Emergence: Workplace Health Management: Complexity – Part 7

Short-Term strategies on the way to a long-term workplace positive health management initiative.

I am very proud of what we have accomplished during our over 40 years of recent history.  We have done our part in bringing wellness to the attention of the whole world. The purpose of this series of eight posts is to recognize where we are currently, and to lay the ground-work for the foundation of how we can continue to move forward in completing the dimensions of health and wellness and increasing our effectiveness and overall health of the nation (and world).

As a Professor Emeritus of Kinesiology, University of Michigan, Health Management Research, I am overly disappointed in the recent quality of our research questions, the uncreativeness in our metrics and measurements (these have fallen on bad times and are stuck in reverse). Clearly, we need to ask better questions, use better metrics and measurements, and find better solutions that match the questions.

In this seventh post, I make suggestions on how we can move our current workplace wellness or well-being programs into short-term strategies by integration of where we are now with the fundamental strengthening of our infrastructure. By this, I mean strengthening the way we conceive the wellness initiative and desired outcomes including pre-program, pre-implementation, communications, implementation, metrics and measurements, and final communications to employees and the organization. This step is critical if we are to regain our momentum of the first decade of 2000 and to set us up for the long-term strategies described in the next (#8) and final post.

In post eight, I will advance my suggestions for long-term strategies designed to take individuals and organizations in the direction of an optimize state where can move towards their integrated human and organizational potential.

If you have read one, two, or all the previous six posts you will recognize I have explored some of the dead ends and some of the promising roads we traveled during our history of workplace wellness. If I were to read only one of the previous six posts, I would read post #6. This post is where I briefly summarize the primary issues in each of the previous five posts.

Who initiates the wellness initiatives?

There are areas critical to creating positive health management initiatives in nearly all companies whether the initiative was conceived by the employees or by management. In the end it should make no difference whose idea it was in the beginning since management and employees must be in total agreement of the value of the initiative, the vision, mission, and support, if we expect to obtain optimal results.

Who has the responsibility to build participation and engagement?

It is the responsibility of management to introduce the why, what and how, of the initiative. Also, to affirm their support of the initiative up and down the management chain (from top management to the local supervisors).

It is incumbent upon management and employees (or a representative team) to demonstrate that the why, what and how of the initiative fits with the values, mission and vision of the employees and the company. A joint affirmation support of the initiative by management and employee representatives will secure enthusiastic support within the ranks of the employees.

Interventions and the questions to be addressed.

The considered questions asked by the local management and employees (combined thoughts about needs and wants) are the guiding principles for the wellness initiative. The choice of interventions needs to be considerate of the focused questions since the interventions, culture, or alterations to the environment are typically a local decision, depending on the context of the employees and the organization. The choice of interventions depends on which interventions have the potential to add the most valuable data to address the most important questions (health status, quality of life, performance, financial or other).

I continue to suggest increased time for early planning involving management and employees, pre-implementation, and communication time prior to actual implementation of any programs. Participation and engagement will increase substantially due to a sense of employees feeling connected to the philosophy, values, and decision making while developing a sense of ownership in the positive health management initiative.  By maintaining employee and management involvement in decision making almost all aspects of the initiative will continue high: quality, efficacy, health, and performance. Staff and employee attitudes will improve as they see employees valuing what is being offered.

The metrics and measurements are determined by the type of questions and the availability of the required data. All of this should be determined early, during the planning or pre-implementation process. In addition, solutions and alternative solutions discussed at this early stage set the stage, in case the data, metrics, or measurements change, and the pre-determined solutions are not feasible.  Metrics, data, and measurements are the basis of adjustments moving forward and the ultimate success of the initiative.

Without pre-program support from management and employees, the initiative will have difficulty during implementation, on-going programing and at the measurement stages. The time it takes to get this early agreement will be well worth it when the program staff gets faced with some differences of opinions as the initiative grows. I assume the above questions and suggestions have been considered and accomplished prior to moving on to the other suggestions.

Observe the organization, management, and employees;
ask questions; find the right metrics and measures according to the questions; and find solutions!

Too many times I have observed workplace wellness and well-being teams jump right to solutions without going through the process of close observation, asking questions, and finding the right metrics and measures. Subsequent processes including an interactive discussion of solutions, including management and other employees. To improve our systems, we need to discover and then agree on: asking better questions, using better metrics and measurements, and finding better solutions.

I am suggesting we lay the ground-work for participation, engagement, quality, efficacy, metrics and measurement during the planning and pre-implementation stages in anticipation of the implementation process. The ground-work is needed to ensure that the systems are in place equal to those used when the company launches of a new product or an athletic team prepares for a new season or a performer prepares for a new performance.

Ask the right questions.

Below are some questions, if asked and discussed, would have saved some of the initiative team months of frustrating reactions to a chosen solution (e.g. a stress management or chronic condition intervention)

  • How and where do interventions, including individual, cultural, and environmental, impact an individual or groups of people and the organization? This is crucial to determine and fundamental to design pre-implementation and implementation, and communications for employees and management.
  • How do we facilitate individuals becoming good listeners and aware of changes in their body and feelings? Listening, hearing, and communication skills are required equally of the providers, management, and employees to ensure the message is conveyed and understood.
  • When and how do we measure the early metrics of participation, engagement, and points of impact the intervention is achieving on its way to influencing the next level and one or more main effects?
  • How do we identify, define, agree, and measure the organizational and individual wins for each intervention, including individuals, groups, cultures, climates, and environmental interventions? How do we expect individuals and organizations to react when they experience the win-win?  What differences in behaviors, if any, do we expect to see following a successful intervention?

Training for success

To improve and coordinate the performance of the Staff, including any individuals hired as an independent contractor or provided by an outside contractor, regardless of their previous training.

  • I expect every workplace health initiative has an effective training and mentoring system for every staff member. If not, could this be implemented through a cooperative effort by the existing staff?
  • Among other basics and the company’s on-boarding processes, does everyone understand the company’s expectations, policies, and cultures?
  • Overall, I feel many teams fall into the trap identified by Einstein and Covey and others

“Definition of insanity: doing the same thing over and over
and getting the same unsatisfactory results”

  • Workplace wellness or well-being program teams have not given enough time and thought to explore the more fundamental issues, the metrics and measurement tools, and how our efforts impact health and performance of individuals and organizations.
  • If we are to maintain a viable position in health, (including wellness and well-being) and performance we must solve many of our own fundamental issues, in addition to looking to other fields for ideas and solutions. How can we find time to ensure that each staff member is fully prepared to answer questions about how the initiative works to bring about better health and performance for individuals and the company?
  • I recognize that workplace health and performance initiatives are integrated with community environments, economics, education, health care, healthcare costs, transportation, poverty rates, safety, culture, crime rates, and many other metrics to begin to impact employees’ and management’s sense of well-being. Does where the company is located and where the employees live allow for effective cooperation with the community? Can the company initiative be effective in this potential collaboration?
  • In addition to looking for more, better, or improved interventions, can we examine the fundamental way interventions or changes in the built environment impact individuals and organizations?

Not all questions, interventions, and measurements were identified early

Some, but not all, of the above observations and questions are exclusive of many others discussed in the previous six posts. The following bullets lay out the pattern that we, as a field, experienced over the length of our existence.  Our initial efforts were focused on reducing health risks and adding additional interventions related to the wholistic dimensions of health, wellness, and performance for individuals and for organizations. Over time we have continued this track.

I assume the manager and staff guiding the workplace health management initiatives select strategies and interventions designed to maintain or improve those behaviors that lead to healthier lives, a high degree of wellness and a sense of well-being, and performance within those individuals and organizations they serve. Below are some comments and questions that now we can consider at the beginning of any workplace positive health management initiative.

  • Are the selected interventions clearly important and critical to the desired level of success in finding positive outcomes in the specific areas of health and performance/economics for which they are intended? What data are necessary to collect during early, intermediary, and end-stage intervention to calculate the metrics and produce the measurements to demonstrate success or failure? Are these the results that the intervention was design to produce?
  • The primary objectives of workplace initiatives for the past several decades have been exclusively main-effect outcomes; such as, healthcare costs, absenteeism, presenteeism, disability, productivity, revenue, cost-reduction, job and life satisfaction, performance, stress levels, employee turnover, and others. These outcomes are important, but if we are to maintain our critical role in organizations we will need to prove our initiatives impact the fundamental pathways used to create maintenance or improvement in lifestyle behaviors and performance.
  • The success of the above tactical activities (interventions) depend upon (a) success of the foundational processes including planning, pre-implementation, and early implementation, (b) delivery of quality programs, efficacy and efficiency of the programs, training of the staff, support of management and peers, recruitment, retention, personal positive internal motivation, and other processes, and (c) discovering why, what, and how the interventions work or do not work.

I am relatively confident that there is no intervention that has a direct line-of-sight to impact a main-effect. This acknowledgment leads me to propose a new level of inquiry into the path taken from being a non-participant to a participant and to the successes as measured by one or more of the early and intermediary results. This success carries forward to impact what we know now?”

We underestimated or overestimated various objectives.

The following two estimations are representative of the mental errors we made during our development.  Anyone who has athletic or sales experience, or facing a challenge knows that the worst case is to under or overestimate the extent of a challenge or the capabilities of a competitor.

Specific to our wellness and well-being initiatives we underestimated:

  • the complications and complexity of health and poor health;
  • the challenges at the workplace;
  • the challenges within individuals; and,
  • the importance of shared values-shared results.

We overestimated:

  • the interest levels of the employees and management;
  • the effectiveness of our single-focused programs;
  • our success in measuring and communicating the results that matter; and,
  • our ability to explain the Why, What, and How to employees and management.

Correcting our mistakes.

These two fundamental mistakes are among the mistakes many of us made at the beginning of our careers. As we continue our careers we think, respond, and teach others at one or more of the following three levels:

  1. Apply simple thinking to what we believe is a simple problem. In hind-sight, we now know we were wrong in many cases when we were not able to sort out the simple, complicated or complex problems.
  2. At a slightly more advanced level, we apply complicated thinking to what we perceive as complicated problems. This is a step in the right direction and could be the right step for a few of our real-life problems. Complicated problems can be solved if one knows the complete set of possible inputs and knows the complete set of possible outcomes, including possibilities of unintended consequences. It will take patience and time to solve these complicated relationships to move the interpretation of our results from associated relationships with early, intermediary, and main effects to causal effects.
  3. At an advanced level, we now recognize we are in the middle of complicated problems but more so, we find ourselves in a nest of complex problems. Recognition is the first step. Currently few, if any, problems are being honored at the level of complexity. The best we can do at this time is solve the simple problems, solve the complicated problems when we know all the variables, and look for partial solutions based on our current understanding of the complexity we are facing.

For those of us working in workplace wellness or in other fields we can only solve what we can with the tools we currently have, knowing full well that, “we do not know what we do not know.” We can use what has been discovered before and, as in any science, build on what has come before us. Without using these stepping stones or building blocks we will end up spinning our wheels by asking the wrong questions, concentrating on the wrong metrics and measurements, and searching for the wrong solutions

The possible down-side of too many single-focused interventions.

We continue to fragment the industry with more and more single-issue interventions or topics. We all know most of these new topics seem to be important in maintaining the health, wellness, and performance of individuals and organizations. Also, they may demonstrate positive impacts on some of the main-effects we have been measuring for many years. However, one can relatively easily show the sum of the “savings” or increased “revenue” from all interventions far exceeds the sum of the actual savings or the actual increase in revenue of the organization.

Why are too many single-focused interventions a distraction from success?

 These important results could be explained by one or more of the following scenarios:

  • Each of the single-focused interventions demonstrate the same or similar savings in terms of healthcare cost reduction or increased revenue as the other interventions.
  • It would appear in terms of health improvement, healthcare cost reduction, performance improvement, or economic gain; each intervention is redundant to other interventions.
  • On the plus side, each of the interventions may be attracting different employees. If so, the total company value should show an incremental increase.
  • When measuring the economic value, an investigator may be too single-minded and focused on one main-effect and not be aware of other positive outcomes. If this is the case the investigator is under-estimating the value of the intervention.
  • A fifth scenario could be that all the savings calculations are equally flawed, resulting in the same outcome regardless of which intervention is implemented or which group of employees is used as subjects. I feel the evaluators and measurement specialists have let the field down by relying on inappropriate designs, quantitative statistics, and deductive thinking while knowing full well of the complexity of healthcare data and additionally did not meet the requirements of their chosen statistical methods.
  • When one intervention is implemented, the impact on the total effect is relatively low. However, when several interventions each focusing on several main-effects are implemented, the impact on the total effect is much higher than the sum of the results from each of the several interventions. In this case, it is difficult, or impossible to credit a single intervention. However, these results indicate that the interventions are interactive, and the sum is greater than the sum of the parts.
  • The sequence of the introducing the interventions could be impacting the outcomes from the intervention. That is, what is the theory for the order of offering the different interventions?  What are the most important considerations when considering the order of implementation? Is there a most effective order for introducing the interventions as determined by the impact on the desired metrics?  On the other hand, each individual employee is unique: therefore, the optimal order of the implementations most likely would be different. However, the desired outcome may be best represented by the groups and in this case the above three answers to the three questions become very important.

In addition to the above discussions, these scenarios uncover the mistake of using main effects results, regardless if one of the interventions is the only one requested by the employer or a group of non-management employees.  Healthcare costs and healthcare financial benefits are a mixture of complicated and complex problems well beyond our current knowledge.

“We do not know what we do not know”

I believe it is necessary for those of us in this field, regardless of the level of investigation, to “ask better questions,” “use better measures and metrics,” and “find better solutions.”

Ask better questions
use better metrics and measures
find better solutions

We do not know what we do not know

In the grand scheme of things, what is known in the world is incomplete because the known knowledge has typically been to discover knowledge within the existing boundaries of the academic disciplines. These boundaries are artificial limits of the disciplines whereas for the most part, true discovery of knowledge in the future will be within the disciplines and in the space in-between the disciplines.  The good news is this space has been narrowing over the past several decades. This does not imply that there is no new knowledge waiting to be discovered within the disciplines. Quite to the contrary, many researchers continue to go deeper and deeper within the discipline and find data to add to our knowledge level.  However, some researchers see that the answers to their questions are not to be found within the discipline, so they look elsewhere for the solutions. (Note: I believe that the future of workplace health is to be found in-between the disciplines, with additional new knowledge from the disciplines.)

The narrowing of the space between the disciplines can be observed: for example, by observing the continual growing number of specializations in medicine. Some of these new fields have come about by the experiences in the traditional and non-academic areas.  Think of a friend’s trip to a medical center for a symptom of some unknown identity and watch how many specialists are called in to consult, which may or may not be successful, but when successful could lead to the advent of another specialization.

Those of us in workplace positive health management know we are in the space between the disciplines and have observed the same phenomenal, as above. With respect to body weight, for example. Americans are concerned about body weight but few, if any, interventions have been successful beyond a few months.  Now, wellness specialists are being called in to collaborate with weight loss specialists including, physical activity, nutrition, stress, anxiety, hormonal, vitamins, biochemistry, neural science, genetic combinations, positive psychology, organizational psychology, social science, behavioral science, environment, culture, climate, or other combinations of known or currently unknown relationships. It is obvious we are into complicated or even complex issues when an enormous number or distinct groups of specialists cannot agree on a solution.  At least we now know calories-in vs calories-out and other simplistic solutions are not the answer for all body weight loss issues.  It will take creative researchers and practitioners or both to collaborate to get closer to the truth or approximate solution. Regardless of future findings it is up to us to do the best we can with what we know now.

We do not know what we do not know.
We make decisions based on what we know now.
Thoughtful individuals did this days, months, and decades or centuries ago.
This is where we are today.
We do not know what we do not know.
We must ask better questions, find better metrics and measures, and find better solutions, based on what we know now.

Beware of False “new” data or knowledge.

Throughout history there have been individuals who stumbled onto new knowledge but was so blinded by their total believe in their previous hypotheses that they let the new knowledge slip through their awareness. I know, because that happened to me several times as a swimming coach, as a cell biologist and as a workplace positive health management investigator.

Beware of some of the projections others have made about Future Trends related to content, incentives, technology, games, finances or the latest ideas or new interventions. Most of these projections have been made with knowledge and tools that are well known, which is OK if the future trend drives additional applications, but it is unlikely to drive future knowledge. These guesses about the future are typically projections of recent experiences, biases, or even projections based upon their company’s own application or revenue projections.

We are in a relatively young field and we are vulnerable to new interventions, tools, or theories based upon the charisma of a presenter, what we think is a silver bullet, or we follow others into one large “group think.” We must become more discriminating in ensuring that we are confident that the new suggestion is the right solution in our context.

Final Words. 

I continue to have an elevated level of respect for this field and for its dedicated people. Recently, I took several months to assess if there are threats to the wellness initiative and if so, are they real or not real. I reviewed the why, what, and how the threats and responses could be addressed.

My objective is relatively straight forward: how to make sense of these past several years where we (as a profession or field) focused on health (wholistic definition) as a tool to help individuals and organizations live to achieve their full potential. We have seen an extraordinary leap forward in knowledge generation from throughout the world. Unfortunately, we observed the use of some of the data, information or knowledge (from the US or other countries) in some of our programs without verification that the data were not biased or inappropriate. The use of these data or isolated or enhanced programs, without verification, could make a negative impact on the outcomes or cannibalize results from other interventions.

Beware of those making high potential claims.

What are the current functional (or dysfunctional) trends that have the highest potential for success or failure to help us continue to be the “go-to” solution for employer and employee health and wellness (or any other selective outcome measure)?

 “Beware, all that glitters are not gold”

My concerns for workplace positive health management are ever increasing when I think of all the conflicting tactical and generic advice from some research, intervention, communication or consulting “experts” who are inadvertently convincing organizations to adopt.

Our true progress sets the stage for future progress.

My appreciation of workplace positive health management initiatives is that we can awaken individuals and organizations to their best chance to achieve their potential by knowing the why, what, and how to acquire the attributes specific to their own needs and possibly the wants and needs of their family and community—this is the point of the story.

  • Everything that happens in our life impacts our health and the health of others, even a smile.
  • Employers win when the employees win, and the employees win when the employer wins,
  • We can help the healthy people and the healthy organization stay healthy,
  • Don’t get worse.
  • Most questions begin with naïve simplicity but soon address the complications of health and poor health and finally attempt to unravel some of the complexity of health and poor health.
  • To get to a higher level of human potential we need to find the right “disruptive innovation” to discover the core of our individual’s and organization’s workplace positive health management initiative.

Final thought. As of 2018 we have not yet laid a solid platform to grow potential solutions, solid metrics, and measurement protocol for all the known and unknown solutions. The purpose of the final post will be to enhance our course and provide the platform to build the solution and grow individuals and organizations into the future.

Post 8 will take us to a future platform and strategy to get us towards the optimal potential.