Podcast interviewers and conference organizers often ask me to talk about my mistakes and failures. Thank you very much.
It’s okay; I get it. Others can learn from our mistakes and also take solace in the fact that we all make them. Listening to some presenter prattle on about how perfect their programs are—especially when they’re from companies with nearly unlimited resources—can be discouraging rather than inspiring. (Besides, if our professional social media is pervaded exclusively by self-promotion and ungrounded thought leadership, it’s hard to grow in a way that’s relevant to the real-life work environment.)
For some reason, two of my professional flops fell in the realms of mental health and emotional well-being. Continue reading »
I’ve fessed up about two of my employee mental health flops. But I’ve had successes, too, including providing health care workers with one of the best-proven opportunities to get stress under control.
The scene was a large population of employees at a major medical center, where I served as employee wellness program manager, and partnered with our internal Employee Assistance Program (EAP) to offer the Yale Work and Family Stress Program. EAP counselors went to Yale to get trained on the program, and made a few adaptions suitable for our health care worker population. Continue reading »
Well-meaning employee mental health advocates, including wellness leaders, may — in our zeal to address mental health — inadvertently reinforce or perpetuate mental health stigma. Here’s how:
1) Viewing stigma too narrowly, especially seeing it only as failure to seek treatment. Mental health stigma includes public stigma, characterized by lack of information (and stereotyping), prejudice, and discrimination, and self stigma, which includes internalization of social stigma stereotypes, reduced self-esteem, and reduced self-efficacy. Reluctance to seek treatment (or not being aware of treatment opportunities) is a critical consequence of stigma. But people who receive treatment, and people who don’t need treatment, experience stigma, too.
2) Not understanding how to address stigma. Anti-stigma campaigns are based on protest (e.g. speaking up against stereotyping); education (like the communication tactics employers commonly implement); and contact (interacting with people who have “lived experience” with mental health problems). Continue reading »
Meaning and purpose at work go far beyond the simplistic “Find your why” self-help trend that’s made millions for certain marketing gurus (though it would be more properly attributed to Nietzsche) or the appropriation of ikigai that’s the latest buzz.
There are no simple answers to meaning, only explorations. I suggest seekers take a look at Viktor Frankl’s “Man’s Search for Meaning” and, for contrast, Maslow’s “A Theory of Human Motivation.” Then bring it into the modern work context with Job Crafting and Cultivating Positive Meaning and Identity in Work, by Amy Wrzesniewski et al.
Today’s big news in the employee health industry is the merger of telemedicine company Teladoc Health and virtual disease management company Livongo. Both have been high flyers in 2020, with their revenues and their stock prices (Livongo just celebrated the one-year anniversary of its IPO and has been a Wall Street darling since then) skyrocketing. Each of the two companies stock prices are up by more than 100% year-to-date.
Telemedicine has been all the rage among employee benefits directors for at least five years, but utilization remained lackluster until this year, when the COVID-19 pandemic radically accelerated consumer uptake.
Benefits of the merger include “joining two leaders in consumer behavior change,” according to a joint news release.
Speaking of behavior change, both companies’ stocks made it onto the markets’ Biggest Loser list on the day of the merger announcement, with Teladoc down 19% and Livongo off by 11% — the second and fourth biggest losers for the day, respectively.
Wellness (orwellbeing, if you will) is usually illustrated as a perfect circle divided into uniform wedges.Gallup’s5 wedges, for example, represent Social, Financial, Physical, Community, andCareerPurpose wellbeing.National Wellness Institutehas its Occupational, Physical, Social, Intellectual, Spiritual, and Emotional dimensions.
There’s no end to how circles can be sliced up into the elements of wellness, whether there are 6, 7, 8 wedges, or — even as some models have it — 12 wedges of an inner circle surrounded by 8 pastel sections that join to form 2 concentric circles. (Stop this ride, I’m getting dizzy!)
These wellness merry-go-rounds are mostly the product of an American spin on wellness. Elsewhere, especially Europe, the focus is on what wellnessis— something related to happiness and life satisfaction. You know…wellbeing! In the US we obsess over thecomponentsof wellness — no time to fret about what they add up to — as you may recall from my post “Wellbeing and Pizza: In Search of the Secret Sauce.”
These tidy geometrics are a swell way to say that wellbeing goes beyond physical health. But a handful of static, one dimensional, and evenly distributed wedges — crammed into a flawlessly circular vessel — don’t resonate with my experience of wellness. And I wonder if they’re an ideal way to describe what other people’s wellbeing — ultimately their lives — are or can be.
Meet My Globules
My wellness is more like a lava lamp: An ever-changing bunch of free-floating globules of different shapes and sizes. I’ve got fitness globules, mental health globules, spiritual globules. Some rise to the surface for as others submerge. They’re fluid. They expand and they contract.
Some globules, like my health globule and my financial globule, merge for a while. My emotional globule occasionally smothers my intellectual globule; other times, it’s the other way around. Look: My creativity globule and logic globule are going at each other right now!
But even the lava lamp analogy eventually runs dry. Ultimately, I want my globules to be set free, to be unbound by time and space, and to interconnect with others’ globules — those of people who love me and those of people who don’t. Any model of real wellbeing has to show our globules interacting and interconnecting. You heard me right: We must have global globules.
The change starts within. To paraphrase an ancient sage: Be a lava lamp unto thyself.
Copyright 2020 by Bob Merberg. All rights reserved. (My globules may be your globules. But my work is not.)
“It’s the damnedest thing, hahaha” my father-in-law would say, his thick Irish brogue muscling its way forward through his baritone laugh. “I hate tomato sauce and cheese, and I don’t like bread, but I like pizza. Hahahahah!”
As a Brooklynite weaned on pizza, this reallywasthe damndest thing I’d ever heard. But the corporate world’s newfound adoration of “wellbeing” gives me insight into my father-in-law’s pizza predilections. And vice versa. Continue reading »
In her incisive Redesigning Wellness interview with Julian Reif (principal investigator of the Illinois Workplace Wellness Study), Jen Arnold elicits answers to controversial questions like how the research team defined “comprehensive program” and why they believe their randomized study design “cancels out” most previous wellness program study findings.
Thanks Jen (and thank you for the shout-outs), and thank you, Julian Reif.
Essential listening for wellness leaders who care about results. Click below to go to the podcast episode page:
I don’t agree with everything in The Hard Problems of Corporate Wellness, including the premise that wellness hasn’t worked. But I’m grateful as all get-out that my friend and colleague Scott Dinwiddie is saying it. We don’t all need to agree, but we progress only by questioning the status quo, engaging in civil dialog, and seeking better solutions.
If we’re inclined to look, in this article we find wellbeing as a microcosm for the human condition. In fact, Scott’s exploration of personal accountability in the context of systemic disorder may shine a light on social issues that appropriately preoccupy us today.
In the aura of this microcosm, we in the wellness profession are called upon to renew our own personal sense of purpose.
New study findings from the University of Illinois confirm that an employee wellness program doesn’t improve health or healthcare costs.
Here’s what will happen next:
Wellness critics will argue that wellness programs must cease at once.
Wellness profiteers will, once again, falsely claim that the studied program was atypical and that the researchers failed to report on measures such as mental health, energy levels, quality of life, or job satisfaction.
Here’s what should happen next:
We should be prepared to accept, based on a growing body of evidence, that typical wellness programs don’t deliver on their promise.
We should collaborate with employees to figure out how we can effectively support their wellbeing.
Research should be leveraged to improve employee wellbeing strategies. Circling the wagons around the status quo or interpreting studies simply as a yay/nay on employee wellbeing are both unproductive.
Check out Margaret Moore’s post, 20 Years to a Vision with Wings, chronicling the path of Wellcoaches Corporation (and wellness coaching) leading up to the organization’s 20-year anniversary.
I’m honored that Margaret, Wellcoaches Founder and CEO, included me amongst the founders of the wellness coaching field, and especially honored to be associated with the other distinguished innovators she mentions:
Our inspiring fellow founders of the field we now call health & wellness coaching included Sean Slovenski, Bob Merberg, Michael Arloski, and Linda Bark.
Congratulations to Margaret, Wellcoaches, and the 12,000 coaches they’ve trained across the globe, who over 20 years have shaped the field that has benefited the wellbeing of so many!
A headline in the Washington Post (April 26, 2020), based on the researchers’ conclusions at the time, blared, “In New York’s largest hospital system, 88% of coronavirus patients on ventilators didn’t make it.” (As of April 25, the headline wasn’t corrected. By May 5, it had been changed to read “…many patients on ventilators didn’t make it.”)
The ventilator mortality rate excluded from the denominator patients still in the hospital.
After an immediate outcry from others in the medical community, the research paper was corrected in JAMA online:
“The sentence reporting mortality for patients receiving mechanical ventilation should read, ‘As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital.'”
This is one example — the cornovirus pandemic has provided many — of the importance of proper denominators.
Denominators often are not scrutinized closely enough by journalists, by businesses, or by wellness professionals. The gross oversight described here reminds us that, without any background in statistics or data science, denominators used in calculations — when, indeed, they are used — are one reasonable starting point (population size is another) when interpreting data.
I don’t know what’s going to happen to the economy or what course the coronavirus pandemic will take. But I’ve had time to reflect on what a new world order may mean for employee wellness and the future of work.
Here are 10 hopes, fears, and questions (not predictions):
1) We’ll re-frame “meaningful work” — I recently heard, in an interview, a worker who delivers tortillas to grocery stores poignantly articulate what will prevail as a fresh take on meaning and work: Continue reading »
A new study repudiates gratitude interventions as a treatment for depression.
The original intention of positive psychology was to expand mental health, not to cure mental illness. But wannabes self-help gurus, and some mental health professionals, hawk positive psychology interventions as a panacea for clinical disorders.
As the study authors note, gratitude interventions have value (for example, improving relationships) — but not much for the treatment of depression or anxiety.
Consistent with past reviews, we found gratitude interventions had a medium effect when compared with waitlist-only conditions, but only a trivial effect when compared with putatively inert control conditions involving any kind of activity.
In other words, gratitude interventions didn’t fair better than other behavioral activities used as controls.
A remaining controversy is how the limited efficacy of gratitude interventions compares to popular antidepressant medications.
Withholding earned pay for 2-week or 1-month “pay periods” is a vestige of days gone by, serving the funds-holder but penalizing the earner.
While some companies already have introduced on-time (on-time = real-time) payment as an opt-in service paid for by employees and/or their employers, it inevitably will become the standard. This is an important option to be considered by employers genuinely committed to their employees’ financial wellness. But it only makes sense if the employees incur no fees. Employers generally don’t charge employees for other payroll services, just as they don’t return dividends to employees when they’ve managed to realize savings (say, through increased payroll system efficiencies, contracting with more cost-effective providers, and so forth.)
There is a cost… in service provider fees and the loss of “float” (the interest employers earn on the money they’re withholding — big money, especially during periods of higher interest rates). This needs to be built into employers’ financial models.
A long-haul truck driver fell asleep during his shift in Sunbury, Pennsylvania, on Jan. 13. Heading north on Route 147, he drifted into the eastbound shoulder for almost 375 feet, struck the side of the road and flipped his rig. Thankfully, the driver only suffered a minor injury and nobody else was harmed.
8 lessons from the 2020Iowa caucuses… for Wellness, HR, and Employee Benefits Managers launching new apps/websites:
Conduct your due diligence with the vendor.Find and talk to the vendor’s ex-clients — not just the references provided to you. Visit the vendor’s offices (i.e. site visits), when possible.
Attach steep performance guarantees to implementation.Look for at least 10-15% of the first year’s total fees.You only get one chance for a smooth launch.If the vendor balks, they’re telling you they don’t have confidence in their capabilities. Consider metrics like launch-date readiness, uptime, loading speed, speed to answer help desk calls and to reply to emails, and participant satisfaction (measured by you, not the vendor) with the initial process. As usual,you don’t want to have to collect these performance guarantee fees. Youdowant the vendor to be motivated and accountable. Of course, you can only hold them accountable for things in their control.
Test, test, and test again.Test as many scenarios (different kinds of users; different ways of using the technology; etc.) as possible.
During implementation, require regular updates on your vendor’s quality assurance processes.
Have an experienced project manager on your team, and an IT specialist who has access to the vendor’s IT team.Include other experts, as needed, and work within your organization to assure selected team members are fully engaged in the project, and not just begrudgingly doing something they consider outside their job responsibilities.
Collaborate with your vendor on systematic pre-launch trainingof key managers, leaders, and team members in your organization.
Require your vendor to identify an executive sponsor for your account — a leader on their team with whom you can establish a relationship and who will make sure the vendor’s organizational barriers are torn down when you need them to mobilize for action on your organization’s behalf.
Don’t scapegoat your vendor.When things don’t go well, look at your own performance and your organization to identify opportunities for improvement. (When things do go well, give credit where credit is due.)
The vendor blog post “Why We Love Patty McCord” perpetuates the cult-like status of an HR exec who made a name for herself blurring the lines between leading with transparency and leading with fear. Early on, the blog post proclaims that great workplace culture “requires companies to show employees they care.”
Another worthwhile read, which lends insight into why the aforementioned exec was fired (falling victim to the consequences of the culture she fomented), is “Working at Netflix Sounds Absolutely Terrifying.” The exec, this article reports, left a legacy of a “harsh, hyper-competitive office culture.” This is the same exec the “great caring culture” vendor says “we love.”
Do the simplistic platitudes that permeate our discussions of corporate culture enable workplaces to cloak ruthlessness as transparency?
Is it enough for a job candidate to “show up” for an interview?
A prominent voice on LinkedIn recently garnered more than 17,000 likes with a post that read, in part:
We just hired a Gen-Z candidate with zero experience. Here’s why… They arrived 10 min early for their morning interview (respect ✊), pronounced my name correctly (major kudos), had a firm handshake, dressed sharp, and brought a hard copy of their resume (I didn’t need it). During the interview they smiled, made eye contact, and were honest about having zero experience (we value honesty). They asked me questions, they wanted to learn, they showed up! To all the hiring decision makers out there, don’t disqualify candidates because they don’t have “experience.”
By all means, don’t discriminate against Gen-Z or any other Gen, or against candidates who don’t have experience if the job doesn’t require it. But be smart about hiring, based on Continue reading »
In 2019, employees filed a class action lawsuit against a prominent employer for allegedly selling out its workers’ 401(k), costing the plan tens of millions of dollars in excess fees and underperformance, in exchange for mega-donations and lavish personal gifts. These shady dealings with employees’ savings were being finagled at the same time financial wellness program promotions admonished employees to “understand their values and get their finances in order.” (Learn more in myFinancialWhatness?article.)
On the other hand, Dan Price of Gravity Payments, who, in 2015 raised his company’s minimum wage to $70,000 per year while slashing his own salary, launched aplanin 2019 to establish the same healthy wage for employees of a new acquisition in Boise, Idaho. Mr. Price has his naysayers, but you’ll be convinced he understandshisvalues when it comes to employee wellbeing — financial and otherwise — after you listen to this interview:
Just when you were getting on board with a plant-based dietcomes a new, supposedly more rigorous analysis by 14 researchers,saying it’s fine (nutritionally) to eat red meat, even processed meats like bacon. The new analysis argued that previous studies were either biased by veggie-lovin’ diehards and food industry shills or simply weren’t rigorous enough.
Browse the nearly 100 blog posts I’ve published onmy websiteand you’ll find no mention ofmillennials— because generational stereotypes have limited validity and are just another way to pigeonhole folks. So, while I can understand the backlash that may have led to 2019’s patronizing #OKBoomermeme,it ultimately serves only to perpetuate polarization.
OKBoomer may lead to someage discrimination lawsuits, or it may just be a soon-to-be-forgotten fad. Either way, it can serve as a reminder for each of us to embrace diversity, inclusion, and connectedness, in all their forms.
In the early going, a typical employee wellness program doesn’t have much impact on healthcare costs, health, quality of life, or job performance. This, based on data from a cluster-randomized study of employee wellness at BJ’s Wholesale stores. (Clusterrandomization means the worksites, not the individual participants, were randomized.) Get the lowdown in my article,The 4 Factiest Facts Overlooked in the Latest Wellness Study Kerfuffle.
But rumors of wellbeing’s demise have been greatly exaggerated. A cluster-randomizedstudyof Gap stores showed thatstabilizing worker schedules led to increased sales and — while it’s no panacea — enhanced employee wellbeing, especially sleep. (Aseparate major studyconfirmed that unstable schedules are strongly linked — more strongly even than low wages — to workers’ psychological distress, sleep disruption, and unhappiness.) The contrasting results from these studies, building on previous research, surely will persuade business leaders to prioritize organizational strategies over health behavior modification products.
Japan’s #KuToo movement — from the words “kutsu” (shoes) and “kutsuu” (pain) — arose in response to dress codes requiring female workers to wear high heels, a workplace policy the Health and Labor Minister declared “occupationally necessary and appropriate.”
Similar requirements have ignited protests elsewhere.
Aside from the unabashed sexism these policies represent, even less woke old-school health promoters will be concerned about health risks linked to high heels. According to a report conducted for the UK Parliament, these include:
long-term changes to gait, which cause knee, hip and spine problems and osteoarthritis;
stress fractures in foot bones;
ankle sprains, fractures and breakages due to trips and accidents;
hallux valgus (bunions);
blisters and skin lesions;
enduring balance problems which persist into old age;
The report also cited psychological distress reported by female workers who were required to wear high heels against their will.
Meanwhile, in the US, HuffPostexposeda prominent professional services firm that set us all back with one of its women’s leadership trainings. The training’s handbook insisted that“the most important thing women can do is ‘signal fitness and wellness.’”?
It advised trainees to have a “good haircut, manicured nails, well-cut attire that complements your body type.” Then it warns:
“Don’t flaunt your body ― sexuality scrambles the mind (for men and women).”
Read the full HuffPo article and to view the employer’s “leaked” video response:
The National Institute of Mental Health reports that 20% of people live with a mental illness.
Mental and behavioral disorders are the 3rd-leading cause of disability in the U.S. That’s a lot and warrants special attention.
Not everyone recovers from mental illness. Many (here, I don’t have stats, but the 20% figure — and my own observations — suggests this is true), suffer their entire lives with mental illness, and an increasing number of people end their lives as a result. Suicide is the 10th leading cause of death in the U.S. We need to help these people.
Mental health and emotional wellbeing, unquestionably, are important for everyone. But in the wellness industry’s well-meaning enthusiasm for covering everyone under the mental health umbrella, we must be sure not to marginalize the large portion of people experiencing mental illness.
If we do communicate that there’s no difference between someone with a common disabling mental illness — like PTSD, bipolar disorder, and anorexia nervosa, as well as severe depression and anxiety — compared to anyone else who may be going through a tough stretch in an otherwise smooth-sailing life, we risk perpetuating mental health stigma rather than alleviating it.
Wellness thought leaders, under the guise of “wellness isn’t just about physical health,” brush physical health aside as if it’s no longer our concern. We’re all about connection, humanization, and collaboration.
You know those organizational inventories we recommend for other dimensions of wellbeing? Before launching a physical wellness program, for example, we conduct audits of workplace factors that influence physical health, like pretty stairwells, healthy food in vending machines, and so forth. Before launching a culture-of-health strategy, we assess the current state of the organization’s culture, using criteria like “Is wellness mentioned in the company’s mission statement?” and “Does the CEO visibly model wellness behaviors?”
We should do the same with our ever-popular financial wellbeing strategies. Before launching strategies to promote savings, budgeting, debt management, and retirement planning, let’s assess Continue reading »
This week, CBS News, CNN, and other major outlets blared headlines and articles — most accompanied by photos of office workers collapsed face-down on their desks — claiming that burnout had officially been recognized as a disease. The news spread like wildfire but was almost completely unfounded. Continue reading »
This is based on a response I wrote to an astute new leader of a wellness industry organization who was asking, “What should be next for the organization to move wellness forward?”
Broaden the base. Reach out to professionals trained in fields other than exercise, nutrition, and HR. Especially, bring in folks trained in the relatively fast-growing field of I/O Psychology, who have a deeper, evidence-based understanding of wellbeing and also tend to be well trained in analytics. Speaking of which…
Train wellness professionals in analytics. HR finally seems to be getting serious about data, and wellness will be left behind if we don’t have stronger competency in this area. We don’t need to be data scientists, but we should be able to direct analytical work and speak the language. I’ve been studying statistics, business analytics, and advanced Excel, and it’s already added value for my clients.
Help us understand the wellness needs of employees. Because wellness in the US has been market driven, we give most of our attention to what purchasers (employers) will buy, rather than what employees want. Unfortunately, these are rarely the same thing.
Help identify and then advocate for where wellness fits in an organization. As long as we’re tucked away in benefits departments, we’ll be undervalued and weighed-down by healthcare cost-reduction fantasies.
The BJ’s Wholesale Club study wasn’t the most important employee wellness research published last month. Let’s look at the Workplace Health in America Survey conducted by the Centers for Disease Control and Prevention.
The CDC asked about companies’ employee health promotion programs. 2,843 respondents completed surveys — targeting whoever in the company was most knowledgeable about its wellness offerings — from a variety of employers.
Not to be missed: Bruce Daisley’s brilliant interview with William Kahn, widely credited with coining the concepts of psychological safety and personal engagement at work. To whet your appetite for the entire interview, here’s a taste: Continue reading »
There’s no need to be either frustrated or complacent with low engagement in whatever you offer employees. Download the free ebook, Now We’re Talking!, written by Jozito’s Bob Merberg and published by HES, to learn how it’s done.
It’s not just for walking clubs and smoking cessation programs. For example: Everyone’s talking about mental health, and lots of employers name EAP as their main mental health at work intervention. But EAP utilization is typically 4% or less (sadly, 7% is often considered good). When I oversaw EAP for an employer, utilization averaged between 14% and 18%… because, once we had excellent program pieces in place (integrating it with wellness, absence management, and other functions; implementing proactive EAP outreach to at-risk employees rather than just passively waiting to be contacted by those in crisis), we communicated about it: All the time. Everywhere.
Download the ebook and get started achieving the participation, engagement, and results you’ve always wanted.
When skillfully incorporated into a broader strategy, external recognition for wellness programs has the potential to be a win-win, serving both the employer and the employees.
In keeping with my recent theme of providing practical tools and tips for wellness managers who do the hard work of creating and operating employee wellness programs in complex corporate environments, I’m pleased to share this post I wrote for one of my clients.
I’m pleased to provide these practical tips for wellness vendor management, one of the most demanding roles of employee wellness managers. Some of these — six tips for implementation and oversight, eight for selection and contracting — may be more relevant to larger corporations, but many are applicable to a spectrum of organizations and a variety of non-wellness vendors. They can help make a manager’s job easier, while eliciting higher levels of performance from vendors. Continue reading »
I agree with the position paper, Behaviour-Based Safety Programs, recently published by The International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers’ Associations (IUF). An employer’s primary role in employee wellbeing is to protect employees from Continue reading »
A new year, a new opportunity for an employee benefits trade publication to randomly drop into an article a chart that makes less sense than a child’s finger-painting. (For legit. A finger-painting can’t be wrong. The chart is blatantly wrong.) Continue reading »
In 2018 aHuffington Post article,Everything You Know About Obesity Is Wrong, went viral, debunking myths about obesity and weight loss. It argued that the “war against obesity” has really been a war against obese people, fostering a culture that encourages fat shaming and alienates overweight people.
2 Slices of Bacon Daily Shortens Life by a Decade?
Ioannidis illustrates his point by describing the real-life implications were we to assume studies of individual foods are legit:
…eating 12 hazelnuts daily would prolong life by 12 years (ie, 1 year per hazelnut), drinking 3 cups of coffee daily would achieve a gain of 12 years, and eating a single mandarin orange daily would add 5 years of life. Conversely, consuming 1 egg daily would reduce life expectancy by 6 years, and eating 2 slices of bacon daily would shorten life by a decade, an effect worse than smoking. Could these results possibly be true?
Ioannidis blames researchers’ failure to properly account for confounding factors:
Relatively uncommon chemicals within food…may be influential. Risk-conferring nutritional combinations may vary by an individual’s genetic background, metabolic profile, age, or environmental exposures. Disentangling the potential influence on health outcomes of a single dietary component from these other variables is challenging, if not impossible.
He also blames selective publication of studies that proclaim a correlation between a food and a health outcome over studies that show no correlation. And he throws shade on nutrition advocates…
Expert-driven guidelines shaped by advocates dictate what primary studiesshouldreport.
Ioannidis didn’t even dig into the type of academic misconduct described in the first story on my Top 10 list, Mindless Cheating.
The Good News
But there’s a valuable learning — making this Number 9 on my list of Top 10 Wellness Stories of the year — we can take from all these stories. The lessons from Ioannidis’ article and Huffpo’s obesity article are essentially the same.
Pursuit of continuous improvement in the promotion of employee well-being demands skepticism.
We have to maintain idealism to believe we can do better. My New Year’s resolution is to cultivate even more optimism in the pursuit of measurable progress, knowledge, and improvement.
This is the 5th in my Top 10 Wellness Stories of 2018.
Not long ago, I attended a panel discussion in which an audience member asked the panelists what their organizations were doing to address mental health. No one had anything to say other than, “We offer an EAP.” A wave of ick swept over the room as the tragedy of this truth dawned upon us — the panelists and the audience.
These readily make clear that countries like Canada, European Union members, and Australia are far ahead of the US in their action planning, and I’ve previously written about Japan’s aggressive approach.
Will the US learn from other countries and develop an evidence-based agenda to address mental health in the workplace (and beyond)?
I’m optimistic and predict that evidence-based solutions prevail.
I’ve writtenad nauseamabout the University of Illinois Workplace Wellness Study, so allow me to just explain why I’m optimistic about where it’s heading.
This evaluation of an employer’s fledgling wellness program gave wellness critics a rationale to declare employee wellness a failure. The evaluation data, which showed almost no positive outcomes during the program’s startup, is only preliminary anddoesn’t say what critics say it says.
Even if you’ve never heard of Brian Wansink, you’ve probably been affected by his research.His studies,cited more than 20,000 times, are about how our environment shapes how we think about food, and what we end up consuming. He’s one of the reasons Big Food companies started offering smaller snack packaging, in 100 calorie portions. —Vox
Wansink led many headline-grabbing studies of eating behavior, showing, for example, that people eat less when food is served on smaller plates and that pre-ordering lunch leads to healthier choices. His work unleashed many employers’ nutritional wellness strategies, especially “making the healthy choice the easy choice.” Continue reading »
A New York Timesarticle recently revealed that the company has protected, arguably even rewarded, executives accused of sexual misconduct. It described one exec who “often berated subordinates as stupid or incompetent.” The company “did little to curb that behavior.”
A screenshot the exec’s ex-wife included in a lawsuit, according to the Times, showed an email he sent to another woman: “You will be happy being taken care of,” he wrote. “Being owned is kinda like you are my property, and I can loan you to other people.”
In our quest for a psychological-safety poster child, we may need to conduct a better search.
Does your Employee Assistance Program proactively address workplace mental health? Are they reaching out and screening employees — like those out on disability, or who have recently given birth, or are dealing with grief, or who have a chronic disease — who are at risk for mental health problems?
In 2013, Carol Harnett and Fran Melmed interviewed Bob Merberg for their CoHealth CheckUp podcast (which is no longer in production). They asked him to discuss a “great idea that didn’t work out.” In this 2-minute answer, he talks about a positive psychology intervention designed to help employees cultivate happiness.
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.
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 wellnessworksordoesn’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 programdoesn’tyield 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 wellnessdoeswork. 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.
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, theiThriveprogram 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.
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:
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…
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;
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 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.]
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?
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.)
“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.
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 wasMonique 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.
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.
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]
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.
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.]
Photo: The Teaching Kitchen Collaborative evolved out of the Healthy Kitchens, Healthy Lives® conference, shown here. Photo creative commons copyright courtesy Culinary Institute of America Leadership Programs. Acquired via Flickr.
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…
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.
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.”
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.
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.
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.]