Evolving Positive Organizational Health: Twelve Issues and Workable Solutions


I remain consistent in believing in the interventions designed for a workplace positive health and performance initiative. They are a crucial and important part of an organization’s win-win philosophy. As we all know, research over the past several decades and within many disciplines combined to contribute to positive organizational health and performance as a win-win philosophy. Economic values are important but not all valued outcomes have a common economic value. Each company will need to find the relevant and valued economic and non-economic outcomes to demonstrate the total value of all tactics related to the initiative.

My focus on the challenges organizations face has led me to describe choices and actions that contribute to success or less than optimal results.  This focus led me to 12 issues that impact the key success factors, especially the early process indicators, of the initiative. The workable solutions to the issues promote a better understanding of the complexity and challenges we face. If solutions can be found for these issues it will ensure that the workplace health initiative will remain credible going forward.

After the leaders of workplace health management initiatives implement their agendas and criteria of success they believed that the initiative will run smoothly.  However, as many organizations discovered, once they miss the mark on one or more of these 12 issues, the negative impact will occur on one or more of the following five key early process success factors.

  1. participation
  2. engagement
  3. motivation
  4. metrics
  5. measurement

We all know that these five factors, and perhaps others, are key to success of the initiative, regardless of the number or type of interventions and choices of important outcome measures. These five success factors have been my targets for this series of posts. Given success in addressing each of the 12 issues, the workable solutions, and the key success factors, a positive organizational health management initiative will lead to the desired win-win philosophy.

“The organization wins when the employees win, and
the employees win when the organization wins”


Issues and Workable Solutions 9 through 12

The eight issues in the previous post (#4) plus the four in this post (#5) represents the 12 issues which, if mismanaged could put the total initiative at risk. In contrast, if managed successfully and continuously will assure that the five-key early process success factors will eventually assure the success of the initiative.  Below, are the final four Issues and respective Workable Solutions.


Issue #9. Low employee morale, frustration, and poor communications

There are times when employees encounter situations where they are not sure how to act but are aware that a wrong response could result in serious reprimands, disruption in their workstyle, and serious stress, health, or performance reactions. I received some valuable advice from a Chief Medical Officer of a major manufacturing company who advised me of his observations of employees, especially those who were recently hired, have three choices if the situation (culture or climate) becomes, nearly unbearable:

  • leave immediately;
  • stay and work to change the culture and climate and if it can’t be changed, they leave;
  • stay and force a fit to adapt to the environment, culture, or the immediate climate and merge with the rest of the employees and adding to the complications of culture change.

This could be the case when employees:

  • Related to work:
    • encounter a lack of civility, respect, good relationships and lack of life-skills in their daily encounters with management or other employees;
    • find the pace of work has increased, the number of work hours has increased, or the work days of the week has increased. This is especially the case when management continues to make decisions lacking prior discussions with employees;
    • find inconsistent messages from senior managers versus the messages from leaders lower in the organization (often the supervisor).
  • Related to the health management initiative:
    • don’t understand the why, what, and how of the health and relationship initiative;
    • feel a lack of confidence to participate if the offerings of the health initiative are perceived to be at a higher level than they believe they can accomplish;
    • lack of time or convenience if the activities are located at an inconvenient time or day or too far from their work location.

Workable Solutions #9. The above are examples of potential issues leading to low morale, anxiety, etc. or even driving employees to deciding to leave the company. This is an opportunity for the health management staff to:

  1. advertise and teach the objectives (why, what, and how) of their sessions while emphasizing the relationships to work performance, family, or life-long benefits.
  2. Self-leadership, in this case, implies an understanding of health as a value to the individuals and the organization. This requires an acquisition of resilience, change, decision support, and self-leadership.
  3. The learnings and others are some of the life skills needed for on-the-job and family success as well as life-long success in all aspects of life.
  4. These self-leadership skills and other skills could also be offered in collaboration with professional development or on the job training sessions throughout the year.

If the initiative does not result in a win-win outcome for everyone, the initiative could be at risk.

  1. Collaboration is a positive workable solution to the negative impact of isolation.
  2. Collaborating with other units could help the director and the staff avert any perceptions of roadblocks from other units in the organization.
  3. Constant internal and external communications is needed to help keep all employees and management informed of the common value of the initiative and the fundamental agreement (shared values and shared results) in forming a common vision.


“Good leaders make people feel that they’re at the very heart of things, not at the periphery.
Everyone feels that he or she makes a difference to the success of the organization.
When that happens, people feel centered and that gives their work meaning.”

— Warren Bennis


Issue #10. Rewards and Recognition (Positive Personal Motivation)  

Motivation is a factor that has mystified and frustrated wellness staffs and directors for years: how to motivate senior leadership and employees.

Low participation has been attributed to:

  • employees feeling a lack of appreciation and recognition for a job well-done;
  • employees feeling a lack of understanding by management for the value of employee contributions to the success of the company;
  • lack of management support for the initiative when the support breaks down someplace between those at top management and those at the supervisor level;
  • offerings when the initiative is not meeting the various and perceived needs of the workforce:
    • do not meet the interests of many employees;
    • are offered during inconvenient times or places; or
    • work schedules do not allow time to participate.

Workable Solutions #10. We must recognize that positive motivation is needed for management as well as employees. There is a tendency to view low participation as an issue for employees and leave management out of the discussion.  In my opinion motivation should be directed at management first and then employees to achieve a mutual understanding to:

  • recognize and appreciate all aspects of good health and wellness;
  • collaborate with groups of individuals in the various levels of management. This is important to discover other suggestions or complaints for the health initiative;
  • listen to other groups of employees in large organizations to understand the root cause of their suggestions and complaints;
  • recognize that issues can be solved by open and honest conversations and compromises, in large, medium and small organizations;
  • understand the critical role of management and how they must get involved to connect the value of the initiative to the competitive status of the company.

If none of the above is a solution to low-participation and low engagement:

  • perhaps the director and staff are asking the wrong questions!
  • perhaps most of the employees live in communities where the same objectives are being met by community resources and the whole family participates. In this case, high participation in the workplace health initiative is not a metric that is applicable to all employees. A survey might be appropriate to get an estimate of the number of employees using outside facilities.
  • perhaps the program communications focus on one form of communication while many employees do not communicate in this way. Multiple messages through multiple channels are needed such as e-mail, text, Instagram, paper, voice, videos, posters, mail, supervisor, team meetings, other).
  • perhaps a sizable number of the employees do not know participation in the wellness, health, and performance initiative is available to them. In some organizations this is nearly 50% of the employees.

There are times when investigating alternative ways to communicate to the employees and management we are left without success. In this case, it would be helpful to conduct any of the many forms of group discussions to give the employees and management an opportunity to tell you their preferred way to communicate and their respective opinion of the initiative.


Issue #11. Measuring only changes in main effects while ignoring those positive earlier stage changes

I remain concerned that many organizations are providing wellness or well-being programs but evaluating them on main effects changes, for example: reduction of healthcare costs, increased productivity of the individuals, or increased revenue for the company. Seldom are the measured results related to the collaborative needs of management and employees. Currently most evaluations are related to the needs of management, third-party providers, or consultants which raises conflict of interest issues. In addition, often the evaluations are conducted with available data related or not to the results, thus disappointing employees and the employer.

Workable Solutions #11. Process outcomes will add to our knowledge about health as a complex issue. As for desired results, I feel we should now rule out simple population results (main effects) for the immediate future. There are simply too many unknowns within the company or between companies which also impact the main-effects. We need to dig deeper into the immediate results to ensure that we are accomplishing what we are now assuming and check what changes are expected during this time.  Outcomes closer to the actual employee experience will be recognized by employees earlier than waiting for the results of analysis of main-effects, which typically is five to six years.

Examples of short-term process outcomes are:

  • participation rates by age, gender, location compared to program site, type of work, eligibility to participate, or other;
  • participation rates in three or more advanced programs, by program year;
  • annual measures of outcomes (including main-effects) for five to six years. Each year ask the number of years of participation in the initiative;
  • response rate by a random set of employees to one or three questions, such as: “How do you feel most days: energy level, attitude, and/or other?” Use the original set of employees every six months or different random every six months or do both every six months;
  • There are several ways to assess the current state of the employees, for example a single question on their mobile phone before work, lunch time, or after work. Be careful not to make it expensive to the employee or to the company or especially to yourself due to data management. You could do this by a single or couple questions interview, which allows you to be more visible to the employees. I, of course, favor the short individual interview.

It is not wrong to calculate the metrics related to the company’s results when accompanied by results of interest to the employees. This is core to the original agreement between employers and employees and the win-win philosophy. You can use some of the techniques above to ascertain some of management’s short-term interests.

When management and employees feel they are not being informed it is many times related to a lack of frequent and current communications with management and all employees?  Without active communications one or the other group or both will forget about you and the positive impact you are making on the organization.

It is not surprising that core interventions offered by the Director and Staff remain relatively the same over the years given a few changes here and there. Recently there have been some additional business, economic, psychological, and sociological interventions added into the offerings of a subset of companies. Considering management’s goals typically do not change to any great extent, and many of the same consultants, providers, and benefit consultant advising in the same way, the outcomes from the 1990s until 2017 are relatively consistent. However, it appears we are still pretty much locked into results relative to management interests and we keep repeating the designs, interventions and outcomes.

“…Effective Leaders are expected to know where they are going,
share with the whole team how they expect to get there, and
disclose the benchmarks and measurements along the way
to both management and employees…”


Issue #12. Measure and Communicate What Matters 

Management tends to follow the intuitive thought process that implementation and maintenance of wellness initiatives will decrease medical and drug metrics and increase productivity measurements. In fact, this was demonstrated in the Zero Trends book.  However, marginal management and employee support, low participation, and misguided analyses often hide the true impact of the health and performance initiative. Often employees are left out of evaluation or measurement due to not being involved in the design and implementation process. Both management and employees do not get a clear picture of the evaluation because:

  • evaluators favor measuring limited main effects rather than step-wise process outcomes;
  • evaluators using inappropriate statistical methods;
  • lack the evaluators giving honest feedback to management and employees on progress towards the vision;
  • lack of a measurement of shared values and desired results between management and employees;
  • evaluators typically do not consider the complexity of health and the measurement of main effects. They also underestimate the complexity and the value of process metrics and methods.

Workable Solutions #12. Measurement is an important part of engagement when it is transparent, sharing, explaining progress towards the vision, demonstrating that it is consistent with values and vision.  Identifying valued outcomes promotes continuous progress.

While we all believe this, we have relied on simplistic attempts to use quantitative statistics to evaluate a complex health problem which we all know has produce the expected positive but minimal results.

The obsession with quantitative statistics requires that we analyze an intervention using a large sample size, a normal distribution, and controlled by every relevant data set available. Using this quantitative process, those who achieve positive metrics are overwhelmed by those participants in the populations who are not successful and thus no overall statistical significance. We lose the recognition of those participants and companies who were successful. I now believe we can learn more about the complexity of health and the intervention by observing those outliers on both sides of the distribution. This will tell us more about the impact of the intervention.  Perhaps just count the number of people who had great outcomes, not just the main-effects, during and following the intervention. We now know that there is a terrific opportunity to engage qualitative statistics into our efforts to understand the complexity.

As we have mentioned throughout these five posts:

“…we need to ask better questions,
focus on intermediate outcomes,
find better methods and metrics,
and finally, we need to seek better solutions…”


Final words for this fifth Post

Throughout these first five posts I have included my thoughts on some of the efforts that are taking place in and workplaces and worksites today. However, we need to unravel more of the Complexity of Health and provide additional, but small steps, in our process to create order out of complexity. As summarized in posts 4 and 5, bringing employees and employers together, agreeing on values, results, vision and mission will go a long way towards improving participation, engagement, motivation, metrics, and measurement and therefore some of the main effects.  We are left with the question, “How shall we respond to our current complications, realizing that all complexity cannot immediately be addressed, reduced, or eliminated?”

I have added a sixth post to include a summary of the first five posts. It will be published in early May or shortly before.

Introduction to Post #6

In addition to the summary of the first five posts, this sixth post will include a discussion of what I have come to think about during my 40 years work in this field. (1978-2018). With the collaborative work of many individuals at the UM-HMRC we created over 1000 articles and presentation and two major books.

I believe Positive Workplace Health Management has advanced to a stage where we are approaching the need for another Positive Disruptive Innovation.  We had four of these major disruptive innovations until now:

  1. The deaths of many corporate executives and other citizens stimulated the focus of workplace wellness in the mid 1960s;
  2. The research from the University of Michigan Institute of Social Research in the 1970s;
  3. The rapid increase in health care costs in the 1980s, and
  4. Workplace health, especially at the wellness end of the continuum, began to fill in the gaps as we returned to the original holistic definitions of wellness in the late 1990s:
    • advances in workplace environments, cultures, climates, other determinates of health and performance beginning in the mid 2000s;
    • the beginnings of positive psychology (Universities of Pennsylvania, Claremont, and Michigan) in the late 1990s;
    • the beginnings of positive organization health (Michigan) in the late 1990s; and,
    • the contributions of many other individuals and locations beginning in the late 1990s.

Going Forward

The following are 12 examples of questions that would move this field forward into a Positive Disruptive Innovation, the use the new understandings about the complexity of health, and to continue our growth into the future and closer to maturity.

Challenges to practitioners and academic researchers on workplace health:

  1. What constitutes a meaningful wellness, well-being, or health initiative?
  2. What constitutes meaningful successes in the short-, medium-, and main-effects?
  3. Is there a possible check list of key activities to accomplish along the way?

Challenges to practitioners and academic researchers on workplace health:

  1. How does one intervention interact with another and how do the outcomes interact?
  2. When do the number or types of interventions begin to show decreasing value of the outcomes?
  3. What is the timeline for each of the interventions to show a meaningful early state and main-effects outcomes?

Challenges to academic researchers and practitioners on workplace health:

  1. Is there a core set of interventions that account for up to 80% or more of the value of the outcomes?
  2. Is it possible to isolate the independent impact of one intervention on the outcomes?
  3. Is it possible to develop qualitative or quantitative methods and metrics to create a path-analysis of impact from the intervention site to the impact on the main-effect?
  4. Is it possible to discover how to reverse the step by step pathway by starting with an outcome and working back to the intervention?
  5. How do clusters of risks impact outcomes more than the sum of the impacts of the individual risks?
  6. Is it possible to incorporate the interaction of interventions and other factors on the strength of the interventions on the outcomes?