Workplace Wellbeing Programmes Part I: What do we know so far?
Psychology is defined by the American Psychological Association as “the study of the mind and behaviour. The discipline embraces all aspects of the human experience — from the functions of the brain to the actions of nations, from child development to care for the aged. In every conceivable setting from scientific research centres to mental healthcare services, “the understanding of behaviour” is the enterprise of psychologists.” (1) According to this definition, psychology has a huge task to accomplish as it has to carry out a wide and mixed range of activities among diverse fields. The workplace is no exception.
Workplace Wellbeing, Workplace Wellness, Wellness Programmes, Employee Assistance Programmes and similar terms are concepts that have increasingly been gaining importance over the last decades. The European Network for Workplace Health Promotion (2) defined workplace health promotion as “the combined efforts of employers, employees and society to improve the health and well-being of people at work”. Traditionally, staff wellbeing has been reduced to physical health conditions, restricted to health and safety focusing on the prevention of workplace injuries or illnesses. Any kind of insurance or special discounts within the insurance were often included. Soon after, these programmes began to gradually introduce other plans such as gym memberships, bike-to-work schemes, nutrition advice, healthy food options at work, weight control management plans, smoking cessation or biometric screening programmes (blood pressure, cholesterol, BMI…). Lastly,a focus on mental health has also been taken into account in order to achieve a more integrated view on wellbeing. Lifestyle coaching or mindfulness are some of the latest trends.
It seems reasonable to considerthat an investment in a healthy workforce could be somehow beneficial for both the employer and employee (and consequently, the wider economy) as having healthy and happy workers would boost productivity. A growing body of institutions (3), (4), (5) thatgrant different awardsto companies who promote and demonstrate their commitment towards staff wellbeing appears to corroborate this. According to a 2016 survey (6) of 1,933 randomly selected public and private companies in the US by the Kaiser Family Foundation, 56% of firms offer health benefits, with 98% of large firms (200 or more workers) offering health benefits to at least some of their workers. The results of workplace wellness schemes have frequently resulted in a number of workplace benefits: reduction in sickness absence and staff turnover, increased productivity, improved staff morale, enhanced self-esteem, etc. Even the World Health Organisation (WHO) has endorsed the workplace as an effective environment to address prevention and control of chronic medical conditions and mental health issues (7).
Wellness programmes seem to be a great idea, but do they actually work?
Countless studies of wellness programmes in the workplace have been publishedanddemonstrate thepositive impact these programmes have on company productivity gains. One of the most famous revisions within the UK was conducted by PricewaterhouseCoopers LLP.PricewaterhouseCoopers LLPwas commissioned by the Health Work Wellbeing Executive in 2007 to look at 55 UK Businesses who implemented Wellness initiatives. Their conclusion was clear: “Evidence from a review of the available literature and case studies provided by the Health Work Wellbeing Executive supports the idea that wellness programs have a positive impact on intermediate and bottom-line benefits. The available literature suggests that programme costs can quickly be translated into financial benefits, either through cost savings or additional revenue generation, as a consequence of the improvement in a wide range of intermediate business measures.”Some of the most remarkable benefits they associated with wellness programmes are shown below. (8)
However, more recent reviews are not as optimistic with findings yielding contradictory or ambiguous results (9), (10) that require further research, or even contradicting these conclusions (11), (12).The article by Austin Frank and Aaron Carroll and published ‘The New York Times’ Upshot column, “Do Workplace Wellness Programs Work? Usually Not.” (13) caused such a stir that triggered an effort to identify some of the reasons behind this.
So, do they really work? Yes, but only if implemented correctly
When looking carefully at the literature, we can clearly identify several explanations to account for this contradiction. A 2014 paper (14) by Goetzel, and another 20experts in the health promotion field, revealed an overwhelming conclusion in relation to the effectiveness of health promotion programmes by compiling nearly 30 years worth of evidence. According to these authors “Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes.”
Some of the most relevant factors to take into account when explaining the differences in the results among different programmes are:
1. The way companies measure their success
This is one of the key elements in explaining most of the discrepancies in the results. Usually, most businesses use return of investment (ROI) as the only way to measure performance in the workplace. However, Larry Boress, president of the Chicago-based Midwest Business Group on Health, explained to the Chicago Tribune (15) that, “We’ve learned that ROI is not the correct measurement approach. Based on research and experience, the value of investment is a better approach. Some initiatives reduce costs in the short term, but there are lagging indicators that you won’t see a difference for three to five years.”
That makes sense in certain situations, for example, an employee with a high risk of suffering illnesses such as heart disease or diabetes. This worker could see improvements in their health after engaging in a wellness programme at work. This case would not reflect an immediate ROI because the employee did not get any medical care before they started the programme, but it certainly reduced or even avoided the likelihood of needing some in the immediate future. The problem with several companies is that they estimate their impact merely and exclusively on a monetary base. Goeztel et al. (14) declared that,“This perspective errs in the assumption that cost saving is the sole purpose of workplace health promotion and, therefore, the only outcome of interest.”
2. Time and Money invested
It sounds obvious but some of the negative results obtained might be explained as a matter of lack of timeand/ormoney. Numerous experts claim that wellness programmes are effective when they are looked at over the long term. It is often observed that some companies have unrealistic expectations as they anticipate substantial ROI within a year. Similarly, firms often fail to allocate sufficient resources and staffto properly deliver a wellness programme. A research report by RAND Corporation 2013 (16) analysing the impact of wellness programmes on health and cost outcomes concluded that, “Our study was able to detect statistically significant and clinically meaningful effects of wellness programs on health risk factors after examining six years of CCA data. Given the long latency between health risks and the development of manifest chronic disease, however, a much longer follow-up period will be required to fully capture the effect of worksite wellness programs on health outcomes and cost.” Well executed programmes appear to improve employee health meaningfully whereas significant reductions in health care costs may take time to materialise.
3. The Role of Incentives
“The carrot or the stick” approach is an analogy psychologists are familiar with. In psychology, positive and negative reinforcements work as effective rewards, whereas positive and negative punishments (unless they are actual rewards framed as a loss (17)) are not the best option when attempting to induce or change specific behaviours. Some wellness initiatives make use of penalties for employers who do not join a programme or who do not stick to it, in the form of an extra fee (usually higher premium insurances). This implies not only a legal/moral concern regarding the privacy of the workers (18) (the employee demands medical information from the staff) but also a risk of participant dropouts who feel dissatisfied if they do not achieve the goals they are meant to with the programme. The use of rewards instead of penalties is important yet they must be used correctly in order to be effective. Some programmes assume that their incentives are motivational when they are simply not, therefore people do not engage in the programme, as it does not have anything to offer them. In any case, more research and effort is needed.
Wellness programmes come in different shapes and sizes. Some can be effective and others just do not work. So, what is the key to designing and delivering a successful wellness programme?
It is clear that designing a well-executed programme seems to improve workers health meaningfully while significant reductions in health care costs might take time to materialise (16). Many studies have been carried out in order to determine the best procedures for a profitable and valuable wellness programme. Aside from the above mentioned points, the American Productivity and Quality Center (14) mentions other key components implicated in the best performing programmes: a state-of-the-art theory, pointed and evidence-based interventions built on behaviour change theory, effective implementation and ongoing programme evaluation. Finally, what seems to be the most common factor supported by Goetzel’s team at Johns Hopkins University’s Institute for Health and Productivity Studies (IHPS) and many other authors, is the adoption of a broad culture of wellbeing. Embracing a holistic approach culture of health with engaged leadership and staff rather than offering isolated health promotion initiatives (14) is vital for a successful programme. This would implicate the need to expand the range of application traditionally focused on physical wellbeing to all aspects of health, including the psychological factor.
*9 Am J Manag Care. 2012 Feb 1;18(2):e68-81. Systematic review of the impact of worksite wellness programs. Osilla KC1, Van Busum K, Schnyer C, Larkin JW, Eibner C, Mattke S.
*10 Karen J. Blumenthal, Kathryn A. Saulsgiver, Laurie Norton, Andrea B. Troxel, Joseph P. Anarella, Foster C. Gesten, Michael E. Chernew and Kevin G. Volpp. Medicaid Incentive Programs To Encourage Healthy Behavior Show Mixed Results To Date And Should Be Studied And Improved Health Affairs 32, no.3 (2013):497-507 doi: 10.1377/hlthaff.2012.0431
*11 California Health Benefits Review Program (CHBRP). (2013). Analysis of Senate Bill 189: Health Care Coverage: Wellness Programs. Report to California State Legislature. Oakland, CA: CHBRP.
*12 A Hospital System’s Wellness Program Linked To Health Plan Enrollment Cut Hospitalizations But Not Overall Costs, by Gautam Gowrisankaran, Karen Norberg, Steven Kymes, Michael E. Chernew, Dustin Stwalley, Leah Kemper, and William Peck
*14 Do Workplace Health Promotion (Wellness) Programs Work? Ron Z. Goetzel, et al.
*16 Workplace Wellness Programs Study Final Report Soeren Mattke, Hangsheng Liu, John P. Caloyeras, Christina Y. Huang, Kristin R. Van Busum, Dmitry Khodyakov, Victoria Shier RAND Health Sponsored by the U.S. Department of Labor and the U.S. Department of Health and Human Services