Last week, I sat down for a discussion with Dr. Ron Goetzel – a Senior Scientist and Director of the Institute for Health and Productivity Studies (IHPS) at the Johns Hopkins Bloomberg School of Public Health, as well as a VP of Consulting and Applied Research at Truven Health Analytics. Dr. Goetzel is a nationally-recognized expert in the fields of health, productivity management and outcomes research.
Greg Kunkel: Thanks again for taking the time to speak with me, Ron. In one of our monthly newsletters that was sent to all Next Jump’s clients back in 2015, I wrote about the Extraordinary Workplace Wellness Programs release from the Institute for Health and Productivity Studies. I thought that with your new study coming out that it would be interesting to follow-up and dive deeper.
Ron Goetzel: Of course. There are actually two new studies – one was published this month that describes our project in the Journal of Occupational and Environmental Medicine. We focused on two categories of best practices: building a culture of health, and strategic communications. We wrote an article back in 2007 that was benchmarking “best practice” companies. We convened with subject-matter experts, conducted a literature review, and visited companies to observe first-hand what they were doing. From that, we developed our list of best practices.
We came back and revisited that 2007 list and, low and behold, it still applies in 2016. In fact, in this article we have a table that lists all of the best practices that are out there from a variety of different benchmarking studies. Initially, we were going to talk about all of them, but that turned out to be thousands of pages, so we decided to narrow our scope to focus on establishing a culture of health and strategic communications.
GK: I recently attended the Global Wellness Summit in Mexico City a few months ago, and a main focus was on building a culture of wellness versus a focus on wellness programs.
RG: It’s actually gone even further than that – it’s a culture of health and wellbeing that’s being described now, so not just wellness. I’m involved in a large, federally-sponsored project that’s trying to define what “wellbeing” is. There are lots of different ways to look at it, both from subjective and objective perspectives. That is the current thinking; that wellbeing is broader than just physical. You can be sick and still have a great life or, vice versa, you can be a billionaire and have a miserable life.
GK: What’s your interpretation of well-being?
RG: It is still being defined, but from a subjective standpoint it’s a state of contentment; of being happy and satisfied with your life, with your relationships, and (in terms of the workplace) happy with your work. You can think about it like this: if you wake up in the morning and get out of bed, are you saying to yourself, “Wow, I’m going to have so much fun at work today and really enjoy it!” Or, are you getting out of bed and saying, “I want to call in sick today because I feel miserable about my job, my coworkers, and my boss.” That’s how it’s operationally defined.
GK: There’s a group of professors from Harvard that just wrote a new book, An Everyone Culture, and they’re coming at it from a unique perspective. They started with this question of “can adults grow”? Then they researched the follow up questions – can corporate environments foster that growth? I found their description of happiness at work fascinating:
“There’s the hedonistic aspect, which would be short-term happiness. Dr. Kegan, one of the authors, is frustrated that there are some missed opportunities with companies that are going after free stuff and focused on keeping everyone happy in the short-term. He argues for a more Aristotelian approach; a path to fulfillment and longer-term happiness that helps individuals grow in the long-term.”
At Next Jump, we’ve really tried to experiment programs along the belief that employees CAN grow at work. Because there are a lot of challenges, and stress will always be present in the workplace, and so happiness in the short-run isn’t always possible. In fact, there’s some evidence that going through stress in the short-term ends up making you more fulfilled and stronger in the long-term, and is an impetus to growth.
RG: It makes me think of Martin Seligman’s work in that area and his book, Flourish, where he provides documentary evidence of that. This project that we’re now just embarking on is tackling this conceptual challenge of what do we mean by “wellbeing,” but – more importantly – wellbeing at work. Because there are both subjective and objective measures.
For example, on the objective side – does your workplace provide you opportunities to be physically active, for eating healthy, for managing your stress? All the things we typically think about when we picture workplace health promotion and wellness programs. But you can do all of those things, and employees still won’t really improve their attitudes about their employer and the workplace because the reasoning behind those programs was very separated from the actual activities… You can go through a blood pressure screening or have multiple programs, but really the culture doesn’t support that.
GK: So it sounds like companies are offering valuable programs, but it’s not clear to the employees what the purpose of those programs, or the higher purpose?
RG: That’s part of it – and from a viewpoint where you get a lot of pushback from employees, they might think it’s a way of saving money for the company. They’re viewing it as something being done to them versus something being done for them. Especially when you bring in this whole movement towards incentives where you have a reach a certain BMI in order to get a lower insurance premium, it can create resentment.
GK: I think you hit the nail on the head. One lesson learned I share when people ask about our fitness initiatives is the importance of sharing the context behind an initiative. I remember when we first put gyms into our offices, employees were so skeptical. Literally, some people were going around saying, “Next Jump is putting in gyms here so we can stay longer at work and work more hours.” But that wasn’t close to the point. So we use that as an example of a lesson we learned on the importance of sharing the context of why you’re doing something.
RG: Yes, and it has to be authentic. Not an email or a flyer; it has to come from the heart. Whenever you talk to anyone – in management, a lower-level employee – they have to really believe in it.
GK: What would be some of the biggest mistakes you’ve seen organizations make in building a culture of health and well-being?
RG: Sure, and I’ll note that each of these “don’t”s are done in isolation and not as part of a larger culture or program. The first is doing just a health-assessment alone, even if it includes biometric screening. In other words, you have somebody fill out a questionnaire, it takes 15 minutes, they get their blood pressure and cholesterol measured, and they’re sent off. Oftentimes, they get $50 to $100 dollars just for doing that. It’s basically like saying, “You shouldn’t be smoking, you’re overweight, you’re too stressed – thanks very much, we’ll see you next year.”
The second thing that’s often done is a lot of companies just send their employees to a website. Aetna or Cigna or Prudential or whatever – they basically say “they’ve got a website so just go there and your problems will be solved.” The utilization of those is microscopic, and the people who need it the most are the least likely to go to that website, it’s usually the “worried well” who are constantly trying to make themselves healthier.
The third one is short-term campaigns, and you see a lot of that – I think the “Biggest Loser” is probably the most famous, where the company will weigh everybody and then weigh you again six weeks later, and whoever loses the most weight gets $1000 or whatever. And that’s it. They aren’t actually effective, and can be quite harmful when people try to lose weight too quickly.
The other big problem – and this is one that’s very prevalent – is the incentive problem. You’re paying people to do stuff that they don’t want to do. They try to pay you to quit smoking or pay you not to eat so much… giving you money for things that you should inherently want to do for yourself instead of having a company pay for you to do it. The whole incentive scheme – and I think there are many variations on that – is a big problem.
I think probably the biggest problem is hiring a vendor to fix all of the sick people, which is often the case. Company A will hire WebMD or Staywell or whomever, and the mentality is “they’re going to fix all my problems, so go to it. I have no involvement, call me when you’re done.”
GK: Those are great examples. Even that notion of “fix my problems” – I could see how the problems are oftentimes viewed within the health cost problem versus getting it to an authentic place. That’s why I really like the language on well-being, because it starts to capture not just the physical aspect of the employees, but also their hearts and minds.
RG: Unfortunately, because I do research and publish a lot on ROI, whenever companies come to me – I even had a call earlier today with a very large healthcare company that runs hospitals and healthcare clinics, and the first question out of their mouth was: “what’s the ROI?” That was the first thing they asked me about. And I’m thinking, “you’re in the healthcare business, aren’t you supposed to be improving health?”
GK: When the first thing out of someone’s mouth is that ROI question, how do you respond to that?
RG: Well, my response is that if that’s what you’re looking for, which is cutting costs, I’ll tell you how to do it really, really fast: by changing your benefit plan design. If that’s what you really want to do is cut your expenditures, just introduce higher deductibles and higher co-insureds. Do all of those things and take away benefits. You’ll cut your costs overnight.
But if you have multiple agendas or multiple aims – for instance, in Next Jump’s case, your biggest goal as an organization is to attract and retain the top talent, right? I mean, that’s your core business. You want the smartest, brightest people in the world and you want them engaged and fulfilled and working to please themselves and please you.
GK: Absolutely. Engaged, growing.
RG: You’re not really interested in cost-cutting medical expenditures. That’s probably way down on the list somewhere, but your main business is having the best and brightest people work for you. So, how do you quantify that? How do you calculate an ROI from that? If you really wanted me to figure out how much it costs to train and recruit, what the turnover rate is and all that kind of stuff, I could do it. But that’s not the metric of interest. You want great people who stay with you and produce great products, and your overall growth reflects that by increasing over time. If you can broaden the discussion away from ROI and towards VOI, or value on investment, then you have a much more interesting and intelligent and higher-level conversation.
But if you still really are hell-bent on calculating ROI, my rule of thumb is that 1:1 ROI is great (for every dollar invested, you get a dollar back), only if you can improve the health and wellbeing of your workers.
GK: For organizations that come to you that are struggling in terms of their culture of health and wellbeing, what would be your recommendation for starting to improve?
RG: First, involve the workers to the extent you can. That may be through interviews, and focus groups and a health committee, but get people to sit around and talk about the work environment. They’ll likely find it’s more than just pure physical health that’s the issue; it’s also emotional health and mental health that is being neglected, too. The first step is to carry out an environmental scan; an analysis of the landscape to review what is going on here, both quantitatively and qualitatively.
Then, identify the strengths and weaknesses, and try to gain consensus. If we brought in a fitness instructor or did free yoga classes, how would that go over here? Do it based upon what is really of interest to the population. At the end of the day, if people don’t get involved and engaged, then all of the spending goes for naught.
GK: Kind of tangentially, one observation I have had is that if senior leadership is not fully engaged and authentic with workplace wellness, it’s a really uphill battle. Is it a losing cause from the HR perspective in that case? If so, what recommendations do you have for getting senior leadership onboard?
RG: I agree, 100%. Every case study you look at, if the senior manager is not involved it’s an uphill battle. There’s one interesting case study that comes to mind: in New York City, Citibank had a very extensive health promotion program in the 1990s, and the CEO at the time was very pro-people. He really built the program, recruited the staff. When he retired, a new CEO was hired, and he basically gutted everything. The whole program shut down overnight. The company didn’t do well financially, and it still hasn’t fully recovered. They now have a new CEO and new program, and it really has revitalized things. We recently did an ROI analysis for Citibank, which showed their program had a really significant positive ROI.
There are some organizations, though, where the culture of health is so woven into the fabric that even if they brought in a new CEO, they wouldn’t change the culture; the culture changes them. They teach the new CEO and educate them on how they were doing it, and the CEO becomes a supporter and proponent of the program.
GK: Thank you, Ron, for your time. Enjoyed the conversation.