Emergence: Workplace Health Management: Complexity to Order Highlights of this Series – Part 6
In 2017, I confirmed what I saw as a discrepancy between what conference speakers, researchers, and authors were promoting or selling; and some of what the popular press was writing about versus what wellness practitioners were continuing to implement as their workplace health management initiative at the workplace.
The content of this post is as follows.
- The first two posts I wrote were a personal response to the current workplace health management initiatives and as a follow-up to my eight months of reflection and discussions with many of the leaders and staffs of the initiatives.
- The third post describes the strengths and barriers found during the process of moving from an early stage workplace health management initiative to an advanced initiative capable of a developing into a win-win philosophy.
- Posts four and five include 12 major traps found during planning, pre-implementation, implementation, and measurement stages where wellness initiatives often fell into. Also included are five major early and intermediary process objective that could lead to success or less than success of the initiative
Brief Summaries of the First Five Posts in this Series
Post #1: My personal and high-level view of these workplace initiatives.
Health, poor health, performance, and many other main-effect outcomes are each a complicated or complex system, which we have come to appreciate over time. Each complex system requires multiple types and levels of solutions to begin to unravel the complexity. However, when I apply this appreciation to our current workplace health management initiatives I come to a roadblock because I continue to see too many single-focused interventions, as well as perhaps too many interventions. This already complicated state is often evaluated by inappropriate designs and statistical analyses. It is now clear that we are involved with complex systems that cannot be solved by simple interventions and quantitative statistics alone.
- Too many single-focused interventions lead to population and participant exhaustion and to low participation.
- Too many interventions decrease the unique contributions of any one intervention.
- If the interventions are evaluated separately, the sum of the benefits severely overestimate the impact due to double, triple or even more overcounting.
- The statistical analyses are typically quantitative which requires the assumption of a normal distribution of participants and non-participant. This assumption is violated since the distribution of people with the health factor is typically skewed. Qualitative statistics should be favored in many of these analyses.
- Results are typically chosen to favor management’s interests and most often target main-effects. Both interests bias the evaluation: the results decided by management ignores the desired results favored by employees. Main-effects are typically impacted by known and unknown factors. This result produces an estimate that is less than the actual impact of the intervention.
- Often the results are measured over a small window of time with a small number of participants and then extrapolated to an annual period and to the total population level, thus the metrics compound the measurement errors and overestimates the results.
It is discouraging to see these relatively obvious deficiencies continued to be widespread practices even in 2018.
Post #2: Where have we been and where are we now?
Early Health Management Programs. Today’s workplace health management grew out of the early 1900s use of recreation programs. The stimulation for increased programs in the 1970s was related to the rising deaths or disabilities of executives due to heart disease. This new impetus was driven by the USPHS Framingham studies which began in the mid-1940s. In the early 1980s we established the risk-cost relationships independent of death. This strategy was documented by our use of the Tecumseh data in using data in 1955 and predicting death or disability in 1980. By 1990 the risks-disability and risks-costs relationship was documented and validated by grouping risks into three categories (0-2, 3-4 and 5 or more risks). Thus, companies became more motivated to provide physical activity and nutrition programs within their organization.
The Shift from Health to Cost Savings. In the 1980’s and 1990’s health care costs greatly increased, and organization became even more interested. Concurrently with the increase in health care cost, shareholder value and executive pay became more competitive. These three issues put more pressure on health management initiatives to move from a wholistic approach to health and wellness to an approach with an emphasis on generating more savings by attempting to lower or postpone high healthcare costs.
The pressure to shift from health, performance and quality of life main-effects to financial main-effects was complicated and overwhelming. We made the shift to accommodate managements interests but with some employee resistance. What we found is that this shift added another degree of complication to the complexity of health—too many additional factors impacting healthcare costs. This shift initially sidetracked our development.
Knowledge from Other Fields. Developments in positive psychology. preventive medicine, and positive organizational health impacted wellness to a great degree by increasing our holistic offerings beyond stress management and relaxation. The downside of this expansion was an increase in single-focused intervention programs and another set of interventions with few or no validations metrics.
When I wrote Zero Trends (2009) and especially when I wrote (with coauthor Jennifer Pitts) Shared Values-Shared Results (2016) we looked at other fields to ensure we were in touch with scientific advancements which impacted the health of individuals and of organizations. This knowledge greatly improved our vision and awareness while expanding our knowledge of additional main-effects, but more importantly additional early and intermediary outcomes in the path towards main-effects.
Risks and Costs Transitions. Our work at the UM-HMRC used a risk-transition model by marking the transitions between low-, medium- and high-risk and the same strategy for costs while using the same people in both transition models. All the other dependent variables could be tracked with the same technique. The objective was to track those moving to low-risk, low-cost, low-absenteeism, etc. This strategy is also useful for tracking the flow of individuals over two or three years to document continuous change and sustainability of the intervention.
Financial Incentives. A questionable strategy, in my opinion, is the use of financial incentives which increased from approximately $25 or $50 to some as high as between $700 and $2,000 for participation in these programs. Given the high investments in financial incentives, there is no question that participation will be increased but the real question is does higher participation, due to financial incentives, drive what is needed to reduce risks and disease. There are also the considerations that high financial incentives could drive participation for the sake of the money and not because of an interest in improving health.
Sustainability of Methods and Outcomes. Each of the strengths and weakness I mentioned in this post needs to be examined by senior leaders in the organization and in the ranks of the employees. This examination should continually test the interest and strategy for workplace wellness initiatives to achieve shared values, results, and methods to arrive at a shared vision and a shared win-win philosophy.
The future of this field demands that the health of individuals and the health of the organizations are dependent upon shared values, shared results, shared mission, and a shared vision. The bottom line is that positive health management at the workplace is at risk as a field and it is urgent we show additional progress towards our objectives.
Post #3: Early planning for a Win-Win Health Management Initiative.
The mission of this post was to help managers and employees create a framework to engage in a serious health management initiative. I feel the early planning and pre-implementation stages are the most important of any workplace health-related initiative. However, these stages should be completed with constant updated communications within a four to eight-week period and involve all stakeholders to maintain momentum and trust.
Early planning, pre-implementation, and frequent Communications
are the most important stages to create a positive implementation and a sustainable
positive workplace health management win-win philosophy
The First Step. The first step after an initial internal discussion is finding common ground for building a shared framework for an initiative that leads to a win-win outcome. A trusted and honored set of shared values, shared results, and a shared vision goes a long way in setting the tone for an honest discussion. Throughout all five posts I continuously emphasized the crucial step of incorporating representative employee and management input into the initiative.
Early in the discussions the following guidelines or questions need to be addressed along with other local issues:
- Does the proposed initiative follow a strategic framework to get to a win-win?
- Does management and employees understand the rationale for a systematic initiative?
- Is the rationale for the initiative consistent with mutual values and objectives and cover the agreed upon aspects, especially values, results, and vision, of positive systemic organizational health and performance?
- Whose needs are being met: management, employees, consultants, vendors, or some other third-party advisor? I recommend management and employees as the most important to ensure a sustainable win-win philosophy.,
- Will measurements and communications be limited to main-effects or will early process, and intermediary related results also be communicated to management and employees?
- Will the measurement be related to the desired outcomes or limited only to conveniently assessable data?
Barriers and Biases. There are known barriers and biases of employees and managers. By working together to find shared values and shared results many of the barriers are uncovered and addressed at an early stage. Perhaps the most common barrier is the information coming from “trusted” benefit consultants, providers, vendors, and other third-party advisors. An organization needs to ask fundamental questions about the origin of the advisor recommendations and how it was adjusted to meet the needs of the current organization. Most advisors have an honest track record for giving customized advice, but even these individuals have other pressures to recommend certain favored solutions.
Psychosocial Programs. There are several of these programs now available or under development and come at a time to strengthen the holistic part of the wellness model. However, I am not sure we know the correct outcomes for these somewhat untested programs. We all can intuitively agree that they are welcomed and necessary. We need to verify that they can achieve the appropriate outcomes that we all need and desire.
Barriers to Success. In Zero Trends I listed four major barriers to success in each of the five categories of organizational structure. Each of these twenty potential barriers have the impact that contributes to success or leads to failure of the initiative.
Importance of Commitment. Finally, every stakeholder needs to be committed to the success of the initiative for each employee and the organization prior to implementation. This commitment should be evaluated at every step of the initiative and more frequently than an annual survey.
Post #4: Workplace Health Management from Complexity to Order: Eight Crucial Issues and Workable Solutions.
I recognize that each workplace location is unique and as such should be approached with that in mind. My discussions in this series of posts has been without reference to individual programs within the initiative. Individuals at each workplace need to be responsible for knowing the needs and wants of the stakeholders their location and the corresponding and available solutions offered within the initiative.
We underestimated and overestimated key parts of our initiative.
The following two estimations are representative of the mental errors we, and several other fields have made during development and continual learning. Anyone who has had experience as an athlete, a sales person, or facing a challenge knows that the worst case is to underestimate or overestimate the challenge.
Specific to our wellness initiatives we underestimated:
- the complexity of health and poor health;
- the challenges at the workplace and with individuals; and,
- the importance of shared values-shared results.
We also overestimated:
- the interest or the employees;
- the effectiveness of our single-focused programs; and
- our success in measuring and communicating the results that matter.
Although these may seem as simple and straightforward problems, they require, if even possible, very difficult solutions. I will address these two categories of estimations in the final post (#7) of this series.
Abstracts of eight of the 12 crucial issues and solutions.
The issues represent what I have experience or have observed over my 40 years in this field. The good news is that many of the negative crucial issues have been overcome but the unwelcome news is that new crucial issues have arisen. Each of the current eight (plus four in Post #5) could lead to success of the initiative or to less than optimal or even failure of the initiative. The workable solutions, provided for each of the issues, suggests how to avoid or fix that respective issue. Remember, the following are brief abstracts of the issues and solutions, for more information see Posts #4 and #5.
- Issue #1. Many employees lack knowledge of the existence of the initiative. Often, close to 50% of the employees claim not to know about the initiative. Solution: Use more aggressive and varied methods of communications of the roll-out of the initiative. Possibly use a major event to kick-off the initiative such as door prizes or food.
- Issue #2. Underestimating a challenge is a well-known mistake in any endeavor. Underestimating the complexity of health is more than a challenge which only now have we come to appreciate. Solution: Since good health and feeling good are a major part of our objectives, begin the whole initiative by developing a mutual understanding what is health and how will the participants recognize it.
- Issue #3. Lack of a guiding model or framework for positive individual and positive organizational health. Solution: Communicate an easy to understand view of health dimensions and the possible negatives influences found at the workplace and elsewhere. Also communicate what the organization is providing plus the opportunities it presents.
- Issue #4. Lack of integration of the initiative with other divisions and with the mission and vision of the organization. Solution: Communicate the various sources of finding help for frequent questions about an individual’s or the organization’s health.
- Issue #5. A wellness initiative that offers programs but with little consultation with others in the organization will likely be short-lived. Solution: Create a small committee with management and employee representation to illustrate the wide-spread interests in the initiative.
- Issue #6. Many workplace health management leaders underestimate the timeline to integrate the initiative into the culture of the organization. Solution: Within the implementation committee develop the timeline and strategies to move from no integration to a fully integrated culture.
- Issue #7. Senior Leadership (engaged and committed leadership) is confused about its role in continuing to serve in an advising commitment. Solution: Make it clear that the role of senior leadership is continuous from the initial formation to the implementation and measurement of the initiative.
- Issue #8. Operations Leadership has a role to develop a positive environment, culture, and climate in each part of the organization. Solution: Make training available to each part of the organization, especially emphasizing respect, caring, values and other aspects of the organization’s culture.
- Issues #9 through #12: see Post #5
The essence of these eight issues and workable solutions, is to address the power of a shared commitment between management and employees. Every individual in the organization needs to be informed of the initiative including equal opportunity to engage in the recommended solutions.
Post #5: Evolving Positive Organizational Health: Four Crucial Issues and Workable Solutions.
This fifth post contains the final four crucial issues and workable solutions to add to the first eight issues in post number four. Also, five process success factors are identified which are related to success or lack of success of the initiative. As with the other posts, I do not discuss specific interventions, which is left to the on-site team to select and deliver to their specific and unique organization and workforce. I need to say again that I remain a strong believer in the interventions designed for positive health and performance. They remain a crucial part of the organization’s win-win philosophy.
Four crucial issues and workable solutions (continued from Post #4)
- Issue #9. Low employee morale, frustration, and poor communications. It is expected that the staff of the initiative are well informed of the work “climate” and have tried to work independently with each employee or work-group. Solution. Take the time and effort to meet individually with the work-groups or known leaders to ascertain the source of the frustration that is impacting the participation pattern of the group.
- Issue #10. Rewards and Recognition (Positive Personal Motivation). This issue of motivation has been around for a very long time and often it is related to employees misinterpreting other employees or management. Solution. It takes a skilled leader to anticipate and then attempt to gain or regain the trust of the employees. As with many other issues the first step is to regain the trust with open and trusting conversations and respect.
- Issue #11. Measuring only changes in main effects while ignoring those positive earlier stage changes. Main-effects are complex and most-often the product of numerous levels of input. Main-effects could well be impacted by forces known or unknown to the staff or (sometimes) to anyone. Solution. This is an important maturity step to avoiding looking too far downstream and miss some of the needed early stage goals. The staff of the initiative needs to orientate the participants to avoid let-downs and discouragements.
- Issue #12. Measure and Communicate What Matters. Many health management initiatives fall into a trap of performing favorite evaluations and using the same metrics regardless of the local issue. Typical the metrics, measures and communication are bias towards the provider and the management of the organization. All stakeholders should have the opportunity to state their values, desired results, know the conditions of participation, and have a mechanism to be kept informed of the progress throughout the years.
These posts are more than just a why, what, and how to implement and revise a wellness program for an organization. Part of the justification for these posts was to encourage positive creativity on the part of the management of the organization; the director and staff of the positive health management initiative; and’ the management and non-management employees.
My goal is to help everyone involved in the initiative to know the potential value to participants and non-participants, the values of employees and management, and positive personal motivations that will be effective within the total population.
The concluding part (#7) of this series will be posted in early July. The purpose will be to (a) to create a view of how positive workplace health management initiative could engage in internal validation of their wellness (or well-being) initiatives, and (b) propose a leadership philosophy for current and future leaders to use as a roadmap to a win-win philosophy. It is clear we need to:
- ask better questions,
- focus on early and intermediate outcomes,
- find better methods and metrics, and
- seek better solutions