The UK’s productivity still lags behind that of other countries, but employers are failing to see the link between employee wellbeing and productivity. Christine Hancock and Katy Coopershare expert insights on how to make the case for connecting wellbeing interventions with higher outputs.
UK productivity – or lack thereof – continues to climb political, business and public-sector agendas. The Office for National Statistics estimated that output per hour worked in the United Kingdom in 2015 was 15.9 percentage points below the average for the rest of the G7 advanced economies. This is despite the July 2015 publication of a Government plan to increase productivity.
But it is puzzling that employee health and wellbeing’s impact on sickness absence and presenteeism is not front-and-centre in discussions about improving productivity.
This article provides ways to make this case: the evidence for action and how to embed wellbeing to improve productivity. It summarises discussion from an Expert Workshop, held in October 2016 by workplace health network C3 Collaborating for Health.*
Evidence for action on wellbeing at work and productivity
Significant evidence exists supporting the link between wellbeing at work and productivity – with wellbeing including physical health and mental wellbeing. ‘Good work’ (jobs that are skilled, autonomous, supported, secure, with good work–life balance, good income) is associated with better physical and mental health – and less absenteeism.
The evidence of the impact of tackling risk factors such as smoking, physical activity and obesity is also clear. A survey of 25,000 health workers found that those who smoked are twice as likely to take time off work, and a study of Transport for London found workers with obesity (BMI>30) take an average of three sick days more annually than those of normal weight (BMI<25), and those with severe obesity (BMI>35) take six days more. There are interventions that are recognised by NICE as effective, but workers are often not given access.
Being smart with the way that evidence is gathered (notably, building measurement in from the start) is key. Greater flexibility in ‘what counts’ is also needed. Although not all studies are academically robust, there are opportunities to make use of case studies and grey literature.
Finally, although organisations may not want to share their data (meaning much remains unpublished and un-peer-reviewed), data from within an organisation can be effective in persuading a board to act.
Making the case
A What Works Centre for Wellbeing survey found that people see wellbeing as important for productivity (both absenteeism and presenteeism). There is also a business case for action (improving the bottom line), a moral case (the ‘right thing to do’) and a taxation case (lost productivity and long-term sickness absence mean lower corporate tax returns and higher spend on long-term health-care and disability benefits).
But too often ‘health’ is seen as a cost, rather than an essential investment. There is a tension between the long-term investment in wellbeing and the financial squeeze affecting the economy.
Investing in a health-promoting workplace may be part of genuine corporate social responsibility, but the non-believers need to be engaged by clarifying the difference that good health can make.
Embedding wellbeing for productivity
Leadership is essential to embedding health within an organisation – through the involvement of the board, trade unions, senior management, line managers and peer leaders.
Role modelling is also important, both within an organisation and as an example to clients (eg trialling a health programme internally before recommending to others).
Strong leadership will bring wellbeing into wider business practices. For example, the current CEO of NHS England is prioritising the health of the NHS workforce.
The CQUIN (Commissioning for Quality and Innovation) system – which makes a proportion of health-care providers’ income conditional on demonstrating improvements in quality and innovation – has been expanded to include employee health requirements. This provides an incentive for NHS Trusts to demonstrate their impact on areas such as physical activity.
Engaging employees has a measurable benefit on performance. A study by Aston University, for example, found that in acute Trusts with more engaged staff there was a clear reduction in the likelihood of a patient dying.
Expert workshop on wellbeing and productivity
The views expressed in this article were captured at an Expert Workshop in October 2016 held under the Chatham House Rule. The workshop featured keynote talks by Professor Kevin Daniels (Norwich Business School and the What Works Centre for Wellbeing) and Dr Steven Boorman (Empactis, and the author of the influential 2009 ‘Boorman Review’ of wellbeing in the NHS), plus eight ‘lightning talks’ (for participants to share their own case studies) and plenary discussion.
Participants included those from the NHS and the private sector, academics, and influencers. The workshop was supported by an Award from the Health Foundation, which is an independent charity working to improve the quality of health care in the United Kingdom.
The Award also supported the development of a set of case studies on best practice in workplace health, and a rapid review of workplace health and the NHS – please contact C3 for more information.
C3 Collaborating for Health (www.c3health.org) welcomes your feedback, and invites you to join the C3 Workplace Health Movement. This is a networking and knowledge-sharing forum for workplace-health professionals to identify ways for businesses to develop healthy, resilient and productive workforces.
The best ideas may not come from the top, and careful discussion with all employees enables employers to ascertain the workforce’s requirements for realistic change.
Discussion can also identify potential health ambassadors or champions. Appreciation of their work – particularly donated time – is essential, as volunteers may be fundamental to initiatives’ success.
However, high engagement does not necessarily equate to high wellbeing. Where individuals are highly engaged, they may work too many hours, and fail to take breaks or time off, which can impact their wellbeing and their productivity if they reach burnout.
Where staff feel obligated to work even when ill, this is good neither for the employee nor the organisation – particularly in the NHS, where infection could be spread to patients.
What works for all and what works for some?
Evidence illustrates that good working practices – such as autonomy, good management and work-life balance – are fundamental to both wellbeing and productivity, and what is good for wellbeing can also be good for creativity, innovation and on-the-job learning.
However, employees face different challenges due to factors such as type of work, sector, gender, geography and age. To be effective, tailored initiatives may be required.
Nurses were cited as one example of a workforce requiring specific interventions. There are 360,000 nurses in England, of whom 25 per cent are obese.
Nurses are expected to work longer, often face 12-hour (irregular) shifts, and may not have time to have a drink of water or go to the toilet. As caregivers and motivators for lifestyle change among patients, an initiative to empower nurses to take control of their own health could have a big impact on their own wellbeing and that of their patients.
The challenges (and solutions) for different sizes of organisation can be very different. Approaches taken by large organisations include running training for shift workers on managing fatigue and nutrition.
For small- and medium-sized enterprises (SMEs) the big barriers are scalability and time pressures – but they can take small steps towards health by encouraging cycling/walking, flexible start- and finish-times to the day, and using existing free resources.
Education and behaviour change
Education and training are necessary for a more health-promoting workplace. Examples include enhanced management training to include awareness of mental-health issues, educating healthcare workers on the link between their own health and the health and safety of patients, or providing screening for employees so that they are aware of their own health issues.
However, education is insufficient for sustained behaviour change: the challenge is to move from knowing to doing. Small steps (eg encouraging stair use, or instigating email-free Fridays to reduce a source of overload) can be effective.
Competitions can create enthusiasm and temporary change, but a longer-term commitment is needed for true habit formation. And this commitment must be to initiatives that employees really want and that are fully supported – employees need to have the capability and the confidence to change.
Impact: some examples
We know that investing in health and wellbeing can improve productivity, as the following examples show.
- The London School of Economics analysed data from the Royal Mail, where an investment of £45 million generated a £225 million return on investment from 2004 to 2007. The study concluded that, were the 13 worst-performing sectors to follow suit, the impact on the UK economy could be £1.45 billion (Marsden and Moriconi, 2010).
- NHS Trusts that score highly on the health and wellbeing index (measured annually through the NHS Staff Survey) have better performance across a range of measures, including financial, spending on agency staff, patient satisfaction and fewer acute infections.
- An organisation that changed its focus to skills and abilities (e.g. training on safety and communication), motivation (e.g. reward-based management) and job design saw a small improvement in job satisfaction (8 per cent), but had a bigger impact on productivity (up by 14 per cent). After the intervention, there was also a 24 per cent reduction in time delays, a 33 per cent reduction in accidents and a 77 per cent reduction in lost-time incidents (Tregaskis et al, 2013).
What don’t we know?
What hasn’t worked? Too often, discussions focus only on the positives, when everyone working in this space knows that improving health and productivity is often about trial and error. More sharing of the challenges (and failures) would be welcomed.
Better definition of terms. Terms such as ‘wellbeing’, ‘health’ and ‘presenteeism’ are often discussed but without a clear definition of what they mean in the context of the workplace.
Evidence. How much evidence (and for whom) is needed on the impact of initiatives and need for investment? How can we make better use of existing case studies and grey literature?
The workplace as a hub: What are the opportunities to spread health messages and initiatives beyond the workplace – to families, local communities and suppliers?
What makes some initiatives snowball? What are the characteristics of really successful health initiatives?
Sustainability: What makes initiatives to improve health and productivity sustainable in terms of behaviour change and investment by the organisation?
Christine Hancock is founder and director of C3 Collaborating for Health. Katy Cooper was the assistant director of C3 Collaborating for Health until the end of 2016.
S. Boorman, Review of NHS Staff Health and Wellbeing (The Boorman Review) (Department of Health, 2009):
HM Government, Fixing the Foundations: Creating a More Prosperous Nation (the Government’s productivity plan) (July 2015):
D. Marsden and S. Moriconi 2010. The Value of Rude Health (The Centre for Economic Performance, LSE):
Office for National Statistics, ‘International comparisons of UK productivity’ (ICP), final estimates: 2015’ (April 2017):
Tregaskis O et al., ‘High performance work practices and firm performance: a longitudinal case study’ (2013) British Journal of Management (24)225–44: