Implementing an evidence-based approach to wellbeing

Is “wellbeing” more than just “fresh fruit Fridays” or mindfulness initiatives? As Nick Pahl reports, a recent event led by the Society of Occupational Medicine examined how we can all work together to create, and communicate, a better understanding of “wellbeing” and what makes a difference.

Workplace wellbeing can feel like a new “wild west” of activity, with everything and anything being implemented – from “fresh fruit Fridays” through to mindfulness. But is anything better than nothing? Clearly, this is an area of concern as stress, anxiety and depression cause 44% of all work-related ill-health.

A recent event run by the Society of Occupational Medicine, the Chartered Institute of Personnel and Development and the British Psychological Society looked at this in detail, and how to make a sustained difference strategically.

About the author

Nick Pahl is chief executive of the Society of Occupational Medicine

There is still uncertainty as to what wellbeing really is and whether it really makes a difference. An evidence-based approach therefore is key. Note, the law in this area is not specific to wellbeing but those working in this area may want to reference health and safety legislation, the Employment Rights Act 1996 and the Equality Act 2010, covering disability discrimination and mental health issues.

What even is “wellbeing”?

First off, what is “wellbeing”? Is it how satisfied you are with life, being engaged and purposeful, with good social connections, and good health?

Professor Ivan Robertson, founder of organisational psychologists Robertson Cooper, highlighted these key areas and how wellbeing leads to better physical health, reduced illness and injury rate, better immune functioning, speedier recovery from operations, injury and illness and reduced death rates.

By contrast, stress and burnout can lead to cardiovascular disease and type 2 diabetes, amongst other issues. Professor Robertson also reviewed what causes psychological health to go up or down, arguing that key indicators were:

  • job demands;
  • control;
  • a sense of achievement; and
  • support.

He said evidence shows that the healthiest jobs are where demands are high, but levels of support and control are high too. Professor Robertson said the research literature states that positive wellbeing does lead to positive outcomes in terms of performance. However, there needs to be an evidence-based approach to interventions. For example:

  • Mindfulness. Mindfulness has been shown to reduce stress levels, anxiety and distress, wellbeing and sleep. However, mindfulness doesn’t deal with structural issues in an organisation that may impact on this area.
  • Wellbeing e-learning. Wellbeing e-learning can be useful as part of a “blended” learning approach, but there can be problems with take-up.
  • Mental health first aid training. This is a popular intervention, but Professor Robertson said the “jury is out as to whether it works”. The Health and Safety Executive has found there is insufficient evidence to draw any conclusions (although those who are trained feel more confident), he highlighted.
  • Management. Studies have shown that manager behaviour affects wellbeing, with those who use a transformational leadership style are more effective in terms of impact.
  • Flexible working. Flexible can be useful but needs to be across the workforce. It can improve personal wellbeing and job satisfaction if there is control.

A key interest area to SOM is how occupational health and wellbeing activity interact and from there to ensure wellbeing interventions are evidence based.

SOM is publishing a report on this shortly, written by Dr Jenny Napier, which argues that OH should work collaboratively with wellbeing activities, as OH understands the hazards and risks of contemporary work, and has a privileged view on organisational life.

OH, as most practitioners will be well aware (but it is always worth recapping), offers:

  • Pre-employment health assessment
  • Attendance management
  • Fitness for work advice and advice on adjustments
  • Ill health retirement advice
  • Health surveillance
  • Health risk management advice

As the World Health Organization has stated, OH:

  • promotes the highest degrees of physical, mental and social wellbeing of all workers;
  • promotes working capacity;
  • improves working environment; and
  • develops work organisations and cultures to support health and positive social climate.

OH professionals therefore have a major role when it comes to influencing policy and practice towards health and wellbeing.

Measuring outcomes and being specific

How, then, can we ensure wellbeing is evidence based? A key step is to measure what we are doing and be specific in the intervention. There are difficulties in this area as often there isn’t a clear link between wellbeing and outcomes (such as reduced sickness absence).

The day then reviewed of some wellbeing case studies. These were:

Rolls Royce. Rolls-Royce has a wellbeing strategy to make informed, healthy lifestyle choices, reduce the business impact of lifestyle risk and maximise performance at work. This includes improving nutrition and eating well to reduce high blood pressure, increasing physical activity and moving more and reducing smoking rates.

Network Rail. Nework Rail aimed first to identify the main barriers and enablers of employee wellbeing. It found female employees were twice as likely to report mental health issues but male employees aged 41-50 were the least equipped. A next step is to develop a network of wellbeing “champions”.

Tesco Bank. Tesco Bank has carried out a survey to look at physical wellbeing, the quality of work life balance, and whether the workplace was supportive. The importance to take a break was highlighted and a wellbeing working group was established with a union representative. The bank has also registered for Healthy Working Lives accreditation. A key result was a rise in people happy with their work life balance and lower levels of attrition and more positive leaver data.

Santander. Santander has tried to understand where to target resources and produced guidance on managing non-work and work-related stress and anxiety and depressions and integrate the facilitation of good mental health into the culture (crucially championed from the top).

In the case of Santander, training has occurred on being positive about mental health, managing pressure, and being “resilient performers”.

The aim was to increase the level of personal wellbeing where colleagues are happy, healthy and have high levels of engagement, with staff going the extra mile. A strategy approach was taken, as follows:

  • Primary. Dealing with the stressors, policies, work-planning and work life balance.
  • Secondary. Helping people to cope through emotional resilience training, and healthy lifestyle programmes.
  • Tertiary. Putting remedial measures in place, such as EAPs, counselling, CBT and so on.

Finally, a useful guidance document from the conciliation service, ACAS, was highlighted. Called Health, work and wellbeing, it focuses on line managers being trained in people skills, using appropriate health services to tackle absence, promoting an attendance culture by conducting return-to-work discussions and ensuring jobs are flexible and well-designed.

Managers also know how to manage common health problems such as mental health and musculoskeletal disorders, promote health and wellbeing in the workplace and set an example. This can be achieved for example by:

  • managing their own working hours;
  • using their full holiday entitlement;
  • taking proper lunch breaks; and
  • encouraging employees to look after their own health.

Overall, wellbeing might be here to stay, but the words of Professor Robertson stuck in my head that job demands, control, a sense of achievement and support are all critical. Ultimately, we must consult and involve employees wherever possible over the way in which they carry out their roles… then wellbeing will follow!


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Health, work and wellbeing, ACAS,

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