Emergence: Workplace Health Management from Complexity to Order

Post #2 in this series:

Where have we been and where are we now?

The first post in this five-part series was written as a high-level personal view of workplace health management and its complicated nature trending towards complexity or even chaos.  Any new field initially (typically) evolves from several existing fields.  The evolution of workplace health management is a case in point: emerging from aspects of medicine, exercise science, recreation, public health and psychology. Most recently health itself is being used by some as a resource for a high quality of life (desired) versus the use by others as a commodity to be bought and sold (not desired). This current post is an abbreviated view of the most recent 40-year development leading to a current and conflicted state between health as a resource or value versus health as a commodity at the workplace.

Where have we been?

Workplace health and fitness programs were adopted by a few hundred organizations by the mid-1970 and the directors of these programs formed a professional organization: American Association of Fitness Directors in Business and Industry (George Pfeiffer is the best contact).  At that time there was evidence that health risk factors led to disease but no evidence that the same factors or clusters of factors plus others led to increased costs. In the early 1980’s the Health Management Research Center at the University of Michigan (UM-HMRC) took on the task of systematically demonstrating to the business community that the risk factors also were associated with overall medical and other costs.  (It would take over 800 publications and presentations before this line of research fully established the financial business case for workplace wellness.)

In 1984 the WHO redefined health as “the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities.” Those of us who believed this definition of health created health promotion and wellness initiatives that were based on holistic definitions, while leaving room for future expansion of the existing knowledge base, new knowledge, and thoughtful interventions.

In the late 1980s and 1990s many companies put renewed emphasis on shareholder value in combinations with increasing healthcare costs that stimulated a changed agenda for workplace wellness from holistic outcomes to simplistic, single focused, risk-reduction interventions and outcomes related to chronic diseases and healthcare costs. These changes forced the field to move to a medical model of waiting for individuals to develop risk-factors, early stage disease, and at-risk levels of biometric testing results and then using interventions to reduce the risks or early stage disease through behavior change models.

Workplace wellness was expanded by the development of positive psychology, positive organizations, preventive medicine, and other overlapping work in several fields. Since we don’t know what we don’t know we are left with the alternatives, do the best we can with what we know at this point in time or do nothing.  My question is, “How does the situation, at this point in time (2017), impact workplace health management, knowing full well that workplace health management impacts everything else?”  We are now at the stage of realizing the full complexity of health and eventually the challenge “create an environment to allow order to emerge from complexity based on what we now know.

By the year 2000 there were thousands of organizations incorporating these health management strategies into their business structures. Companies were quick to accept the intuitive belief in the efficacy of prevention, disease management, risk-reduction, and behavioral change strategies. The experience with those strategies turned out to be marginally successful.  We found out we were not good at helping the low-risk people stay low risk.  The experience with return-on-investment (ROI) as determined by the estimated changes in medical costs were weak for many reasons, including low participation, variability of costs, and the complex nature of health. In addition the workplace health management field added other job-related estimates of outcome metrics, which were susceptible to poor health and found similar and additional barriers when calculating an estimated value-of-investment (VOI).

In response to the relative inconclusive outcomes we recommended a low-risk analyses could be a more successful outcome.  We established the natural flow pattern of individuals over a 3-year period and proposed a successful company should be able to demonstrate data showing their results were better that the natural flow in moving a population to low-risk.  Healthcare costs followed the same pattern. Other costs including absenteeism, presenteeism, disability, worker’s compensation, and other costs are likely to follow the pattern.

By the early-2010’s wellness vendors and consultants were frustrated by low participation rates and felt it was easier and quicker to come up with revised disease management, health risk reduction, and behavioral change interventions, rather than creating alternative theories or frameworks to incorporate the new knowledge and to account for past weaknesses.  Another very questionable innovation was the use of financial incentives that continue to escalate even to this day with a few financial incentives as high as $2,500.  It remains a question “Why do senior leaders in organizations buy wellness services from vendors or consultants and then have to pay employees to participate in the services?”

Where are we now?

One of the facts we know is that within the United States and other parts of the world there are five major diseases that need to be addressed immediately: heart disease, mental illness, cancer, respiratory disorders and diabetes.  These and other diseases also impact our overall health, work efficiency, functionality, morbidity, family/friends and overall quality of life and happiness. Clearly, we know there are age, gender, socio-economic, genetic, environmental, and educational demographics that give us clues as to which specific outcomes impact specific individuals. The complexity and interaction of these independent and dependent outcomes challenges us to urgently transition to a designed framework based on what we know now.  However, we must be careful not to assume any simplistic solution will be the solution.

Further consideration supporting the urgency is the unrest within the field related to some actions that could lead to a splinting of the field rather than a constructive disruptive innovation. The following is an abbreviated list of some of the current issues heard and observed from on-the-ground wellness professionals over the past couple of years. These issues are continuing to be expressed and they keep increasing in frequency.

  • Many claim results beyond our knowledge competencies
  • Excess claims of our successes
  • Fake news about the field
  • Claims of failure of others in order to promote self interest
  • Over saturation of companies promoting simplistic solutions
  • Undocumented positive results
  • Little overall consistency of initiatives
  • Rapid growth of dollars for financial incentives used to increase participation
  • Publicity and marketing promoted first and results promised for later
  • Too many of those who claim to know it all
  • Divisive strategies
  • The high number of solutions and results may overwhelm companies.

We should be concerned about the future of Workplace Health Management given the basic complexity of what we know (the complexity of health)  complicated by the rapidly increasing new knowledge and overwhelming number of options for interventions. Much of the new knowledge is filling the knowledge gaps in the dimensions of positive individual and organizational health. We need a new model for workplace health management which incorporates all the dimensions of positive individual and organizational health.

Will Workplace Health Management blossom, explode, implode, or gradually disappear? The difficulty, confusion, and intricacy of health in organizations, or even the disappearance of  workplace health management, challenges senior leadership to rise to a higher level of thinking and collaboration to create a health management model with strong acceptance among all stakeholders. This dilemma is not an unusual situation since many companies and organizations, throughout the world, have encountered internal or external threats to their existence at one time or another.  The path to survival and success has been to recognize the internal or external situations and move to consolidate and  find a way to a win-win solution.  The way translates into the ability to cooperate, understand mission and purpose of each other while understanding the facts and the research that gives basis to the arena of health at the workplace and workforce, and to move toward the goal of both employees and the organization becoming more successful.

Some individuals see the recent and current “enhancements” (increasing numbers of new programs, repetitive books, and new or modified interventions, strategies, outcomes, redefinitions, etc.) as a positive sign for the field. Others see these same enhancements as possible threats due to dilution of the quality of programs, stretch of existing personnel, limited or available support, a splintering of core objectives, and a clash of personal and organization values.  The worst case is when the threat grows too fast without thoughtful consideration and where the consequences splinter the field into non-sustainable fragments and thus threaten workplace health management as a major marker of a successful organization. The best case is that we hear and collaboratively act on the message of most if not all points of view and eventually create order and a framework for win-win solutions.

Our overall realization is that health is a wicked problem and simple main-effect analyses are inadequate.  The learning is that future solutions will require more complex analyses including multiple level analyses and process metrics from several viewpoints. Also, we realize we will experience the best results when driven by additional knowledge from other fields, our own decision-making skills, our degree of creative curiosity, and by the degree by which we accept failure and success. Expanding knowledge is an opportunity to incorporate new learnings into our health management strategies.  New research findings are coming at a rapid pace from health sciences, sociology, psychology, business, engineering, economics, architecture, and other areas wherever new knowledge is discovered. As we have done in the past these new learnings will become integrated into workplace health management. It is becoming clear everything that happens in an organization impacts the health of the organization and the health of the employees. The functional definition of wellness has continued to expand as we come to acknowledge the complexity of health.

Going forward.  The intention of this post and the first post in this series was to frame the need for a revised model for workplace health management.  The high costs of healthcare among all stakeholders are being driven by poor health; increasing cost of health insurance, hospitals, medical devices, drugs, medical care workers; and finally, vendors and consultants working within their prevention or health management point of view.  So where does workplace health management fit in?

Worksite health management leadership at the policy level of thinking has yet to break away from trying to fix or address the unworkable aspects in healthcare costs at the workplace, whether it is because of lacking enough credible research, grass roots movements, senior corporate leadership or vision from each of those.

An alternative view of our current state could be explained by considering we may have been too successful too fast and now relying on our past strategies to drive future successes. Even some of the newer strategies now being promoted are derivatives of the past strategies. Using Einstein’s quote once again:

 “We will not solve current or future problems
with the knowledge and tools we used to solve past problems”

The conclusion is that any new model will need to take the form of employers and employees working together toward a healthy and high performing workplace that grows in parallel with healthy stakeholders (a win-win philosophy).  Working within the current situation, respective leaders need to exert their collaborative vision of health as a resource and value resulting in success where everyone wins.

(Also see the Edington and Pitts 2016 book: Shared Values-Shared Results: Positive Organization Health as a Win-Win Philosophy)

The next post will address the beginning stages of a win-win solution for employees, employers, and communities. By adding advanced strategies and outcomes from many different disciplines the win-win philosophy will demonstrate to employers and employees that good health as a resource is sustainable and good for all. The final two posts in this series are designed to complete the development of the Win-Win Philosophy using the newly proposed framework.