Bob Merberg and Jen Arnold Strikethrough the Year 2020 in Employee Wellbeing

in Uncategorized, Wellbeing, Commentary, Featured

Scene from Fury Road

At the end of each year, a hush falls over the world, as it awaits the arrival of…

…the annual end-of-year wellness wrap-up that Jen Arnold and I record for her Redesigning Wellness podcast! It’s here!

This year was no different.  Of course, this year was completely different, but Jen and I still managed to offer some reflections on 2020 in employee wellness. Unlike previous years, this time we forgot to prepare for took a pass on the nerding out on analysis of peer-reviewed studies that have tested the patience of delighted audiences in years past.

Predictions? Oh, we have predictions. We’ve got nothing. Our best shot at predictions were: Continue reading »

Job Demands-Resources: Untangling Stress and Motivation

in Stress, job crafting
Still shot from Charlie Chaplin's "Modern Times" illustrating high demands, low resources, no social support on an assembly line.

High demands, low resources. No social support.

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.

Job strain illustration shows relationship of demands, control, social support, and health.

Job strain

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.

So…

      • • Demands regulate job stress. 
      • • Resources regulate job motivation and engagement. 
      • • And the two forces may act upon each other.

Looking Forward…

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

6 Surprising Ideas That Will Transform the Employee Wellness Industry (Webinar)

in Uncategorized

surprise faceRajiv 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.

Marvelous Food, Beautiful Food, Glorious Food!

in Uncategorized

cookiesCongratulate 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

Arianna HuffingtonLast 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.

My “Tell-All” Interview about Employee Wellness

in Uncategorized, Employee Wellness Programs

NewspaperWow. I’m super appreciative of Dean Witherspoon from Health Enhancement Systems letting me be me in a “tell-all” Well-Being Practitioner interview.

[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)]

Partnering with Community Supported Agriculture May Be the Best Wellness Thing an Employer Can Do

in Uncategorized, Commentary, Employee Wellness Programs

Farm fresh vegetablesLast 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.)

A version of this post first appeared on Medium.com on May 25 and on LinkedIn on May 26.

15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Palooza

in Commentary, Employee Wellness Programs
Strawberries and workers

Photo by JD Hancock

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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?
  7. 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.)
  8. 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.
  9. 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.
  10. 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.)
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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]

Counting on Pedometers for Workplace Wellness

in Uncategorized, Employee Wellness Programs

Activity Trackers

[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

The (Theoretical?) Framework of Employee Wellness

in Uncategorized, Employee Wellness Programs

tape measure, notebook, appleHow is employee wellness supposed to work?

For starters, here’s the prevailing rationale that serves as the framework of most employee wellness programs today:

  1. Most health problems, and their associated costs, are preventable.
  2. Modifiable health risk factors — such as tobacco use, sedentary lifestyle, and unhealthful eating habits — are precursors to many of these health problems.
  3. Many modifiable health risks are predictive of higher healthcare costs and decreased worker productivity.
  4. Employer sponsored wellness programs can reduce modifiable health risks.
  5. 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.