25 May 2016

Health, happiness or hype: do wellness programs work?

KnowCents Practice Management

 

Promoted as the next big thing to improve health and productivity at work, are wellness programs all they are cracked up to be?

It’s a truth universally acknowledged that the happier and healthier a workforce is, the more productive and less stressed and costly they are to a business.

According to Medibank’s 2005 report The Health of Australia’s Workforce, absenteeism in Australia costs approximately $7 billion each year, while the cost of presenteeism (i.e. not fully functioning at work because of medical conditions) is nearly four times more, at nearly $26 billion in 2005-06.

But, while employers have long been offering healthcare benefits to their staff, there’s a new kid on the block that’s aiming to help further improve worker health and productivity: wellness programs.

According to The McKinley Health Center in the US, wellness is “a state of optimal well-being that is oriented toward maximising an individual’s potential”. Chances are you’re probably already practicing one form of wellness technique to help deal with an increasingly digitised, fast-paced and stressful life – be it mindfulness (the practice of consciously focusing on the present moment), gratitude, meditation, or yoga.

Although some brush off mindfulness as a faddish therapeutic technique, there is real medical benefit to the practice, says Craig Hassed, who is Associate Professor, Senior Lecturer, and Mindfulness Co-ordinator at Monash University.

“Mindfulness is more than sitting and practicing mediation. It very much relates to quality of attention in day-to-day life,” he says.

“Studies have shown that mindfulness can reduce stress, reduce recurring depression when used in conjunction with usual treatment, stimulate new brain cell growth, help prevent the future development of dementia and cognitive impairment, help facilitate healthy lifestyle change, improve immune defences, lower inflammation, improve DNA repair, and even slow down the rate of ageing.”

With the average person spending around a third of their life at work, how we manage our health at work has huge impacts on our lives. It’s part of the reason nearly half of Australian businesses have implemented wellness programs to reduce sickness and stress, stave off preventable illnesses, and boost morale.

So, what do wellness programs involve? Although there’s no hard and fast rule, wellness programs can cover some or all of the following: free flu vaccinations; free fruit or healthy vending machines; rewards for stopping smoking, drinking less alcohol, and increasing exercise activities; flexible working hours and options to buy extra holidays; in-seat massages; free or discounted gym memberships and counselling sessions; free “mindfulness” colouring books; sports days; healthcare screening; lunchtime pilates or yoga sessions; and meditation classes.

Other companies also make use of more alternative therapies, such as UBank’s iridology consultation offering, or Symantec’s laughter sessions.

HOW TO MEASURE?

But quantifying the benefits of wellness programs on a macro scale is difficult – as there is a lack of impartial and empirical data and a void of verifiable causation for any benefits reported.

For the most part, studies and surveys on the impacts of wellness record employee or employer satisfaction or awareness of a specific wellness programs – rather than any hard and fast facts about whether the programs, on the whole, actually benefit workers.

However, one commonly-cited report from 2009, undertaken by career management consultancy Right Management (which involved 28,000 participants across 15 countries), found that when health and wellness was managed well, organisation performance increased by more than 2.5 times, whereas when it is not managed well, organisation performance decreased by more than 3.5 times and the company was four times more likely to lose talent in the following 12 months.

There are plenty of case studies showing the reported benefits of specific wellness programs, however. For example, Transport for London started up a six-week mindfulness course in 2009, which incorporated cognitive behavioural therapy and other techniques as well as mindfulness. So far, the local government body has seen 600 staff go through the training, and its qualitative evaluation has found that, immediately afterwards, nearly all employees said that they made changes to their lives as a result.

Further, after employees went through the mindfulness training, the number of days off for stress, anxiety and depression fell by 71% over the following three years, while absences for all conditions dropped by about half. There were also qualitative improvements, with 80% of participants reporting benefits in their relationships, 79% were able to relax better, 64% improved their sleep patterns and 53% cited greater happiness at work.

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GETTING IT WRONG

But it’s easy to get wellness wrong. For example, Professor Jones*, from a leading Australian educational institution, has voiced concern that wellness sessions are being used as a substitute for effective management.

“We’ve been going through funding cuts and restructures at the level of staffing and teaching and there have been decisions that have been quite controversial, so there has been a lot of disruption and unhappiness in the workplace”, she explains.

“Every year [management] do a workplace survey and last year it found that staff morale was very low and that people were very unhappy for one reason or another, including unhappiness with management. To address this, everyone in the department was sent a very strong email telling us to attend a compulsory wellness day.

“This made the stress even worse, as everyone was already working long hours, and people were complaining about not having time to do their work if they had to put a whole day aside for wellness.”

Professor Jones says that many of the staff felt that management was attributing the low morale and high stress to the employees, rather than to a fault in the system.

“The term is ‘responsibilisation’. It made us out to be unhappy and stressed through our own poor management. It was like senior management was patronising us and saying: ‘If your workload has increased and you can’t handle it, it’s because you’re not meditating enough, or not doing enough yoga.

They were just not listening.”

Although Professor Jones says that the sessions given “were good and quite interesting” with “good tips about managing stress and learning about proper posture and the need to move around more”, things ended on a sour note.

“At a wrap up session at the end of the day, the facilitator asked what we’d learned and what we could apply at work. A few people said that while the lessons were well and good, they couldn’t take the place of workplace reforms, and that genuine grievances at work still needed to be dealt with.

“The facilitator had obviously been briefed to quash any negativity, and they just shut this person down saying they didn’t want any negative vibes. So, the next person was even more bolshie, and stood up and said we needed to take industrial action if management wasn’t going to hear and deal with our complaints (which largely concerned funding cuts and being in run down buildings).”

Members of the union did eventually undertake industrial action.

Professor Jones said that the whole situation could have been handled better if there had been a genuine effort by management to listen to staff concerns, if there had been an overarching longer-term wellness program in place, if the session had been a voluntary lunchtime session, and if the facilitator had responded to staff talking about their grievances in a serious and supportive way.

“I think a wellness program is a really good idea, but it needs to be part of the infrastructure and not just a one-off day in response to a staff survey”, she says.

“But even though mindfulness techniques may be useful and it may make you feel better, they’re not a substitute for joining the union, having a functional workplace and fixing the root cause of the problem. It can’t be a replacement for good management.”

The Workplace Health Association of Australia agrees that having a one-off wellness session is “the antithesis of best practice”.

Dr John Lang, chief executive of the association, adds: “It is a complex issue requiring a multi-tiered approach from senior managers down to the shop floor, overseen by people who know and understand the drivers and can follow an evidence-based approach.

“Staff wellness days can be a component of a multidisciplinary program, but without the support of other program components, such as educational workshops on stress management strategies or life balance/time management principles, the wellness day impact is likely to be nil/minimal.”

In fact, making wellness days compulsory is a risky business. For example, if an employee is suffering from post-traumatic stress disorder, which may or may not be diagnosed, being forced to meditate can induce panic attacks or rekindle traumatic memories.

A study from the University of California, Irvine, found that 63% of participants in a meditation study suffered at least one negative effect, while 7% experienced adverse effects including panic, depression, pain and anxiety.

Another danger is that by making wellness compulsory, it will be viewed as yet another job requirement by employees. This can lead to resentment, especially if employees don’t feel they have benefitted from the program. Plus, it’s easier for businesses to blame staff for poor self-management if they can demonstrate that the company has already offered stress-resilience classes.

And when programs prove effective, leading to a drop in employee stress and absenteeism, some critics fear that companies could use this as an opening to push employees harder and increase their workloads.

GETTING IT RIGHT

When done properly though, with a long-term evidence-based program, health and wellbeing programs appear to be beneficial.

For example, property and infrastructure group Lendlease’s comprehensive Health and Wellbeing Framework was introduced in 2014 and has helped boost employee engagement and has been correlated with reduced absenteeism.

After partnering with BUPA to undertake a health assessment of staff, Lendlease found that 84% of employees did not get an adequate nutritional intake, 59% were overweight, 56% did not undertake the recommended amount of physical exercise, and 9% were likely experiencing work-related stress, with 16% at high risk of developing depression.

To counter this, the company brought in a broad-level framework aimed at improving mental health, physical health, cultural health, and creating a healthier environment.

Geoff Dutaillis, Lendlease’s group head of sustainability, explains: “You can’t use this as a solution to other underlying issues – that’s not what it’s about. It’s about moving to a health system which is focused on prevention rather than cure, and that provides information at the point of choice for employees.

“It’s not Big Brother, it shouldn’t be overbearing. It’s also important that it’s not a top-down framework, but informed with bottom up initiatives – a freedom-within-boundaries’ approach.”

The company’s program includes free skin checks, flu vaccinations, subsidised Fitbits (movement trackers), fitness challenges, stress-resilience training (both at lunchtimes and as longer sessions), healthy food choices, and even offers employees three days of “wellbeing leave” a year to focus on physical and mental wellbeing.

Dutaillis notes the program has helped identify some serious health issues early. For example a UK-based subcontractor employee discovered he had a skin defect after attending a company skin check, while an Australian-based employee noticed her Fitbit was showing her resting heart rate was increasing week by week – something she followed up with her GP, who diagnosed an underlying condition.

Overall, since the framework has been implemented paid sick leave has dropped by 63% (although there is no direct proof that this is as a result of the framework), and employees have reported a 56% improvement on the provisions of health benefits and health management, a 43% improvement in senior leadership’s awareness of the need for support of employees, and a 54% improvement in healthy leadership.

The workplace health association’s Dr Lang says that in order to ensure that wellness programs are beneficial to staff, Lang says that businesses need to work with their employees to ascertain what areas the wellness program framework should address, have a rigorous evidence base, and have active support and participation by senior leadership, amongst other things.

To try and improve the quality of program delivery, the association has released best practice guidelines and a paper on how companies or providers can assess the value of their interventions and outcomes.

But when it comes down to it, the most important step to creating a healthy and happy workforce is establishing and maintaining trust – a concept some businesses are yet to learn.

*Name changed at source’s request