The organisational culture and environment plays a critical role in supporting and sustaining effective use of wellbeing technology at work. In the fifth of a series of articles, Stephen Haynes considers some of the foundations needed before organisations adopt wellness technology
A 2004 research paper called Health Promotion in the Workplace: Framing the concept (Shain M, Kramer DM, 2004), noted that workplace health promotion was a “multidimensional concept that embraces at least two major philosophies about what health is and how it is influenced”.
The first of these philosophies is about health as the product of employee behaviour and personal responsibility, while the second relates to the influences outside the employee’s control, namely “the organisation and design of work in both its physical and psychosocial dimensions”.
Essentially, workplace wellness initiatives and organisational culture are interrelated and synonymous. Both feed each other, and neither work alone.
Why is this important? Many experts believe that some of the technology-based interventions, services and benefits introduced into workplaces can be of limited or questionable value. Some are introduced based on insufficient information and understanding of the workplace, while some lack a sufficient evidence base.
Does size matter?
It seems size really does matter when it comes to having a workplace health programme.
In a review to identify the role of business size in assessing the uptake of health promoting workplace initiatives in Australia, Taylor identified that companies with less than 20 staff were much less likely to offer any form of health promotion activities compared to larger employers (Taylor AW et al, 2016).
Management in small businesses were less likely to feel that health promotion belonged in the workplace, with many considering workplace health “a luxury and not a serious focus of their activities”.
Despite this, the study did show that perceived effectiveness of any programme was high for all businesses, regardless of size.
Health, work and wellbeing specialist Jane Abraham says: “For small businesses to engage with health promotion and wellbeing they need to be convinced of the link between the issues that concern them, and how these interventions can help address them.
“Focusing on improving productivity, engagement and attracting the best talent in highly competitive labour markets, are their main concerns.
“They have limited resources, and time, and need to focus on business survival and the day to day issues that arise, therefore [worker health and wellbeing] just seems like an additional burden.”
Abraham says that making the business case explicit in these areas might sway the argument for SMEs if it looks easy to implement, but it is going to take significant time and effort to achieve this.
However, wellness technology offers tremendous potential to employers to support a broader culture of health, provided the workplace and environment play a key role in supporting and sustaining workplace health- and wellbeing-related initiatives. Here we investigate some of the foundations that organisations need to consider when adopting wellbeing technology.
What problems are we trying to fix with ‘wellbeing’?
Why do employers invest in wellbeing in the first place? In the UK, in the past decade we’ve shifted away from the aim of cost control (arguably influenced in the early days by US programmes – and a driver which failed to be widely adopted largely due to the differences in healthcare systems and insurance models). Instead, UK organisations are focusing on business performance, improved engagement, organisational culture, sickness absence and, to a lesser extent, insurance benefit spending and secondary outcomes.
Nancy Hey, director of the What Works Centre for Wellbeing, sees a variety of different drivers for wellbeing. Hey says: “What I’m hearing is a mix of things – employers usually say they want increased performance and/or productivity with reduced costs, but usually employers do it because it is the right thing to do, recognising that their employees are their most important asset.
“In fact, the programmes that are introduced with the aim of improving wellbeing rather than just performance, we see are much more effective – and I don’t think companies do this just because they want to improve performance.”
Wellbeing expert Professor Cary Cooper says: “The whole area of workplace wellbeing has grown following the recession – we have fewer people doing more work, working longer hours, more people are feeling overloaded and jobs are no longer for life – employers are taking wellbeing seriously.”
Christian Van Stolk, vice president at RAND Europe, who oversees the Britain’s Healthiest Companies survey, finds that employers are also using wellbeing as a means to improve access, engagement and inclusivity, particulary in large and diverse workforces.
Dr Justin Varney, National Lead for Adult Health and Wellbeing for Public Health England says: “Workplace wellbeing has grown significantly in the UK, particularly following the recession where many of the jobs that came back have been short-term contracts, or self-employed positions… businesses had become so lean and mean during the downturn, that the focus today has shifted to talent attraction and retention – and employee wellbeing plays a critical role in this.”
In the US, the chief focus has historically been on medical/disability insurance cost control (one of the main reasons for the $6bn wellbeing industry). However, we are starting to see a shift to an approach that is closer to the UK.
Sallie Scovill, associate professor at the University of Wisconsin Stevens Point, who leads the university’s workplace health study programme, sees a shift in the goals of employer’s wellness programmes.
Scovill says: “Although US employers still look for direct bottom-line impact such as reduced absence and lower health insurance costs, the more progressive employers are looking beyond the ‘employee as a health statistic’ and looking at the impact on business performance by focusing on things like organisational design and culture, job control and support infrastructures, for example. These are beginning to outweigh the traditional nice-to-have wellness initiatives.”
Al Lewis, CEO of Quizzify in New York and author of Why Nobody Believes the Numbers, is cynical when it comes to traditional wellness programmes – particularly incentive-based programmes. He says: “Short-term incentives haven’t changed [employees’] weight. Nor have they changed true health outcomes.”
He adds that “outcomes-based [wellness] programmes have more in common with training circus animals to do tricks in exchange for treats than they do with helping employees improve long-term health”. Lewis believes that incentive-based models can be “attempts to create a culture of health [which] often create a culture of resentment and deceit”.
So are we starting to see US workplace wellbeing programmes following the UK’s model, shifting the focus from healthcare cost control to the fundamentals of ‘employer of choice’? Scovill says: “In the UK, employers have to look at the impact that stress has on worker health; but nobody is mandated to do this in the US – and I believe this needs to happen”.
International workplace wellbeing consultant Wolf Kirsten says that while “much of the focus of US-headquartered employers remains on reducing healthcare costs, most of the ‘talk’ is now on improved employee engagement and morale”.
He adds that often, “employers don’t necessarily know what problems they want to fix when they reach out for guidance on their programme/organisation”.
More evidence of the trend is provided by the growing literature base. For example, a 2016 paper based on a survey of 275 large US employers by Ron Ozminkowski et al, at IBM Watson Health (and previously Optum) along with the National Business Group, references the decline in employers seeing healthcare cost savings as the preferred method of assessing workplace health programmes.
The paper identifies the growing number of employers considering the broader business case for workplace health (WPH) programmes, referred to as a value-of-investment (VOI) and includes other metrics such as “reduced turnover, business profitability, health risk reduction, increased productivity and quality of life”.
Scovill adds: “Much of the recent evidence supporting the shift from cost control to ’employer of choice’ in the US is coming from the big consulting firms, and less so from the published scientific evidence.”
What is the scientific evidence on successful workplace health programmes?
In 2015, researchers sought to understand the key themes that drove successful workplace health programmes (Wyatt KM et al, 2015). They identified the following ingredients as essential in informing programme development:
- Senior management endorsement
- Collective sense of ownership
- Presence of visible “quick wins”
- A sense that participation was easy and fun, not mandated
The study also identified some key barriers to successful programmes, including a lack of belief in the possibility of change in their workplace due to time and workload pressures, a sense of “us and them” relationship with management, as well as environmental barriers.
Although there are numerous studies which link the wider organisational factors such as culture, work design, job autonomy and leadership style with employee health and productivity, there are few studies which directly consider engagement of specific health and wellbeing initiatives with environmental or cultural factors.
A 2013 analysis of the effectiveness of workplace health promotion programmes (Rongen A et al, 2013), identified that, while most reviews conclude that health promotion improves the overall health of staff, the impact still tends to be small.
The analysis stated that “reviews are hampered by a large heterogeneity in interventions and study populations”. This analysis considered 3,668 studies but only 18 met their inclusion criteria, and few considered external factors.
However, a 2012 review of healthy worksite cultures showed policies and environments that supported a culture of health were “important to helping employees adopt and maintain healthy behaviours” (Aldana SG et al, 2012).
This review referenced how health and safety initiatives had been successfully adopted in the past because they created a culture of safety where employee behaviours “are guided by safety procedures and norms … and incorporated into the vision and goals of leadership”.
It also noted that “organisational and environmental policies and supports that encourage the adoption and maintenance of healthy behaviours are components of behaviour change referred to as ‘opportunity’”. Specifically, opportunity means creating an environment that makes choosing healthy behaviours the normative choice.
Case studies in 2007 (Heward S et al) illustrated that programme effectiveness and sustainability needed a strategic vision from leadership. Simply introducing a new wellness “toy” into a new or existing programme is likely to be of limited impact if employees do not see ownership and direction – essentially permission from managers and leaders. It also highlights a need to focus on organisational change to secure ownership and commitment to any new initiative.
Another study which examined the relationship between the workplace culture and wellness programme engagement is a 2016 paper which looked at the relationship between a workplace culture of health (CoH), job satisfaction and intention to leave (Kwon Y, Marzec ML, 2016).
The workplace CoH measures employees’ perceptions of five main areas – senior leadership and policies, programmes and rewards, programme quality, line management support and involvement, and co-worker support. It is similar to the Health and Safety Executive (HSE) Management Standards model in the UK (a population-based approach to reducing work-related stress based around six working conditions: demands, control, support, relationships, role and change). A wealth of evidence demonstrates that successfully managing these areas improves business outcomes.
In their 2016 white paper Achieving a Culture of Health in the Workplace, Karen Marlo from the National Business Group on Health (NBGH) and Seth Serxner, SVP of Population Health at Optum defined a culture of health as “a work environment where employees have the resources, tools and a support system that empowers and motivates them to take responsibility for their own health”.
They surveyed 545 large US employers and found that organisations with a CoH were generally categorised as those with these features: higher and longer engagement in wellness initiatives; investment in incentives to drive engagement; strategically planned programmes that were holistic in design (encompassing physical, mental, financial, social wellbeing etc); and leveraged multiple metrics.
As Shain and Kramer argued in 2004: “Focusing on personal health practices through programmes targeted exclusively at individual behaviour is likely to yield minimal benefits compared with interventions that also target the organisation and design of work as key influences on health”.
Technology and mental health at work
A 2009 literature review prepared for the Department of Health categorises interventions relating to stress and mental health into multimodal and organisational approaches (Hassan E et al, 2009).
Technology is playing a role in multimodal approaches, which combine various methods such as education, physical exercise, and short-term solutions-based counselling.
However, technology arguably only has a supporting role to play in “organisational” development approaches; for example, adjustments to the work environment, working practice, working relationships, job design and role autonomy.
More specifically, effective stress and mental health-based programmes look to intervene at a primary, secondary and tertiary level.
Primary interventions seek to address the source of the stressor/s; for example, by improving the physical or socio-political working environment such as job design, work scheduling, employee control and autonomy, interpersonal factors, management style and organisational characteristics.
Secondary interventions focus on stress management and prevention at an employee level. An example of this is training to help people self-diagnose, to identify the source of stress and better manage it (such as relaxation-focused interventions such as meditation, mindfulness and progressive muscle relaxation, cognitive behavioural skills training to focus on altering the way in which people interpret situations or time management and assertiveness training).
Tertiary interventions focus on the treatment of a particular condition, rehabilitation and recovery… offering an employee assistance programme (EAP), providing support from OH advisers or return to work interventions.
Most of the technology available to manage stress at work focuses on particular areas – for example, real-time employee survey tools can support an employer in determining effective primary interventions, while helping employees at risk by signposting them to appropriate information, support and advice.
Susan Carty says there is a place for this type of technology in the workplace, but cautions that “this would need to be seen by employees as part of the way things are done around here and part of their culture”.
She adds that this approach “would work well in a young, start-up business, but you would need to do a lot of work to make it effective in larger organisations”.
There are numerous tech-based solutions aimed at secondary interventions, such as mindfulness-based apps, and improvements in EAP technology have made visibility and access to tertiary interventions easier.
But without the proper infrastructure, training or involvement from leadership, managers and employees, technology by itself will have limited benefit on improving mental health or reducing stress at work.
Stephen Haynes is a workplace health specialist, and currently the programme director of Mates in Mind, which provides the UK construction industry with a framework to improve mental health
Aldana SG, Anderson DR, Adams TB, Whitmer RW, Merrill RM, George V, Noyce J (2012). A review of the knowledge base on healthy worksite culture. Journal of occupational and environmental medicine, 54(4), 414-419.
Hassan E, Austin C, Celia C, Disley E, Hunt P, Marjanovic S, Shehabi A, Villalba-Van-Dijk L, Van Stolk C. (2009). Health and Wellbeing at Work in the United Kingdom A literature review Prepared for the Department of Health.
Heward S, Hutchins C, Keleher H. (2007). Organizational change—key to capacity building and effective health promotion. Health Promotion International, 22(2), 170-178.
Kwon Y, Marzec ML (2016). Does Worksite Culture of Health (CoH) Matter to Employees? Empirical Evidence Using Job-Related Metrics. Journal of Occupational and Environmental Medicine, 58(5), 448-454.
Ozminkowski RJ, Serxner S, Marlo K, Kichlu R, Ratelis E, & Van de Meulebroecke J. (2016). Beyond ROI: using value of investment to measure employee health and wellness. Population health management, 19(4), 227-229.
Rongen A, Robroek SJ, van Lenthe FJ, Burdorf A. (2013). Workplace health promotion: a meta-analysis of effectiveness. American journal of preventive medicine, 44(4), 406-415.
Shain, M., & Kramer, D. M. (2004). Health promotion in the workplace: framing the concept; reviewing the evidence. Occupational and environmental medicine, 61(7), 643-648.
Taylor AW, Pilkington R, Montgomerie A, Feist H. (2016). The role of business size in assessing the uptake of health promoting workplace initiatives in Australia. BMC public health, 16(1), 35.
Wyatt KM, Brand S, Ashby-Pepper J, Abraham J, Fleming L E (2015). Understanding how healthy workplaces are created: implications for developing a national health service healthy workplace program. International Journal of Health Services, 45(1), 161-185.