Resources
- Seeking resources
- Seeking challenges
- Reducing hindrance demands
- Job Crafting “Classic”
- Task crafting
- Relational crafting
- Cognitive crafting
(It helps if you read some of the Jozito blogs about job crafting Bob Merberg previously published here.)
Do Employees Pick Up the Wellness Programs You Throw Out There?in Uncategorized, Employee Wellness Programs
On a snowy winter day, as I listened on a conference call with a client, I watched through the window of my cozy home office as the curbside recycling truck lurched to a halt.
A burly guy jumped off the truck, where he’d been clinging in the blasting snow and arctic wind. In his orange reflector-striped parker, snow-dusted cap, and humongo gloves, he lifted my recycling bin out of the snow bank where it’d been half-buried by the city plow and in one swift move heaved the clinking and clanking contents into the backend of the truck.
He tossed the emptied bin onto my snow-covered driveway and stepped back onto the rear of the truck as it grinded away. With its amber caution lights flashing and sparkling in the icicles that hung off its rim like a damaged chandelier, the truck — its passenger clutching the back and ducking his head out of the wind — vanished into the whiteout.
“What kind of wellbeing program would appeal to this guy?” I thought. “What would be useful to him?”
On my conference call, the client was chatting about placing fruit-infused water stations in break rooms.
Would the recycling worker want a fitness challenge to track his steps? Would he like a health coach to call that evening to “nudge” him to eat fewer carbs? A work-life balance lunch-and-learn?
In the latest iteration of employee wellbeing, where all the buzz is about purpose, authentic self, mindfulness, and gratitude, would the recycling worker pick up what we’re throwing out there?
I don’t know what this individual worker wants and I won’t make assumptions. I haven’t spoken to him yet, but, like you, I chat with blue collar employees, manual laborers, and lower-wage workers every day. Some I meet in the course of my daily business, some are friends, some are family members. And I do ask what they want and how their workplace can support their wellbeing.
The above was originally the preamble to my LinkedIn post, “How My Dad Proved Steve Jobs Wrong About Loving What You Do…”, but I cut it because of length, relevance, and tone. Still, I’d love to hear from you. How can we serve employees in job classes like this recycling worker? How can we best support their wellbeing?
I’ve practiced mindfulness and meditation since 1977, and have had the good fortune to have learned from some of the greatest teachers in the world.
In 2000, I took personal vows to commit my life to mindfulness (admittedly, I haven’t been diligent in recent years).
In my 2003 book — now out-of-print — the longest chapter was called, “Mindfulness: The Secret to Health Change?”
Around 2004, I founded a small mindfulness group in upstate New York that is still going strong.
If I had final words of wisdom to offer my kids, I’d commit my last breaths to advising them to practice mindfulness.
That said, I still believe mindfulness is being oversold in the corporate and wellness worlds.
Job demands cost energy and affect job stress and health. Job resources affect motivation and performance and can buffer the negative affects of demands.
All job characteristics can be thought of as either demands or resources. This is the foremost proposition of the Job Demands-Resources theory of job stress and motivation, which I described in Stay Woke About Work: Job Demands and Resources Shed Light on Stress and Motivation.
Richard Lazarus and Susan Folkman’s classic 1984 book, Stress, Appraisal, and Coping, defined different kinds of stressors: challenges and hindrances. Jeffery LePine and his team at University of Florida expanded on this and found that challenge demands are linked to improved job performance; hindrance demands lead to impaired work engagement and performance.
Opportunities and Obstacles
We’ll get to some examples, but for now know that:
- Challenge demands cost energy but are viewed by workers as opportunities to grow, improve, advance, achieve.
- Hindrance demands cost energy and are perceived as unnecessary obstacles, thwarting personal growth, wellbeing, and achievement.
(By the way, there also are different types of resources — for example, job resources and personal resources. Job resources include things like performance feedback, training, and autonomy; personal resources include self-efficacy (confidence in your ability to have an effect) and optimism. For a more detailed and expert analysis of different types of demands and resources, see Maria Tims and Arnold Bakker’s article, “Job Crafting: Towards a New Model of Job Redesign.”)
Demands-Resources Job Crafting
In job crafting with the JD-R model, employees
- Seek resources
- Seek challenge demands
- Reduce hindrance demands
Some of what researchers point to as resources — like performance feedback and training — are sometimes viewed by employees as hindrances. And occasionally there’s a fine line between a resource like autonomy and a hindrance demand like role ambiguity.
For clarification, it’s helpful to see what experts consider demands and resources. Below are examples adapted from a book chapter called “A Critical Review of the Job Demands-Resources Model: Implications for Improving Work and Health,” by Wilmar Schaufeli and Toon Taris.
- Cognitive demands
- Computer problems
- Emotional demands
- Interpersonal conflict
- Job insecurity
- Work-family conflict
- Difficult customers
- Physical demands
- Inadequate rewards
- Role ambiguity
- Unfavorable shift work schedule
- Unfavorable work conditions
- Work pressure
- Work-home conflict
- Work overload
- Goal clarity
- Innovative climate
- Professional development
- Participation in decision making
- Performance feedback
- Procedural fairness
- Positive customer interactions
- Quality of the relationship with the supervisor
- Safety climate
- Social support
- Skill utilization
- Strategic planning
- Task variety
- Team harmony
- Trust in management
- Emotional and mental competencies
- Intrinsic motivation
- Organization-based self-esteem
Wellbeing — What Is It Good For?in Uncategorized, Wellbeing, industrial organizational psychology, job crafting
In previous posts about the transition from wellness to wellbeing, I neglected to address the studies of wellbeing — including many attempts to define it — that were done before corporate America appropriated the term.
As legendary occupational psychologist Sir Cary Cooper says, “Define wellbeing? We can’t even agree on how to spell it Hyphen or no hyphen?” (I’ve paraphrased Sir Cary.)
One employer survey defined wellbeing by contrasting it with health and wellness. In an article called “Survey Shows Shift from Wellness to Holistic Wellbeing,” the investigators declared:
“Wellness programs focus on physical health while well-being addresses ‘all things that are stressors in an employee’s life.’”
So far, so good.
Then they wrote:
“ Improving employee health was the most frequently mentioned (82%) reason for offering well-being programs, followed by: decrease medical premiums and claim costs…”
If those two quotes don’t have you scratching your head, you’re reading too fast. Please back up and keep rereading until you’re appropriately distressed.)
Gallup’s Essential Elements of Wellbeing
In recent years, Gallup describes wellbeing, based on their massive surveys, as consisting of (these are verbatim):
- Purpose*: liking what you do each day and being motivated to achieve your goals
- Social: having supportive relationships and love in your life
- Financial: managing your economic life to reduce stress and increase security
- Community: liking where you live, feeling safe, and having pride in your community
- Physical: having good health and enough energy to get things done daily
In 2010, Gallup’s Tom Rath and James Harter published “Wellbeing: The Five Essential Elements.” The book served up the same five elements that Gallup advocates today, except the book used the label “Career,” whereas Gallup now calls the same element “Purpose.” Hmmm.
Gallup, with their partner Healthways (which eventually was acquired by Sharecare — creating the Gallup-Sharecare pair) argues that employers should address all five elements of wellbeing. For a price, they offer consulting services to help.
Employers faithfully adopted the five elements, depicting their wellbeing program goals with circles perfectly divided into equal parts — each representing one of the five elements — sometimes shoehorning in another element or two, like “emotional,” “environmental,” or “spiritual.”
But employers have not been well-served by their simplistic pie diagrams, which are used as virtual checklists to perfunctorily confirm that each element is addressed…
A fragmented effort to address what is in wellbeing, rather than a cohesive strategy to support what wellbeing is, may be one reason why, in practice, nothing but the name has changed.
Since his groundbreaking review, “Subjective Wellbeing,” first appeared in 1984, psychologist Ed Diener has probably published more wellbeing research than anyone. Though Diener evaluated the elements of what he calls “subjective wellbeing,” he defined it not by its elements but by the experience. To Diener, wellbeing is…
“…how people evaluate their lives — both at the moment and for longer periods… These evaluations include people’s emotional reactions to events, their moods, and judgments they form about their life satisfaction, fulfillment, and satisfaction with domains such as marriage and work. Thus, subjective wellbeing concerns the study of what lay people might call happiness or satisfaction.”
“Happiness or satisfaction.” Isn’t that what we always knew wellbeing to be, before we picked it apart?
I Feel Good!
With the various definitions of wellbeing circulating helter skelter, Uncle Sam (in the form of the CDC) played peacekeeper:
“There is no consensus around a single definition of well-being, but there is general agreement that at minimum, well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good.”
Rath and Harter’s description of wellbeing and other definitions of wellbeing emphasizes how you get there — the road to wellbeing. Diener and other psychologists emphasize how you are when you arrive.
Wellbeing and Burnout
Diener mentioned marriage and work, referring to domain-specific wellbeing. Here’s where that comes into play…
In job crafting research — as with a lot of organizational development research — “wellbeing” often is measured in the work domain only. Work wellbeing doesn’t just mean job satisfaction; it goes deeper to how employees are.
How do you measure how employees are at work?
For perspective, consider the symptoms of burnout:
- A feeling of not making a difference
It’s not unreasonable to say that the opposite of burnout is work wellbeing — having energy, purpose, and optimism at work. This is why burnout metrics have, sometimes, been used to measure work wellbeing.
Focusing on work wellbeing — which, on the surface, seems to be just one domain — may be heresy to employee wellness leaders looking to check off their list each element of wellbeing.
But employee wellbeing programs risk getting in their own way if they try to do too much. Would it make sense to help employees thrive at work — the domain over which employers have most control — before trying to get them to thrive in, say, relationships, community, or even physical health?
On one hand, focusing on work wellbeing seems to contradict arguments against checking the elements off one-by-one. On the other hand, if the elements are interdependent, bolstering work wellbeing helps support the other elements. And if the others are supported at the appropriate time and place, work wellbeing will benefit.
To understand what job crafting has to do with employee health and wellbeing, it’s important to understanding the inner workings of job stress and motivation.
In a previous post — “I’ve Seen the Future of Employee Wellbeing: It’s Name Is Job Crafting” — I explained how, in 2001, Amy Wrzesniewski and Jane Dutton proposed that employees tweak their job tasks, workplace social connections, and perspective about their role to gain a greater sense of purpose and meaning, potentially leading to better job performance.
Around that same time, in the Netherlands, Evangelia Demerouti, Arnold Bakker, and others introduced their model of Job Demands-Resources (JD-R), which has since been fine-tuned and validated as relevant to a full range of occupations and outcomes in countless studies around the world.
If you’re familiar with job stress research, you know that job stress has causes, and shouldn’t be dismissed as a choice employees make.
Forget trendy notions that “stress is good.” It’s wishful thinking based on cherry-picked evidence. If stress is so great, why aren’t employees demanding more of it?
Forty years of research has shown that harmful job stress is a result of jobs that have low levels of autonomy and high demands.
Job Demands and Autonomy Are Linked to Health Problems
Over the years, job autonomy (or control) has been defined different ways, but can be broadly understood as limited flexibility (for example, with the tasks of the job) and limited decisional latitude, meaning the employee isn’t permitted or encouraged to make decisions in their work or about their work.
Job demands originally meant the psychological intensity of work, but ultimately can be understood to include workload, time pressure, and physical demands.
Robert Karasek introduced the theory of demands and control in 1979. He and others have shown that jobs in which workers consistently encounter high job demands with low job control — the combination of which is called job strain — are linked to a variety of health issues, especially high blood pressure and cardiovascular disease, as well as depression, anxiety, burnout, and metabolic disorders. Reducing job strain can improve productivity.
Karasek later learned that social support “buffers” the negative effects of high-strain jobs. Social support originally meant supervisors’ and co-workers’ support for performing job tasks, but can be understood in all of the many ways it’s been defined: Having a sense of “belongingness” at work; having co-workers who are empathetic and confidantes; having supervisors who take a genuine interest in the personal and professional lives of team members; and having a best friend at work.
In sum, high demands and low control are an unhealthy combo. (High demands and high control are not necessarily bad.)
Effort-Reward Imbalance Is Linked to Health Problems
Unhealthy job stress has been framed in other ways. Germany’s Johannes Siegrist found that work in which the required effort is disproportionately high compared to the job rewards— effort-reward imbalance — leads to the same kinds of health problems that result from job strain. “Rewards,” here, doesn’t just mean financial compensation, but also career opportunities and level of esteem within the organization.
The effort-reward imbalance model reminds me of an encounter I once had with a business analyst who transferred to another department because she didn’t feel valued in the department she was hired into. When I asked her, “What would have made you feel more valued?” her answer was not “better pay” or “someone saying ‘good job’”…
“I just wanted someone to listen to my ideas,” she told me.
A worker who doesn’t feel valued (i.e. esteemed) by being “listened to” is likely to have a higher level of disengagement and health impairment. This offers a glimpse into how management style, job design, organizational culture, performance, turnover, health, and wellbeing are all interconnected.
Overtime, Job Insecurity, Injustice, and More…
Several other causes of job stress have been identified, and most of them can in some way fit into the demand-control and/or the effort-reward imbalance model:
- • chronic overtime
- • job insecurity
- • work-life conflict
- • role ambiguity (not being clear of what’s expected, receiving contradictory direction, duplication with other workers’ roles, or not understanding how the work fits into the overall organization — all of which are among the most common complaints I’ve heard from employees who report high job stress).
- • organizational injustice (being treated unfairly, which at the extreme includes bullying and harassment)
- • lower levels of status within the organization
- • sustaining high levels of vigilance (e.g. first responders, air traffic controllers, etc.)
Back to Bakker
The overlaps between and the nuances of these job stress theories makes them difficult to understand and apply. That’s where Bakker and Demerouti’s Job Demands-Resources model comes in. While building on the existing theories and expanding upon them, it also provides a simpler way of making sense of job stress and motivation. I consider it a comprehensible and practical unifying theory.
JD-R posits that all job traits can be categorized as either demands or resources.
- • Demands require sustained effort from employees. They’re an expenditure of personal energy.
- • Resources help fuel progress toward work-related goals. They’re restorative, buffering the effects of job demands —and activating personal development.
I interpret JD-R to mean that Karasek’s “demands,” Siegrest’s “efforts,” as well as role ambiguity, job insecurity, injustice, tedium, and work-life conflict are demands.
Job autonomy, social support, rewards, recognition, feedback, task variety, and training are examples of resources.
Side note: If you’re familiar with Edward Deci and Richard Ryan’s self-determination theory — popularized in the Daniel Pink bestseller, Drive — which tells us that motivation and flourishing depend on autonomy, competence, and relatedness (i.e. social connection), you may recognize that job resources generally can be matched to the components of self-determination.
- • Demands regulate job stress.
- • Resources regulate job motivation and engagement.
- • And the two forces may act upon each other.
That’s enough theory for now. What I’ve come to appreciate about JD-R is how, according to research by Bakker and others, it serves as a foundation for a practical application: job crafting.
JD-R takes job crafting beyond meaning and purpose — which has received most of the public attention — and ties it directly into health and wellbeing.
I’ll spell this out further in a future post, and also draw the important distinction between positive and negative job demands. I’ll share what research shows about the effectiveness of job crafting interventions for improving employee wellbeing, work engagement, absenteeism, performance, and productivity. And I’ll offer evidence-based tips on how you can prime your organization for job crafting.
For an excellent overview, see Bakker and Demerouti’s 2016 article: Job Demands-Resources Theory: Taking Stock and Looking Forward
If you can find some downtime (or some treadmill time?), listen to “Dealing With Burnout” the Wisconsin Public Radio Morning Show. One of the guests was Monique Valcour PhD CPCC, who has a gift for articulating, in super-practical terms, the connection between work and wellbeing. Monique explains what burnout really is, and delivers keen insight when the first caller makes a reference to the role of autonomy in addressing his own burnout. She talks about burnout as an “interpersonal phenomenon” and notes the supportive effects of mindfulness and emotional intelligence. And she provides practical tips for workplace leaders.
By the way, not only is it essential for us wellness professionals to address the burnout that occurs amongst employees, but I’m observing that it’s increasingly common within HR, Employee Benefits, and Employee Wellness teams. So if you don’t feel the need to learn about burnout for your organization, learn about it as an act of compassion for yourself.
Rajiv Kumar, M.D., and I explore 6 surprising ideas that will transform employee wellness in this webinar recording from Thursday, February 22, at 2 PM ET.
I’ve had the pleasure of co-presenting with Rajiv on several occasions, and the conversations always take a turn toward the unexpected. I elaborate on my latest passion, job crafting, and how it may surpass other popular solutions for health-related job stress, burnout, and disengagement.
Rajiv brings his unique perspective as a community-minded entrepreneur, physician, and vendor. I’m always enriched by our conversations, and I think you will be, too.
The process of evaluating employee wellbeing and sustainability programs depends on the organization and its goals.
Here are tips that can be applied in almost any situation to assure your findings meet your needs:
- Have a plan. Include program component evaluations, communication (and other process) evaluations, and overall program outcome evaluations.
- Identify metrics based on program goals. You wouldn’t, for example, spotlight biometric screening data to measure a program’s effect on culture or employee engagement.
- Rely on data. Use story and data visualization to communicate and provide insight into data.
- Benchmark against reference groups, including vendor book-of-business, national norms, and (yes) sometimes non-participants.
- Understand biases, including the powerful affect of selection bias.
- Leverage existing sources of data, such as HRAs, biometrics, safety, employee engagement surveys, EAP, HR info systems, and disability.
- Identify relationships between findings. How are physical health, productivity, employee engagement, behavioral health, and well-being strategies affecting each other?
- When using surveys, use validated instruments, when possible.
- Engage in-house experts (eg data analysts), if available.
- Require vendors and consultants to provide expert evaluation consultation.
- Take vendor self-evaluations with a grain of salt.
- Be conservative in conclusions.
- Communicate evaluation findings throughout the organization, including to participants.
- Be transparent about findings, even when they are disappointing.
- Follow participant cohorts to show change over time.
- Generally, seek to measure sustained outcomes, not just results immediately post-program.
- Understand intent-to-treat methodology, and use it if you’re trying to do a rigorous analysis of health interventions.
- Evaluation goals differ – for example, garnering program support vs. quality improvement. Establish methodology accordingly.
- If in doubt, strive to be as rigorous as possible, but don’t get bogged down in perfectionism unless you’re publishing research.
If your organization needs help with its program evaluation, contact Jozito LLC’s principal consultant, Bob Merberg, using this website’s contact form.
First, the Premise: Work Shapes Wellbeing
The foundation of employee wellbeing isn’t employee behavior — it’s workplace exposure. Exposure to things like…
- the physical environment,
- the psychosocial environment,
- the policies of the organization,
- the work itself.
Designing jobs to optimize these exposures is a direct path to creating healthier work.
The employer that values employee wellbeing will design jobs that offer
- manageable demands,
- well defined roles,
- appropriate rewards,
- plenty of personal and professional support.
As the business world crams countless sections into its wellbeing pie charts, it persistently omits the core: For a sustainable workforce, healthy work comes first.
What Is Job Crafting?
In job crafting, employees tweak any combination of…
- their tasks,
- their workplace interactions,
- the way they view their jobs.
One of the most commonly cited examples comes from Amy Wrzesniewski and Jane Dutton, who first coined the phrase job crafting in 2001. In their study of hospital housekeepers, some workers distinguished themselves by envisioning their role as part of the care team, taking the initiative to chip in where they could to make the environment more patient-friendly — adjusting a picture on the wall of a patient’s room, delivering a glass of water, or spending more time interacting with patients and visitors.
The researchers wrote,
When hospital cleaners integrate themselves into patient care functions, they are able to see their work as being about healing people and to see themselves as a key part of this process, thus enhancing work meaning and creating a more positive work identity.
A variety of workers studied, from machine operators to engineers to sales professionals, have been found to experience greater job satisfaction, better performance, less burnout, and enhanced wellbeing by bringing more meaning to their jobs via self-initiated or intervention-based job crafting.
I’ve come to see job crafting as the workforce sustainability intervention many of us have sought: An evidence-based, employee-centric methodology that can enhance employee wellbeing in a manner aligned with employers’ priorities.
Job crafting is not the solution, but it may be the keystone for employers that have their house in order. It’s one answer to the question, “Okay, we value autonomy, employee engagement, a supportive environment, and the rest… But what do we do about it?”
Job crafting is a tool — not a substitute — for good management.
If you may be interested in hosting a job-crafting beta workshop later in the coming year, touch base via the Jozito.com contact form.
A version of post was originally published on LinkedIn on December 28, 2017.
The Secret About Wearables Is That There Is No Secretin Uncategorized, Wellbeing, Employee Wellness Programs
Last year, online media had a field day when a survey showed that one third of respondents who owned a “wearable” activity tracker stopped using their device within six months. The firm that conducted the survey referred to this as “the dirty secret of wearables.” But it’s premature to judge this disengagement rate, and there’s no secret to keep. Sixty-six percent adherence for wearables after six months may, in fact, be something to celebrate.
Is It Time to Disengage from Disengagement Rates?
We haven’t identified universally accepted goals for activity trackers (by “trackers,” we’re talking here about devices like Fitbits, Jawbone Ups, and the like). Is the purpose to increase activity? To lose weight? To (perish the thought) have fun? Without goals, there’s little we can say about effectiveness or the significance of disengagement rates.
The assumption behind the negative publicity for disengagement rates implies that users should wear their trackers indefinitely. But…Says who? Many consumers wearing a tracker for the first time will see, within a few days, that they aren’t as active as they thought. This may be a first step to modifying behavior, even if they ultimately rely on non-tracker strategies to make changes, and even if those strategies take place at a later date.
Business Insider writer Erin Brodwin recently published an article called, I Tried Fitbit for a Month, and Taking It Off Was the Best Decision I’ve Made. Judging from the title, we might think that Brodwin’s story is a testimonial to the transience of tracker engagement (or that she needs to make better decisions in her life). And it may be. But this observation she makes near the end of the piece may exemplify unexamined potential of wearables:
I still do some of the healthier things I learned to do with my Fitbit, like taking the stairs at work and going for a walk when I take a phone call.
In Brodwin’s case, sustainability of her Fitbit use would have been the wrong metric if her goal was to increase physical activity.
Do One Third of Users Disengage with Wearables after Six Months? Or Do Two Thirds Continue?
What benchmark are we using to judge sustainability of engagement with wearables? Do we compare it to the 20% of patients that drop out of psychotherapy early? Or to the attrition rate for Crossfit, physical therapy, yoga, walking groups, Weight Watchers, or gym attendance? What about mindfulness, our panacea du jour? What percentage of mindfulness practitioners sustain their efforts for more than six months?
I don’t have credible citations for disengagement rates on any of these potential benchmarks, because hardly anyone’s even asking the question. But, by most accounts, a 66% adherence rate after six months compares favorably to…well, just about anything that requires effort.
Previous research on pedometers and early-day accelerometer devices has shown they can be useful tools for increasing physical activity…when they’re integrated with a sound behavioral program. And this was the optimistic conclusion of the “dirty secret” survey — that use of wearables can be sustainable when integrated with behavioral approaches.
Through my job, I’ve overseen the distribution of thousands of pedometers and hundreds of modern tracking devices to people engaged in top-tier behavioral programs lasting several weeks, often offered periodically throughout the year. The pedometer users, I did indeed find, are usually eager to abandon their device in the junk drawer after a program ended. But those who stop wearing their pedometer after eight weeks tend to be perfectly happy to resume wearing it when the next program rolls around. And I’ve seen unpublished data showing that the effects of this intermittent participation on activity levels is sustainable for more than a year. Using it or not using it for the first six months of ownership doesn’t seem essential.
Our wearable technology is ahead of our research. Do we know what consumers expect from trackers? Not everyone wearing a tracker wants to change. Some may be quantified-self devotees. Some enjoy a tracker as an expensive toy.
As for me: I need to have an activity tracking device because I’m in the business, and I’m extra motivated to continue so that I can contribute my data as a subject in the Heart Study (which, I hope, may ultimately resolve some of our questions about wearables). If my job was unrelated, I doubt I’d pony up the bucks for a glorified pedometer.
Calorie-counting apps have come under similar criticism, but there’s no arguing that expectations of these apps are more clearly defined. Consumers come to these apps to lose weight, though research shows that attrition is high and that the apps, perhaps like wearables, are useful as a measurement tool and not a standalone strategy.
I use MyFitnessPal to track calories for 3 to 4 weeks each year. In the first three weeks I used it, I suffered the revelation that I consumed more daily calories in snacks than I did in meals. While I caution that n=1 — my experience may be irrelevant to anyone else’s — approximately three weeks was all it took to trigger a lasting change in my eating patterns. I consider that a win and, as of this moment, it’s no secret.
[This post was originally published on Medium.com on May 18, 2015]
Pay No Attention to the Magnate Behind the Curtain?
In 2000, a bunch of diet “gurus” were assembled to debate the pros and cons of different weight loss diets. Robert Atkins, Dean Ornish, John McDougall, the Sugar Busters guy, Barry Sears, and Keith-Thomas Ayoob from American Dietetics Association were in attendance.
At the time, the Atkins diet was booming in popularity. The low-fat guys demanded from Atkins data supporting his advocacy of high-fat, high-protein, low-carb diets. Atkins said he hadn’t been able to secure research funding.
Ayoob chided, “Excuse me, 10 million books in print and you can’t fund the study?”
Eventually, Atkins funded his own studies, which demonstrated that his’ conclusions about carbs and fats were not something to be ridiculed (they influences much of today’s emerging thinking about weight loss). Many of these studies were published in distinguished journals, such as the New England Journal of Medicine. Regardless, they were viewed warily because they were funded by Atkins.
In other words, skeptics belittled Atkins for not funding studies of his diet. Then, when he did fund them, they dismissed the results as biased…because he funded them.
Damned if you do, damned if you don’t.
Almost all employee wellness research is commercially funded, and I do believe bias and distortion are prevalent. On the other hand, I respect companies that endeavor to publish their results.
My job, as a consumer of science information is:
- to be aware of the potential for bias;
- to try to understand how bias may or may not influence outcomes;
- to seek less biased sources;
…and then to use my own critical thinking skills to reach or reject a conclusion based on all the information I have at hand.
[This post was adapted from a reply I wrote in response to Ted Kyle’s blog post Head Spinning Bias About Funding Bias. Ted blogs prolifically about obesity on his ConscienHealth – website, and is uncommonly faithful to scientific evidence. He’s a voice that needs to be heard.]
I’ve compared, in a separate post, the terms health, wellness, and wellbeing.
But even “wellbeing” doesn’t go far enough. The term, as it’s typically used in employer circles, overlooks the interaction between an employee’s wellbeing and their work — the job conditions, the people they work with, the support they receive… indeed, all the way to the very way work is done. The consequences of a sustainable workforce are the very ones employers seek: work engagement, productivity, consistent attendance, and retention.
One of the best descriptions of workforce sustainability is offered by researchers Ellen Kossek, Monique Valcour, and Pamela Lirio in their chapter, The Sustainable Workforce: Organizational Strategies for Promoting Work–Life Balance and Wellbeing, published in the book Work and Wellbeing: A Complete Reference Guide:
“A sustainable workforce is one where the work environment is caring and supports employee wellbeing. Employees are not seen as primarily resources that can be deployed (and depleted) to serve employers’ economic ends. Their skills, talent, and energies are not overused or overly depleted. They are not faced with excessive workload nor with a relentless pace of work for weeks or years on end. During times of crisis (e.g., natural disasters, sickness), employees are given time to recover or seek the extra resources they need to be able to perform in the future. Burnout is avoided and workers are given time for renewal.
“When human resources are used in a sustainable way, employees are not only able to perform in-role or requisite job demands, but also to flourish, be creative, and innovate. Sustainable human resource management practices develop positive social relationships at work, which enhances business performance, including greater cohesion among organizational members, commitment to common purpose, hope for success, resilience, knowledge sharing, and collaborative capacity.”
There’s no secret sauce to achieving a sustainable workforce. But it’s important to understand the essential elements of workforce sustainability when implementing a wellness program, so that program offerings are crafted through a sustainability lens.
I recently read an article about business’s revolutionary transition from employee wellness to wellbeing. “Historically speaking,” the author wrote, “wellness has been thought of as strictly pertaining to physical health, usually measured by biometrics.”
But, accurately speaking, this is not so.
Of course, there’s no single arbiter who can proclaim what exactly health, wellness, or wellbeing mean, but it’s worth understanding some of the ways these words have been interpreted in order to fully appreciate the implications, or lack thereof, of the “transition” from wellness to wellbeing
“Health” was defined by the World Health Organization (WHO) in 1946 as
a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
WHO’s definition, incorporated into its constitution, remains unchanged to this day. But in 1986 the organization held an International Conference on Health Promotion in Ottawa, which resulted in the famous Ottawa Charter for Health Promotion that elaborated on the definition, stating,
An individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
The Charter went on to list the conditions for health: peace, shelter, education, food, income, a stable eco-system, sustainable resources, and social justice. A far cry from biometrics.
In the late 1950s, the chief of the US Office of Vital Statistics — Halbert Dunn, MD — described a dynamic state-of-being he called “high-level wellness.” This is generally considered the founding of wellness, and Dr. Dunn’s sermon-like lectures reveal his concept to be anything but a simple embodiment of physical health. Dr. Dunn said…
The state of being well is…a fascinating and ever-changing panorama of life itself, inviting exploration of its every dimension.
I believe Dr. Dunn was amplifying — not refuting — WHO’s original definition, and the Ottawa Charter later adopted much of his take on wellness as a never-ending interaction with the environment.
But Dr. Dunn’s framework may have proven too cosmic for the mainstream. And many thought leaders have since distilled wellness into the sum of its various dimensions.
The National Wellness Institute adopted a model that incorporates six dimensions of wellness — occupational, physical, emotional, spiritual, intellectual, and social. Others have divvied wellness up into five, six, seven, or eight dimensions, sometimes tossing in a “relationship” dimension, sometimes “environmental,” “financial,” or “community.” A quick image search reveals a galaxy of multidimensional wellness models in the shape of pies, hexagons, prisms, Venn diagrams, concentric circles, and geodesic domes.
I don’t know exactly how “wellbeing,” in the last few years, worked its way into the hearts of employers and the wellness industry. But one catalyst probably was the bestselling book, The Five Elements of Wellbeing, by Tom Rath and Jim Harter. Both authors are workplace consultants with Gallup (a partner of wellness vendor Healthways) and entrepreneurial marketers with a track record of successfully persuading employers to their way of thinking.
Rath and Harter argue, based on Gallup findings, that wellbeing is more profound than health and wellness, incorporating career, social, financial, physical, and community wellbeing. Sound familiar?
In practice, employers are rallying around mindfulness programs and financial planning, and repackaging stress management as resilience, and using these incremental expansions of the status quo as markers to distinguish wellbeing from wellness. Ultimately, the transition amounts to little more than a name change.
I’m more than happy to dispose of the word “wellness.” I never cared for it — not because of its definition, but because it has failed to resonate with employees or the public at large. And I see no harm in calling it wellbeing instead of wellness. Certainly, while the employee wellness industry has been celebrating this “transition,” I doubt many employees have noticed a difference.
Besides, I’m open to the evolution of language, as long as it isn’t contrived to cover up a deception (like calling participation “engagement,” which I’m sure no self-respecting wellness professional would ever do).
Here’s my bottom line based on this incomplete and superficial exploration of the terms health, wellness, and wellbeing: Some people are inclined to see connections, whereas others are more drawn to compartmentalize. Maybe surgeons and benefits directors are more likely to see what’s tangible and quantifiable, while artists and farmers see the whole and the dynamics it contains. Both points of view probably deliver value.
Either way, I’m guessing that anyone who views health and wellness as only physical phenomena is likely to see wellbeing the same way. Others who view these concepts holistically are likely to do so regardless of the labels we attach to them.
Health, wellness, wellbeing: In the end, what we call it won’t matter as much as how we think of it…and how we act on it.
(Originally published on LinkedIn May 3, 2016)
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.]
Chez Workplace: Study Links Teaching Kitchens to Good Employee Wellbeing and Health Behavior Outcomesin Uncategorized
A study investigating the feasibility of workplace teaching kitchens, and the outcomes that might result from integrating them with other types of health behavior interventions, may herald a new and important movement for employee wellbeing programs.
The Teaching Kitchen Collaborative — led by the Culinary Institute of America and Harvard TH Chan School of Public Health — endeavors to promote teaching kitchens as “catalysts of enhanced personal and public health” across a variety of settings, including workplaces.
The study — led by Dr. David Eisenberg, Director of Culinary Nutrition at Harvard TH Chan School of Public Health and published in the Journal of Lifestyle Medicine — set out to determine the feasibility of an interdisciplinary teaching kitchen curriculum that includes…
- nutrition education
- hands-on cooking instruction
- encouragement and resources to promote physical activity
- mindfulness training, and
- personalized health coaching
… and to measure the program’s behavioral and health outcomes.
At the completion of 14- and 16-week interventions participants showed statistically significant decreases in body weight, body mass index, waist circumference, systolic and diastolic blood pressure, and total cholesterol.
Participants who completed the program also were more likely to engage in positive behaviors, such as cooking meals from scratch at home more often, relying on ready-made meals less often, reading nutrition labels on purchased foods more often, and feeling more confident in cooking.
The study had several limitations, as the researchers noted in their published article. The number of participants was small (40 all told) and the pool of potential participants was comprised of (non-culinary) employees of the Culinary Institute of America, which meant they had state-of-the-art teaching kitchen facilities available to them. The intervention was expensive, and many of the results weren’t statistically significant or sustained over 12 months of follow-up.
Models for teaching kitchens, in the workplace and in other settings, will continue to be refined and studied. The pilot study described here represents an encouraging first step. As Harvard wrote in its summary of the findings:
With dramatic increases in obesity and diabetes, the search is on for innovative strategies to change the paths of those living with, or at risk for developing these and other lifestyle-related chronic diseases. In conjunction with good medical guidance, holistic strategies are needed.
Dr. David Eisenberg may have tapped into one winning strategy with Teaching Kitchens—a kind of cooking laboratory that combines culinary instruction using healthful whole ingredients, nutrition education, exercise, mindfulness, and personalized health coaching.
10 Books for Wellness Afficionadosin Uncategorized, Wellbeing, Communications, job design, job strain
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.
Resistance to offering healthy workplace food options — whether it’s raised by cafeteria operators, vending machine operators, or company leaders — is often based on a myth that assumes employees demand unhealthy food, and don’t want healthy unprocessed food.
A new survey provides some evidence that it’s time we toss this myth down the garbage disposal. According to the 2017 Food and Health Survey, conducted by the International Food Information Council Foundation:
- 73% of college educated consumers and 51% of non-college educated consumers use nutrition information when eating out.
- 76% are trying to avoid or limit sugars in their diet.
- Healthfulness, along with taste and price, is a top driver of food purchasing decisions.
- Women favor foods and beverages with no artificial ingredients.
- 60% of those who regularly use nutrition info when eating out say it’s important that their food contains only natural ingredients.
- The length of an ingredient list affects the perceived healthfulness of nutritionally identical products.
Overall, Americans say they take steps to eat healthy and understand the importance of expert nutrition guidance.
Undoubtedly, the Foundation brings food-industry bias to its positions. But that doesn’t necessarily invalidate its findings about increasing consumer demand for healthy food.
Other market surveys have had similar findings. A 2015 Workplace Food Insights survey by Sodexo, for example, found that eating healthy is “extremely” or “very important” to nearly 80% of surveyed workers.
I brought this point home in an article just published by Carol Harnett — employee benefits visionary — in Human Resources Executive Online…
Good food isn’t something you’re trying to convert employees to eat. It’s a need you’re seeking to accommodate.
Check out the article to get a taste of how the need for whole, fresh, well-prepared food has been met by at least one employer.
As an employee wellness manager for a large company, I was given responsibility for dining services — cafeterias, catering, and vending machines — with the express goal of accelerating our commitment to providing healthier options.
Easier said than done.
A slew of challenges ensued, but most perplexing were those instances in which food service operations directly conflicted with wellness goals.
Converting Brown Baggers
We were hosting finalist meetings for food service vendors, and it came to light that our “participation rate”— the percentage of employees who regularly use our cafés for breakfast or lunch — wasn’t up to par. The standard in our region is about 35%, and we were well below that.
We attributed our low participation to our homebody culture and demographics that include a lot of likely “brown baggers” — employees who bring their lunch from home. Our facilities don’t have competition from nearby eateries that could’ve been drawing business away.
The vendor’s sales guy told us, “We can convert a lot of those brown baggers to café customers, so that they’re buying their lunch instead of bringing it.”
There was a long silence as our wellness-focused team conjured images of employees leaving their brown bags — with their simple sandwiches in zip-lock baggies, or leftover lasagna in Tupperware — sitting on their kitchen counter as they headed out to work in the morning with a pocketful of cash to spend at our café.
I looked at my boss and asked, “Do we want to convert brown baggers to café customers?”
The Other Side of “Nudging”
Our company needs to generate revenue in our cafés in order to keep them operating affordably for employees. On the other hand, research tells us that food prepared at home is likely to be more aligned with healthy eating compared to eating out (notwithstanding our efforts to offer plenty of healthy menu options). Eating home-cooked food is better for financial wellness, too.
We’ve faced other dilemmas: Several years ago, before it was fashionable, we started diverging the prices of “healthy” foods from the prices of foods considered unhealthy. The idea was to “nudge” customers to buy the more favorably priced healthier food. Each year, we raise prices, on average, according to the Consumer Price Index for Food (about 3% or 4% in recent years). We’d achieve the average increase by raising prices more for the so-called unhealthy food and less (or not at all) for the healthy food.
We were victims of our own success. Sales shifted from soda to bottled water, from fried food to salads, and from beef burgers to turkey burgers (this harkens back to a simpler time when experts agreed that lean meat was healthier than red meat).
The problem was that our margins decreased. We were making less “profit” because we’d nudged people to buy the least profitable food menu items. Don’t get me wrong, we hold true to the belief that we are not in the business of making money from employee cafeterias. But we all have budgets to meet.
Advocating for the Opposite
One more example: We have trays in most of our cafeterias, but for some reason they’re rarely used. A consultant observed this, noting that it was unusual. More importantly, he advised us that we could increase our “check average” (the amount of revenue earned on each purchase of a meal) by encouraging the use of trays.
Customers are limited by what they can hold in their hands, and using trays would allow them to pile on the food well beyond what their hunger level actually demanded.
Did we want to encourage trays, so that employees would buy more food than they wanted or needed? In most companies, the wellness manager would advocate for the exact opposite: Making trays less convenient in order to “make the healthiest choice the easiest choice.”
(The trayless strategy, you’ll be interested to note, has been refuted by Cornell’s Food and Brand Lab, led by Brian Wansink.)
I’m proud to report that we’ve consistently opted for whatever we determined to most effectively serve the best interests of employees. Sometimes it served their nutritional wellbeing and sometimes their financial wellbeing. And sometimes it served their career wellbeing by assuring sustainability of good food at work. Sometimes it was all of the above.
Organizations are complex. It’s easy for consultants, vendors, and academics to sit in their home offices hollering at you about what you should do. But real jobs have real people, with real goals, real pressures, real personalities, real challenges, and real conflicts.
Seeing the big picture, and recognizing that it can be viewed from different angles, sometimes is the first step to success.
Wellness 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.
- In 2014, San Francisco enacted the Formula Retail [i.e “chain store”] Employee Bill of Rights, which requires covered employers to provide employees with two weeks’ notice of work schedules, advance notice of schedule changes, and additional pay for schedule changes made on less than seven days’ notice and unused on-call shifts.
- Seattle’s City Council passed on September 19, 2016 secure scheduling legislation that, in addition to protections similar to those offered under the San Francisco bill, addresses clopening by requiring employers to schedule employees no less than 10 hours apart. Costco, Starbucks and the Washington Retail Association reportedly opposed the measure, whereas Safeway/Albertsons expressed its support,
- New York City’s Mayor Bill deBlasio has launched, as a centerpiece of his re-election campaign, a law affecting fast food workers that would limit unpredictable scheduling and clopening in a manner similar to Seattle’s law.
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.]
I was thrilled to read Community Cookbooks Help Tell the Story of Canada’s Past in a recent edition of the Globe and Mail.
The brief article lays out the role crowdsourced recipe books have in painting a picture of a culture, bringing communities together, and even rallying contributors and readers around a cause.
Community cookbooks help tell the story of Canada’s past https://t.co/eR6YoE9kdQ
— The Globe and Mail (@globeandmail) March 13, 2017
As the article mentions at the end, community cookbooks are still alive…
Community cookbooks are worth flipping through if you come across a boxful at a garage or used book sale… You may find a current self-published book from a group connected to your own community.
Employee recipe books are a form of community cookbook. They help employees build community at the workplace and — in the context of the type of cookbooks Gig Goodies will produce, they help workplace health seekers rally around a more hospitable work environment.
For an example of how I used an employee cookbook for just this purpose, check out the new blog post Health Enhancement Systems was kind enough to allow me to guest-author: How to Counter the Workplace Cake Culture. It’s the follow-up to a post I recently published right here on Gig Goodies.
— Dean Witherspoon (@DeanWitherspoon) March 16, 2017
Make-your-own fruit cones (photo, below) are the perfect fresh-food option for workplace meetings and events.
They’re easy to serve, and attendees will love the novelty, the choices, and the refreshing sensation. And, unlike what may be served at, say, an ice cream social, your attendees will feel energized and ready to go after this delicious treat.
Candy bowls at work — social lubricant for some, diet disaster for others.
The Washington Post recently took a deep dive into office candy bowls, uncovering their influence over co-workers and citing some caloric implications, as well.
Some data points from the article:
We secretly tracked how quickly candy disappeared from a jar in The Post graphics department for 10 weeks beginning Nov. 1. During that time, people took nearly 30,000 calories’ worth.
Who takes candy from coworkers' candy jars. https://t.co/ruqeuv1rHS
— Post Graphics (@PostGraphics) February 13, 2017
The author, Post graphics reporter Bonnie Berkowitz, writes,
At least 26 people in The Post’s 700-person newsroom have help-yourself candy containers at their desks (as opposed to those who keep their own private stashes).
Berkowitz cites the desktop-candy-bowl research conducted by behavioral scientist/jester Brian Wansink, which found that the probability of dipping into the office candy bowl is influenced by…
- Proximity to the bowl
- Translucence of the container
Why does no one ever take the last piece from the office candy jar? That and other deep psychological truths: https://t.co/oxX9THGmuL
— Bonnie Berkowitz (@bonnieberkowitz) February 17, 2017
But Berkowitz is more captivated by the social norms candy bowls reveal. Why do people have candy bowls? What’s the personality profile of those willing to snag the last morsel? Was Forrest Gump’s mama right about life?
Check out the Post article for life-changing answers to these and other questions about office candy bowls.
Employees at many workplaces have a big role in shaping their environment. Sometimes those environments can be harmful. Nowhere is this more clear-cut than in the environments employees — in many offices — shape via their nutritional and food-sharing practices.
I’m not talking about employee cafeterias and vending machines — food provided by employers. They’re important, but receive due attention.
This is about employee-provided grub — a harder nut to crack.
As wellness professionals, it’s tempting to overlook the less-than-wholesome food shared at workplace birthday celebrations, the candy passed around at meetings, the treats at trainings, the potlucks, the chocolate that co-workers sell for their kids’ fundraisers, the “food days,” the desktop candy bowls, munchable business gifts and giveaways, breakfast donuts for the staff, leftover halloween candy, Friday ice cream socials, and so on. In fact, with a wink and a nod, we may sometimes enable this culture in our desire to buddy-up to co-workers.
Speaking of buddying up, let’s not forget sugary rewards doled out by managers — a demeaning ploy applied to school-children, and no better with workers.
My awareness about shared-food has been raised after listening to employees’ complaints about it or overhearing those who indulge while engaging in self-talk about lack of willpower, excess body weight, or plans for self-punishment. Unhealthy eating environments foster a culture of guilt. And guilt is fundamentally incompatible with wellbeing.
As I’ve chatted with employees and employers, my mention of the overabundance of indulgent food at work is met with knowing groans.
As a manager responsible for cafés, catering, micro markets, and vending machines at my own workplace, I’m fully aware of the behavioral economics manipulations we can use to make the healthy choice the easiest choice and the policies we can create to support healthy eating via the food channels under an employer’s control.
— Suzanne Lucas (@RealEvilHRLady) December 6, 2016
But I also know these efforts are for naught if candy, pastries, soda, and pizza are dangled in front of workers in every break room, displayed on credenzas along every aisle of cubicles, served at every event because “people will always come for free food,” and generally tempt employees everywhere they turn.
I’ll post more on this topic in the coming days and weeks, and explore strategies to understand and influence the pervasive sharing of unhealthy food. Throughout, I’ll challenge some of my own assumptions — and perhaps some of yours. For now, mine include:
- A lot of workers want to make healthier food choices.
- Acting as “food police” always backfires.
- No food is bad when consumed occasionally.
- More choice is rarely a successful strategy to support healthy eating goals.
- Employers aren’t obligated to provide unhealthy foods.
- Workplace eating touches multiple dimensions of wellbeing.
- Workers should never be shamed regarding their body weight, food choices, or anything else.
- Different channels of food at work — cafeterias, vending machines, food brought from home to share, treats and celebrations, catered events, farmers’ markets or local produce delivery — interact to create a nutritional milieu.
- Habits like desktop dining, skipping lunch, eating alone, and brown-bagging vs. buying are vital pieces of the workplace eating puzzle.
Failure to lunch: the lamentable rise of desktop dining https://t.co/aroEUGA9S5
— jane_black (@jane_black) February 25, 2016
Rest assured I come to this conversation with no airs of self-righteousness. My personal weakness is sugar-free Red Bull sipped through a Twizzler. But I ain’t sharing.
A couple of years ago, I wrote that partnering with local farmers — via community-supported agriculture — could be the best wellness thing an employer can do. Based on the experience of at least one employer with 10,000+ office workers nationwide, I may have found my next best thing.
A survey completed by employees at this firm showed “healthier food at meetings, in cafeterias, and in vending machines” to be the second most requested wellness offering (after gym membership discounts). And 30% of employees who reported having unhealthy eating habits said they were actively engaged in trying to improve them. Some employees want to eat healthier.
The employer had, years ago, dug into a bag of age-old merchandising tricks that had become trendy when some bestselling author dubbed them “behavioral economics”: pricing healthier food more attractively than unhealthy food and making the healthiest choices the easiest choice.
The behavioral economics nudges had some success, but there was another obstacle afoot for employees who wanted to make healthier food choices…
Eating healthy is not always easy for consumers during the work day, with a little over half finding it only “somewhat” to “not at all” easy…Most attempt to eat healthy, but encounter challenges along the way. Some backslide the rest of the day and continue to indulge and eat less healthy as a part of a more emotional cycle of guilt and reward.
— Sodexo 2015 Workplace Food Insights
Free food is everywhere in offices and call centers. Sometimes it’s provided by employers, like not-so-refreshing refreshments served at long meetings and special events, or sweet treats used to reward workers the way you might use Milk Bones to reward a paper-trained labradoodle.
Sweet treats don't aid engagement and motivation https://t.co/TQ0KDiWJaO
— Dr Christine Sprigg (@DrSpriggy) January 5, 2017
But much of it is introduced and shared by co-workers. I’ve previously described workplaces flooded with cakes, candy, and other treats, and cited studies that coined the terms “food altars” (where leftovers and treats are reliably displayed) and “cake culture.”
Navigate around the 'food altars' & head to the water cooler – Avoiding the high calorie office snacks https://t.co/Yk3bXG7IR9
— Sharon Natoli (@Sharon_Natoli) August 4, 2016
The challenge this employer faced was how to meet the needs of employees seeking healthier choices and a healthier environment — without taking on the role of “food police.”
A pulse poll found that, when co-workers brought in treats, 23% of this company’s employees ignore them because they don’t fit into the respondents’ eating style, diet, or health concern; 9% sample some to be polite but “wish it wasn’t there”; 8% tend to overindulge and “feel gross after.”
Did I mention that some employees want to eat healthier?
When asked what type of foods they are most likely to bring to an office potluck, 32% of respondents from a separate poll of the same employees said they’d contribute an indulgent dessert; 15% said they’d bring “pizza and wings, or something like that”; only 16% said they’d bring a healthy dish; and 12% said it depended on their co-workers’ dietary concerns.
Not much can be concluded from informal poll data, but at first it may seem like there’s a reasonable match between employees that bring treats and those who consume treats. That’s not a problem if workers are only bringing in food, say, once every week or two.
But “cake culture” isn’t about what happens once every week or two. It’s about what happens every day. That’s what makes it cake culture… and not just…you know…cake.
If the majority want to have their next slice of cake within arms’ reach all day every day.…what about those who don’t?
Remember that “choice” thing? Does it only apply to those who fall into a narrow majority?
Some will argue, “Who cares?! It’s a matter of personal will. Employees who don’t want unhealthy food don’t have to eat it!”
Did I say “some will argue”? Nix that. Most will. But this stance reflects an unfounded belief in willpower, which has little to do with behavior (or obesity, in case you’re interested), a lesson even many wellness professionals have not yet learned.
Americans Blame Obesity on Willpower, Despite Evidence It’s Genetic https://t.co/4PB9LQzOhb
— The New York Times (@nytimes) November 1, 2016
Research has shown that people who demonstrate what might appear to be a high level of willpower generally are not exercising willpower at all, but in fact craft their environments in a way that supports specific behaviors. If anything, some researchers have said, naive faith in willpower reduces your chance of adopting a healthy behavior.
How to keep your resolutions (clue: it's not all about willpower) https://t.co/iEgwExIY8D
— Society Guardian (@SocietyGuardian) January 7, 2017
This employer endeavored to support the normalization of healthy food, so that the needs of employees seeking healthier choices, even if they weren’t a majority, were not drowned in a sea of cake, candy, cookies, pizza, and chips.
In an upcoming post, we’ll see how this employer leveraged a feel-good crowdsourced tactic to support employees when their own workplace food culture sometimes failed to do so.
I recently celebrated ten years at my current job.
I started in the thick of the holiday season. 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.
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.
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 ten 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 abundance of edible goodies pervasive in the workplace — my workplace and others — and I’ve learned that it’s a force 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.
Food at work. It’s a thing…for a lot of us. And that’s the topic of my new post, My Nine Assumptions About Workplace Food-Sharing — And Why They Matter to Employee Wellbeing. Please check it out.
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.
Food at work. It’s a thing…for a lot of us. And that’s the topic of my new post over at LinkedIn, My Nine Assumptions About Workplace Food-Sharing — And Why They Matter to Employee Wellbeing. Please check it out. If you like it, click “Like.” And if you don’t like it, click “Like” anyway…because that helps get the post into other people’s LinkedIn feeds and encourages them to chew on it and chime in with their own point of view.
And…speaking of feeds, I sincerely hope you enjoy a magical holiday, feasts and all!
Arianna Huffington’s New Venture: Wellness Game Changer?in Uncategorized, Commentary, Employee Wellness Programs
Last week, Arianna Huffington resigned from the Huffington Post to lead a new venture, Thrive Global. The new company will focus on both employee and consumer wellness.
Business Insider published what they say is Thrive Global’s investor pitch. A review of the document and Thrive Global’s public announcement suggest the company plans to be more than an old-school behavioral modification wellness vendor.
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 Arianna Huffington
- Abby Levy serves as the President of Thrive Global. In the Business Insider article, Levy offered this compelling comment:
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.
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:
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.
Sleep loss and its cost to business are hot topics these days. Employee Benefit News recently published an article titled, Companies Can’t Afford to Ignore Sleep in Wellness Offerings. Fast Company published Your Employees’ Sleep Problems Are Costing Your Business Time And Money. The Institute of Health and Productivity Management created its Sleep Health and Wellness division, to be introduced with a day-long conference. And a book, Work and Sleep, will be published next month and will draw additional attention to workers’ sleep loss.
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.
[READ THE FULL INTERVIEW (page 4 of the pdf)]
You’ll find the interview to be a light-hearted and quick read (I called it a “tell-all,” but I’m stopping short of calling it a “romp”!). In it, I offer my offbeat musings on employee wellness:
- The common culprit that induces stress in all industries
- The underpinnings of employee wellness program success
- Challenges that lie ahead for the industry
- My numero uno best practice.
But I also get personal, sharing…
- How I achieve balance in my own life and work
- My wellness pet peeves
- The book that transformed my take on work and health
- Why I’m optimistic about wellness
There’s more fun crammed into this quick read… About banishing jesters; Dean’s offer to grant me unlimited funding; and how employers can really get their wellness on.
Check it out, if you have a chance. And let me know if you like it. 🙂
[READ THE FULL INTERVIEW (page 4 of the pdf)]
Sitting is the New Smoking. Smoking is the Old Standing. The Old Standing is the New Sitting.in Uncategorized
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.
A group of international experts commissioned by Public Health England recently obliged, publishing a consensus statement that recommends:
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:
First: An analysis of the Whitehall II study data (which I’ve described elsewhere) determined that sitting is no worse than standing. Reporting in the International Journal of Epidemiology in October 2015, the researchers found no association between sitting time and mortality. Their recommendation:
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.
The UK’s Hazard Magazine, which covers health and safety issues — from a decidedly pro-labor perspective — chronicles the history of European workers seeking the right to sit at work. But let’s not dismiss the right to sit as a relic of European history… In 2014, AT&T Mobility settled a complaint by workers and agreed to redesign stores with “learning tables” that gave retail staff the option to sit if customers also chose to do so. (The settlement also required AT&T to pay approximately $250 per eligible retail employee.) In 2007, Safeway — self-anointed prophet of all that is righteous about employee wellness — was unmoved when a customer took sympathy and gifted stools to cashiers.
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.
[Feel free to comment on the LinkedIn version of this post.]
For further reading:
Sitting Is the Smoking of Our Generation — Harvard Business Review article by Nilofer Merchant
Taking A Stand at Work — Wall Street Journal interview with Dr. Anup Kanodia
Effort-Reward Imbalance Underpins Worker Stressin total worker health, Uncategorized, Stress, job design, job strain, industrial organizational psychology
It 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:
- 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
- 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.
- 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.
Partnering with Community Supported Agriculture May Be the Best Wellness Thing an Employer Can Doin Uncategorized, Commentary, Employee Wellness Programs
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.)
Mapping Workplace Demons to Health, Costs, and Mortalityin Uncategorized, Stress, job design, job strain
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
And — again, using secondhand smoke as a benchmark — the conditions that had a greater affect on mortality are:
- Low job control
- 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.]
15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Paloozain Commentary, Employee Wellness Programs
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: Start with changing employees’ behaviors.
Do: Focus on changing your organization. Healthy employees require reasonable job demands, input regarding job demands, appropriate rewards, reasonable work schedules, fair treatment, empowerment, less work-life conflict, and more social support.
- 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: Invest heavily in health incentives. Incentives don’t support behavior change, and may stand in the way.
Do: Offer wellness programs and opportunities employees want.
- 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: Limit yourself to the conventional American perspective on wellness.
Do: Read the World Health Organization Healthy Workplace Framework and also RWJF’s Work, Workplaces and Health. (They make scant mention of biometric screenings, health risk assessments, incentives, coaching, apps, portals, or wearables.)
- Don’t: Fret about what external critics think.
Do: Define a clear goal and measure progress toward achieving it. Satisfy the needs of the organization.
- Don’t: Expect much from your health risk assessment. It’s outdated and was never an effective catalyst for behavioral change.
Do: Leverage your aggregate health risk assessment data as a tool to assess how you’re doing and how you can most effectively serve employees.
- 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]
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.
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.
Job 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]
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.
(Surface acting occupies one end of a spectrum of emotional labor — in contrast to physical labor — opposite the more intrinsic deep acting. For more info about emotional labor, check out the pdf, When The “Show Must Go On”: Surface Acting and Deep Acting as Determinants of Emotional Exhaustion and Peer-Rated Service Delivery,” which was published in the American Journal of Management).
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.
Pedometer Programs: 10,000-Steps-Per-Day or Individualized Goals?in Uncategorized, Employee Wellness Programs
[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.”
In 2011, Catrine Tudor-Locke and a team of distinguished researchers, in their comprehensive scientific review, “How Many Steps/Day Are Enough? for Adults,” added:
“…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
Health Risk Assessments: The Baby and the Bath Waterin Uncategorized, Commentary, Employee Wellness Programs
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]
How is employee wellness supposed to work?
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.
I first tried mind mapping three years ago — to plan a family vacation to Oregon. But I’d jumped straight to the software without really understanding mind mapping, and I crashed into the mechanics…and burned. Then, last year, I tried using new mind mapping software to illustrate a project I was working on at work. That attempt may have helped me, but when I showed it to team members, it was greeted with profound silence, bewilderment, and polite smiles. I still hadn’t even tried to educate myself about mind mapping. But intuitively I knew that it’s important.
Now I’ve started to understand the Why and the How of mind mapping, and I see tremendous potential: For problem solving in the workplace, for communicating, and, personally, for learning, memory, and unlocking creativity.
I was fortunate enough to come across the work of Jane Genovese, of Learning Fundamentals in Australia. As part of her mission to make learning more effective and fun, Jane has created beautiful and engaging mind maps on a broad range of topics. She was kind enough to allow me to re-post here her mind map on Behavioral Change Programs. Click on the map [below] to open the full-sized version. Jane’s map is extraordinary in the thoroughness with which it depicts the elements of successful wellness programs, and I would recommend it to any health promotion professional — especially newcomers to the field. I hope you enjoy and learn from Jane’s mind map as much as I have. (And please be sure to visit her site. Lots of great mind maps and other innovative resources.)
I’ll be writing more about mind maps, and publishing my own, and hope to explore with you how we can use mind maps and other visual thinking tools to advance employee wellness (and, beyond that, human resources and organizations overall). I think we are just getting started and the possibilities are unlimited.
[A version of this article was originally published on my The Employee Wellness Network blog in October 2011 — Bob]
Which is Better, Telephonic or Face-to-Face Health Coaching?in Uncategorized, Commentary, Employee Wellness Programs
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 to caution 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:
- Phone and e-mail counselling are effective for weight management in an overweight working population: a randomized controlled trial
- Telephone-assisted Counseling for Physical Activity
- Telephone Counselling for Smoking Cessation
- Telephone Counseling May Be As Effective As Face-to-Face Counseling In Weight Loss Maintenance (as reported in ScienceDaily)
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.