Employee Health and Wellbeing - whose responsibility is it? by Corporate Research Forum

research C O R P O R AT E R E S E A R C H F O R U M

November 2014

Employee Health and Wellbeing – whose responsibility is it?

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”Where does responsibility for employee health and wellbeing lie? Expectations on both sides are higher than ever. Employees expect their employer to back up the ‘people are our greatest asset‘ rhetoric with tangible actions, quality services and support. In return, employers expect their people to engage with wellbeing programmes and take responsibility for looking after their health as best they can.” Gillian Pillans, Report author.

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All rights reserved. Employee Health and Wellbeing â&#x20AC;&#x201C; whose responsibility is it? No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without prior permission in writing of the publisher. Corporate Research Forum One Heddon Street Mayfair London W1B 4BD United Kingdom ISBN: 978-0-9564488-7-3

research C O R P O R AT E R E S E A R C H F O R U M

November 2014

Employee Health and Wellbeing â&#x20AC;&#x201C; whose responsibility is it? Gillian Pillans

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CONTENTS

Contents Foreword

Acknowledgements

Executive Summary

1 What‘s the issue?

2 The business case for health and wellbeing

3 Implementing a health and wellbeing strategy – practical considerations 21 4 Building a ‘culture of health‘

5 Building resilience and energy

6 Conclusions and recommendations

7 References and further reading

8 Appendix

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FOREWORD

Foreword

Mr Nerio Alessandri Founder and President, Technogym S.p.A

When I founded Technogym over 30 years ago in Cesena, Italy, the ancient Roman saying “mens sana in corpore sano” – “a healthy mind in a healthy body” – formed my guiding vision for the development of the company into the world‘s leading wellness company. I strongly believe that the precondition for creativity and productivity is a healthy, welltrained body that is fit for purpose and fit for life. Wellness is essential to the success of any organisation, large or small. Companies worldwide are increasingly committing to programmes to promote wellness in the workplace, to protect their employees as a major asset for corporate development and growth. Against a backdrop of global concern over the epidemics of obesity and ill health, this report from Corporate Research Forum (CRF) could not come at a more opportune time. CRF found that while companies are directing more effort and resources on employee wellness programmes, they are also increasingly adopting a more holistic approach to defining the parameters: instead of simply conducting interventions to help sick people get better, they are focusing on a wider swathe of activities that include sickness prevention, building morale and performance and growing overall employee satisfaction. It is also not enough to carry out one or two disconnected activities. A commitment to employee wellness needs to be embedded within the corporate culture and a long-term strategy planned and implemented consistently in order to garner the best possible results. There is no one-size-fits-all strategy; each individual organisation is different, and its corporate wellness programme should reflect these differences. It is certainly encouraging to see this growing interest and commitment in employee health and wellbeing amongst organisations, and this report is a strong step towards guiding companies in the right direction. I applaud CRF for placing the spotlight on this very important issue, and look forward to the debate and discussion that arises as a result of its conclusions. Mr Nerio Alessandri Founder and President, Technogym S.p.A

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ACKNOWLEDGEMENTS

Acknowledgements The author would like to thank all the research participants, who generously gave their time and shared their insights. A full list of interviewees is provided in the Appendix. Thanks also to Jane Simms for editing the report. Gillian Pillans

CRF would like to thank Technogym for sponsoring this research, and for writing the Foreword.

About the author Gillian Pillans Gillian Pillans has worked as a senior HR practitioner and OD specialist for several organisations including Swiss Re, Vodafone and BAA. Prior to her HR career, she was a management consultant with Deloitte Consulting and is also a qualified solicitor. Gillian has written various CRF reports on subjects including HR strategy, organisation design and development, leadership development, coaching and diversity.

About CRF Founded in 1994, Corporate Research Forum (CRF) is a membership organisation whose international focus is on research, discussion and the practical application of contemporary topics arising from people management, learning and organisation development. CRF has become a highly influential focal point and network for over 150 members representing a cross-section of private and public sector organisations. • Its annual programme of research, events and publications fully reflects members‘ interests, in addition to the annual international conference. Side meetings and interest groups are also initiated to meet challenges that members might have. • Contributors are acknowledged experts in their field with a worldwide reputation as leaders and innovators in management thinking and practice. • Sharing and collaboration among members is a key feature of CRF‘s activities. We actively encourage networking at all events, and especially through member lunches and HR director dinners. • CRF is led and managed by highly-regarded former HR professionals who have a passion for delivering excellence in the leadership and development of organisations and people. CRF‘s goal is to be valued for excellence, rigour, relationship building and providing an independent view which, together, lead to measurable improvement in members‘ people and organisation performance. For more details on how your organisation can benefit from membership to CRF please contact Richard Hargreaves, Commercial Director, on +44 (0) 20 7470 7104 or at richard@crforum.co.uk. Alternatively, please visit our website at www.crforum.co.uk.

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EXECUTIVE SUMMARY

Executive Summary “For me, the view of the importance of health and wellbeing, particularly mental health, has changed within organisations over the last few years. There‘s a growing acceptance that it‘s a good thing to do, from both a business and a human point of view.” Catherine Kilfedder, Head of Wellbeing, BT

• Demographic change, particularly the ageing workforce, is likely to put greater pressure on employers in future.

Employee health and wellbeing – and the employer‘s role in helping employees adopt and sustain a healthy lifestyle, and return to health after illness – has become a hot topic over recent years. This report considers the current state of health and wellbeing at work, the actions employers are taking, and the business reasons for investing in health and wellbeing. Health is defined as ‘being free from illness or injury‘, whereas wellbeing is much broader, bringing together physical, mental, and social health into a broader concept of ‘life satisfaction‘. Current approaches to employee health and wellbeing are increasingly focused not just on helping ill staff get better but on proactive steps to prevent ill-health, educate employees and build resilience.

• Employers are filling gaps left by government‘s failure to offer preventative services. • They recognise that it‘s the right thing to do. It can be difficult to prove a financial return on investment in health and wellbeing, but we consider the body of evidence pointing to a positive impact on health outcomes, bottom-line measures and productivity. 5

Many organisations are thinking more strategically about health and wellbeing, viewing it as an essential feature of their employee value proposition, employer brand and how they engage with the community. We found many organisations in transition, either revisiting the programmes they offer or developing a more coherent strategy.

• In the UK alone, the direct cost of absence to employers is estimated at £17bn. • The estimated annual median cost of absence per employee is £595.

The factors behind employers‘ growing interest in this area include the following.

• Presenteeism – being at work but unable to work productively due to ill health – is also rising, increasing the burden of cost on employers.

• As economic conditions improve, organisations recognise that staff have taken the strain through the recession. • There is a growing body of evidence that investments in health and wellbeing are worthwhile. • Employees‘ expectations, especially those of new generations joining the workforce, are higher.

We investigate the current state of health and wellbeing. Life expectancy continues to rise and workplaces are generally much safer and healthier than 30 years ago. However, the incidence of ‘lifestyle‘ diseases such as cardio-vascular disease and diabetes is on the up. Mental health is also a major concern, being one of the top two reasons for absence from work.

The features of an effective health and wellbeing strategy include the following. • A clearly defined strategy, linked to business objectives and outcomes.

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EXECUTIVE SUMMARY

“Companies that are in the more advanced stages of health and wellness tend to have more effective workforce plans as well. They often integrate health and talent strategy – recognising that they are two sides of the same coin.” Wolfgang Seidl, Partner and Head of Health Management Consulting, Mercer

• A coherent set of evidence-based actions, rather than gimmicks or ‘random acts of wellness‘.

We consider why interest in ‘resilience‘ has grown of late and how organisations can develop it in the workforce. We also explore the growing popularity of mindfulness and positive psychology, and look at what sleep research tells us. We consider how organisations can apply these concepts to improve the wellbeing of their employees.

We conclude that ultimate responsibility for health and wellbeing lies with individuals themselves, but employers are playing a greater role in creating healthy environments, helping their people to make good lifestyle choices and providing support where it‘s needed.

• Activities reflect the specific demographic profile and health needs of the workforce. • A focus on prevention of disease, as well as support for those who fall ill. • Activities designed to support long-term lifestyle and behaviour change in unhealthy populations. • A robust approach to communications, so employees know what services are available and are encouraged to use them. • Proper evaluation of outcomes. Through exploring examples and case studies, we look at how various organisations have applied these principles in practice, and what specific actions they have taken. 7

We find that the best employers do not just spend money on high-quality health and wellbeing services; they also focus on developing a ‘culture of health‘, which is characterised by • senior leaders and line managers who are engaged in and committed to the health and wellbeing of their staff • a work environment that promotes good-quality work, gives people sufficient control over their work and builds a physical environment that‘s conducive to health • open, honest communications, particularly around ‘taboo‘ subjects such as mental health.

WHAT‘S THE ISSUE?

Topics covered

Introduction

1.1

Health and wellbeing – a concept whose time has come?

1.2

The state of health and wellbeing

1.3

The essential features of effective health and wellbeing programmes

1.4

Who‘s responsible – employer or employee?

In this chapter we introduce the key themes to be explored in this report. We consider how to define health and wellbeing, the current state of health, and how employers are responding.

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WHAT‘S THE ISSUE?

“Health and wellbeing have become more prominent than ever in the collective corporate, government and public consciousness.” Ben Moss, Managing Director, Robertson Cooper

1.1 Health and wellbeing – a concept whose time has come? Health and wellbeing is moving up the corporate agenda. Many of the organisations we interviewed for this research are either reviewing their strategy for health and wellbeing, or have recently done so. Wellbeing at work is not new: improving quality of life for employees and their families was a founding principle of some of the UK‘s longest-running businesses, including Unilever and Cadbury. However, it has become an increasingly important aspect of business performance in recent years. This research highlights a number of key trends. • Many organisations are thinking more strategically about health and wellbeing. • There is a greater focus on proactive approaches designed to predict and prevent illhealth, to educate people on how they can improve wellbeing, and to build mental and physical resilience. • There‘s a move away from viewing health as merely the absence of sickness, towards seeing it as the presence of vitality and energy. • Although spend is still largely focused on dealing with ill-health and absence, employers increasingly recognise that they can do things to stop individuals in low-risk health groups moving into higher-risk categories, thus avoiding future ill-health and associated costs. • Recognising that life outside work can profoundly affect productivity, organisations are now creating programmes that look at the ‘whole person‘, and seek to engage family members and communities. • There is still considerable reluctance to acknowledge the impact of mental health, but more organisations are now tackling the associated stigma, prompted in part by recent high-profile cases that have brought the issue into the open. • Organisations are building stronger links between wellbeing programmes, corporate social responsibility, and diversity and inclusion initiatives. • There‘s growing interest in mindfulness, neuroscience, compassion at work, and the effects of sleep on performance. What factors are driving this change in emphasis around health and wellbeing? • As we emerge from recession, organisations are acknowledging that their people have taken the strain, particularly in terms of their mental health. • A growing body of evidence points to a conclusion that investments in health and wellbeing can pay off. • Work is no longer 9 to 5, employers expect more of their staff and need to do more for their employees in return. • Employee expectations around company provision of health and wellbeing services are changing.

What do we mean by health and wellbeing? Health is defined as being ‘free from illness or injury‘. However, wellbeing is much broader, with many definitions incorporating a wider range of factors than just physical or mental health. The broadest definition is epitomised by the concept of ‘life satisfaction‘, which is used by the OECD to compare levels of wellbeing across different countries. Life satisfaction comprises three sets of factors. • Economic wellbeing – such as levels of income, education and work. • Social wellbeing – covering family and community life and the environment. • Personal wellbeing – including physical and mental health. Life satisfaction links strongly with the concept of ‘eudaimonic wellbeing‘, which describes the different mental attributes that contribute to psychological ‘flourishing‘, including a sense of meaning or purpose in life, control over one‘s destiny and positive relations with others. The emergence of the positive psychology movement, which we discuss further in chapter 5, has popularised this concept. Some commentators also identify a spiritual dimension to wellbeing. Wellbeing in the workplace is about more than managing the working environment to avoid causing harm to employees; it is about actively helping people to maximise their physical and mental health. The Business in the Community (BITC) Workwell campaign encapsulates this in its definition of wellbeing: “Wellbeing is comprised of the mutually supportive relationship between the physical, psychological and social health of the individual.”

• Modern medicine means the greatest threat to health is no longer communicable diseases, but chronic conditions that can be either avoided or managed. • Demographic change means there are growing numbers of older workers, who are more likely to suffer from chronic conditions. • Investors increasingly choose to back organisations with robust human capital policies. • Governments are increasingly interested in wellbeing and the impact of ill-health on populations. 11

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WHAT‘S THE ISSUE?

“We want our employees to be informed consumers of healthcare.” Kathy Lawrence, Wellbeing Co-ordinator, BP

Topics covered in this report In this report we explore • what we mean by health and wellbeing • the business case for investing in health and wellbeing • the connection between health and wellbeing, employee engagement, the employer brand and corporate social responsibility (CSR)

We find that employers are playing a greater role in educating their people about health, in providing wellbeing services and in encouraging healthy lifestyles – sometimes stepping into governments‘ shoes. There are a number of reasons for this. • Not only are healthier workers more productive, but also, helping employees live healthier lives enhances the employer brand and engagement because it sends a strong message about how organisations value their people. • As Western economies such as the UK shift away from manufacturing towards services and knowledge businesses, employees need to be in a good state of physical and mental health to give their best.

• the actions leading employers are taking in this area

• Employers are best placed to do something about health and wellbeing: the average person spends over one-third of their waking life at work, and changes to the physical and social environment at work can encourage and sustain behaviour change.

• the concept of a ‘culture of health‘ and how that can be developed

• Employers feel a growing sense of responsibility for helping their employees to cope with the psychological demands of work.

• the role leaders play in supporting the development of healthy workplaces.

• Many employers simply see it as the right thing to do.

1.2 The state of health and wellbeing Life expectancy in the West is at an all-time high and continues to rise (see figure below). The number of injuries at work has fallen by 70% since the Health and Safety at Work Act was introduced in 1974. The risk of death by communicable disease such as influenza has decreased dramatically over the past century, while advances in treatments for diseases such as cancer have also reduced death rates. In the UK, employment is currently close to its peak, and the proportion of disabled people in work is at an all-time high. However, the incidence of ‘lifestyle‘ diseases such as cardio-vascular disease and diabetes is increasing. Although we are living longer, many people will spend years at the end of their lives suffering from illnesses that may have been preventable. The figure below shows that, although UK life expectancy is now around 82 for women and 78 for men, ‘healthy‘ life expectancy is much shorter – 70 for women and 68 for men. Male and female life and healthy life expectancy at birth 85

FEMALE – life expectancy

Age

MALE – life expectancy

FEMALE – healthy life expectancy

65 60

MALE – healthy life expectancy

Year Source: Department of Work and Pensions, 2008

2005

2003

2001

1999

1997

1995

1993

1991

1989

1987

1985

1983

1981

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WHAT‘S THE ISSUE?

“Physical inactivity is one of the most important health problems of the 21st century.” Professor Steven N Blair, Department of Exercise Science, Arnold School of Public Health, University of South Carolina

The message that long life does not necessarily mean healthy life is reinforced by recent research by PruHealth Vitality. Of the 25,000 people it surveyed as part of the Britain‘s Healthiest Company initiative • 87% had a health age older than their actual age • 88% had at least one risk factor (such as nutrition, BMI or smoking) outside the recommended healthy range, while 13% had four or more • 19% reported at least one existing diagnosed lifestyle-related health condition such as heart disease or high blood pressure. What are the key health risks at work? Musculoskeletal complaints and mental illness are the main causes of absence at work. Analysis by Mercer of 375,000 UK incapacity claims in 2011 showed that mental illness has overtaken musculoskeletal problems as the main source of claims for long-term absence. • Towers Watson has found that one in three employees report that they are often affected by excessive pressure in their job. • Household surveys show that around 20% of the adult population in advanced countries will be diagnosed with mental illness – mostly clinical depression or anxiety disorders – at some point in their lives. Other health risks are also increasing. • An ageing workforce. According to the UN, by 2050, 22% of the world‘s population will be over 60 years of age, compared with 11% today. In addition to the potential health issues associated with older workers, these people will increasingly be called upon to care for elderly relatives. Bupa estimates that by 2032 there will be 2.9 workers for every pensioner, down from 3.3 in 2007. • Inactivity. One in four of the UK population is classed as physically inactive, which increases the risk of chronic illness such as heart disease and high blood pressure. Physical activity levels in the UK have declined by 20% over the past 50 years. A 2012 study published in The Lancet found that inactivity is responsible for 17% of premature deaths in the UK every year, and shortens lifespan by three to five years. Inactive people also spend 38% more days in hospital and visit the doctor more often than active people. It appears that prolonged periods of inactivity are bad, regardless of how much time people spend on high-intensity exercise at other times. Prolonged periods of sitting should be broken up with regular exercise breaks.

Absence and Presenteeism Levels of absence in the UK are lower today than they were 20 years ago. However, they have risen over the past two years, and the cost to employers is significant. • PricewaterhouseCoopers (PwC) found that in 2013 UK workers took an average of 9.1 days off sick per year, up from 8.7 two years earlier. This compared with 4.9 in the US and 2.2 in Asia Pacific. • The Chartered Institute of Personnel and Development (CIPD) estimates an annual median cost of absence of £595 per employee. • In 2011, the CBI estimated the direct cost to the UK economy of sickness absence to be over £17bn. • PwC estimates total annual costs of absence to UK businesses to be nearly £29bn. A rising concern is ‘presenteeism‘ – where employees come to work but are unproductive because they are unwell. The CIPD‘s 2013 Absence Management report found a significant increase, and some organisations estimate that presenteeism costs twice as much sickness absence. The Sainsbury Centre for Mental Health estimates that British industry loses £15.1bn a year to mental-health-related presenteeism alone. According to Bupa: “The full costs of ill-health to employers are poorly recognised as few employers measure the hidden or indirect costs of absence or the costs of presenteeism.”

• Obesity. People are getting fatter, not just in the West but also in emerging markets. Diseases that are linked to obesity – and that are therefore likely to become more prevalent – include cancer, heart disease, diabetes and strokes. • Smoking, alcohol and nutrition. According to Bupa, nearly one-third of the total burden of disease and disability in the UK is linked to lifestyle behaviours such as smoking, alcohol consumption and poor diet. This proportion is likely to increase in future. Bupa estimates that around 17 million people in the UK are living with a long-term health condition such as diabetes or arthritis, and expect this number to increase over coming decades.

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WHAT‘S THE ISSUE?

“Our approach used to be more like letting people walk off a cliff and then helping them recover when they hit the bottom. Now our aim is to help them avoid walking off in the first place.” John Lyday, Senior Vice-President, Human Resources, Bunzl Distribution

How are employers responding?

The overall health picture is not encouraging, and it has significant implications for employers.

Given the current state of health and likely future trends, employee health and wellbeing is clearly a significant business issue. We believe that employers need to take a strategic approach to health and wellbeing, one that responds to the specific needs of their own workforce and is aligned to their overall business objectives.

• More people working while in poor health.

We found that the best employers focus on developing a ‘culture of health‘ that not only supports individuals in being healthy, but also fosters an environment where positive attitudes to health and wellbeing are the norm. But our research also suggests that many employers have a long way to go – a finding backed up by the CIPD‘s 2013 Absence Management report, which found that only 41% of employers had a wellbeing strategy in place.

We found that the most effective approaches to employee health and wellbeing have a number of features in common.

However, Towers Watson has found that over two-thirds of UK employers plan to increase spending on health and wellbeing over the coming year. This is a welcome development. • Helping employees to adopt healthier lifestyles can help avoid or delay the onset of chronic health conditions, boosting productivity and reducing absence costs. • In spite of popular perceptions to the contrary, work is good for both physical and mental health. People in work are healthier, have higher self-esteem and enjoy a better quality of life than those who don‘t work. • When employees do become ill, a more proactive approach from employers is likely to pay off. Statistics show that employees who are absent for more than 20 weeks have a very low chance of returning to work. Early intervention is critical to avoid long-term absence. We explore the business case for investing in health and wellbeing in more depth in chapter 2.

• More employees with long-term conditions requiring ongoing treatment and management.

1.3 The essential features of effective health and wellbeing programmes

• A clearly articulated wellbeing strategy, linked to business objectives. • Leaders who are visibly engaged with the strategy, at multiple levels in the organisation. • Programme elements that are coherent, consistent and well-integrated. • Application of evidence-based practices, focus on measurable outcomes and avoidance of ‘gimmicks‘. • Distinction between health promotion – which can sometimes be cosmetic – and evidencebased wellbeing interventions. • Activities aligned to the demographic and health characteristics of the workforce. • Services easily accessible for those who most need them. • Spend focused on areas that can have the greatest impact. • Consistent with the organisation‘s culture and values. • A focus on preventing ill-health, enabling healthy employees to stay healthy, and early intervention when employees are ill. • Taking actions that support behaviour and lifestyle change, as well as building awareness and promoting good health • Good quality programmes, which recognise that change can require multiple interventions. • Good communications, so employees and line managers are aware of what‘s available and how they can access services they need. • Clear connection to the employee value proposition, so employees understand the purpose of the programme, and how it benefits them. • Proper evaluation of outcomes. Sadly, we find that few organisations have reached this level of sophistication, and many of the initiatives in place are failing to have the impact that employers hoped for. Again, this finding is backed up by a 2014 study by Towers Watson, in which only 17% of employees reported that they had adopted a healthier lifestyle as a result of employer wellbeing activities. The study concluded: “Employers therefore need to start thinking about strategy: either the programmes in place are not the right ones, or they are not communicated well, or they are not as engaging as they could be.” Similarly, a survey by HR Magazine in July 2014 found that while 47% of respondents run several health initiatives in their organisations, only 17% have implemented a comprehensive health and wellbeing strategy linked to the success of the business.

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WHAT‘S THE ISSUE?

“Although it‘s ultimately the individual who‘s responsible, we are seeing a shift towards the employer influencing people to change their own behaviour.” Research participant, Global Financial Services Organisation

1.4

Mental health

Who‘s responsible – employer or employee? Given the greater interest employers are showing in employee health and wellbeing, does this mean responsibility is shifting away from individuals towards their employer? Not necessarily. • It is becoming more acceptable for employers to take an active interest in the health of their employees, although there are concerns around privacy and free choice. • Employers‘ intentions have changed: they have moved away from seeing health initiatives as ‘keeping us out of jail‘ towards a genuine care for employees‘ welfare. • In many cases, employers are stepping in where, in the past, governments might have taken action to promote good health. Lawyers at legal firm Bird & Bird have also noticed that employers are taking greater responsibility for the physical and emotional needs of their employees. Clearly employers have to comply with all relevant employment laws. But what does this mean for the employer‘s duty of care in relation to avoiding physical or mental illness as a result of workplace pressure? Ian Hunter, Partner at Bird & Bird, comments: “The legal threshold that must be met to trigger a duty to take steps to prevent illness in the workplace, namely that indications of impending harm to health arising from stress at work must be plain enough for employers to realise they should do something about it, is quite high. In spite of this, consideration of these issues in some circumstances may have to go beyond employers‘ immediate legal duties towards employee health and safety, to ensure that poor wellbeing does not lead to mental or physical illness later.”

On the one hand, employers no longer take a ‘paternalistic‘ view, typified by the Lever Brothers‘ Port Sunlight and Cadbury‘s Bourneville employee villages. But on the other hand employers are generally less laissez-faire about employee health than they have been in the past. Somewhere in the middle, it‘s becoming more of a partnership, where employers provide information, services and support, but expect employees to take responsibility for their own wellbeing.

In summary, although ultimate responsibility for health and wellbeing lies with individuals themselves, organisations have a significant vested interest in creating an environment that supports wellbeing and in providing information and services to help employees maintain good health.

Mental health is one of the top two causes of absence in the UK and other industrialised countries. Despite its impact on productivity, there is a ‘culture of silence‘ around mental health in much of the corporate world, even though the majority of mental health problems are caused by factors outside work. A 2014 survey by Friends Life found • 40% of UK employees had experienced stress, anxiety or depression and not told their employer • over 50% felt being open about a common mental health problem would damage their career prospects • more than one-quarter had said a sick day was for a physical problem when it was actually due to a mental health issue. Friends Life is spearheading a campaign to make mental health a boardroom issue. The insurer ran an event for senior executives in October 2014, chaired by the company‘s Group CEO, to discuss their experience of dealing with poor mental health at work. Friends Life is also looking to set an example for transparency, by publishing its own Employee Assistance Programme (EAP) and absence data related to mental health, along with numbers of grievances, as part of its Corporate Responsibility (CR) reporting. Attitudes appear to be slowly shifting. • High-profile cases, such as that of António Horta-Osório, who was treated at the Priory rehabilitation clinic for ‘exhaustion‘ shortly after being appointed Group CEO of Lloyds Banking Group, show that it is possible to admit to vulnerability and return to work after treatment. • Recent deaths of young City workers have prompted some banks and law firms in particular to examine their role in creating the high-pressure, long-hours culture that contributes to stress and other mental health conditions. • A consortium of large City employers recently set up the City Mental Health Alliance, which aims to increase mental health literacy, create a culture of openness, and help employers to take practical steps to avoid ‘toxic‘ work environments.

THE BUSINESS CASE FOR HEALTH AND WELLBEING

Topics covered

Introduction

2.1

Return on investment in health and wellbeing

2.2

Wellbeing and employee engagement

This chapter considers the business case for investing in health and wellbeing. We discuss the difficulties of measuring return on investment, and explore both financial and non-financial outcomes, including enhancing the employer brand and employee engagement.

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THE BUSINESS CASE FOR HEALTH AND WELLBEING

“The best employers don‘t pontificate on the business case and ROI – they just get on with it, and use the money they would have spent on this to offer better wellbeing services.” Patrick Watt, Corporate Director, Bupa

2.1

Evidence of return on investment in health and wellbeing

Return on investment in health and wellbeing What is the evidence that employee health and wellbeing is good for the bottom line? As with any people-related intervention, it is extremely difficult to find an unequivocal answer. There is no standard measure, so different studies measure different factors, and outcomes are also highly variable. Most evidence of positive returns on investment (ROI) comes from the US, which has a unique healthcare model. US employers fund employee healthcare costs directly, either through insurance or self-funding (there is no state-funded healthcare for employees). US employers therefore have a greater incentive to reduce healthcare costs, as they make up a significant portion of employment costs, and any improvement in health outcomes has a positive impact on the bottom line.

In spite of these caveats, there appears to be evidence of a positive correlation between investments in health and wellbeing and financial results. See the column. The University of Michigan Health Management Research Center (HMRC) has analysed the relationship between the results of individual health assessments and healthcare costs. The chart below shows an inverse relationship between wellness scores and health costs – the higher the wellness score, the lower the healthcare costs. Relationship between annual medical and pharmacy costs and wellness score Annual Medical Costs

One Point in Wellness Score Equals $56

$2,817 $2,700 $2,508

$2,369

$2,200

$2,087 $1,800

$1,700

$1,643 $1,415

$1,200 65

Wellness Score Source: Edington, 2009

HMRC also found that participation in health promotion programmes can lead to reductions in healthcare costs. Employees who took one or no health risk assessment over a ten-year period saw their average healthcare costs rise by 12.6%, whereas the increase for those who completed at least two health risk assessments over the same period was only 4.2%.

• Research by Berry, Mirabito and Baun, reported in Harvard Business Review in 2010, suggests the ROI of comprehensive wellrun wellbeing programmes can be as high as six to one. • The healthcare company Johnson & Johnson has been running one of the most sophisticated programmes we encountered, for over 30 years. An evaluation spanning 2002 to 2008 found that, although medical expenditure grew by 1% over the period, this was 3.7 percentage points lower than equivalent large organisations. The ROI was estimated to be between $1.88 and $3.92 for every $1 invested. • A 2012 meta-analysis of 42 studies by Chapman et al (cited in Goetzel et al; see References) found that participants in workplace health programmes incurred 25% lower absence and medical costs. • Research by PwC, commissioned as part of Dame Carol Black‘s 2008 review of UK workforce health, found a positive impact on both the bottom line and on ‘intermediate‘ factors such as sickness absence, staff turnover, accidents and injuries, employee satisfaction, productivity and company profile. • Some studies differentiate between the impact of disease management (which treats illness) and health/lifestyle management (which promotes healthy living). It appears to be more difficult to prove positive ROI for lifestyle management than for disease management. For example, research by RAND in the US (cited in Goetzel et al), found that the disease management programme at a large consumer goods company achieved a return of 3.6 to 1, but the wellness programme broke even at best. • There is evidence, however, that employers benefit from investments in health management. Aggregated US data show that US employers with proactive health management programmes have, on average, lower increases in healthcare costs than comparator organisations. But the evidence on whether lifestyle management programmes return more than they cost on purely financial measures is so far inconclusive.

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THE BUSINESS CASE FOR HEALTH AND WELLBEING

“We now know that instituting environmental changes that encourage healthy behaviours works on both sides of the economic equation … [lower spend] on healthcare costs on one side … increased healthrelated productivity on the other.” Dee Edington, University of Michigan Health Management Research Center

Links to productivity There is evidence that healthier employees are more productive, although this is difficult to quantify. • Research by Harvard Medical School suggests the healthiest 25% of the workforce is 18% more productive than the least healthy quartile. • A 2005 study of 16,000 employees across 15 organisations by Donald et al found that “higher employee productivity was associated with … better … psychological wellbeing.” • Employees who have a medium-to-high risk of disease as a result of lifestyle behaviours (smoking, obesity, lack of exercise), can be 6-12% less productive than those with low health risks. • Employees who improve their health risk status, for example by reducing their body mass index or blood pressure, experience a measurable improvement in work productivity. The New Economics Foundation‘s 2014 study of the literature relating to the impact of wellbeing at work, Well-being at Work, concluded: “The evidence shows that people who achieve good standards of well-being at work are more likely to be creative, more loyal, more productive, and provide better customer satisfaction.”

Annual cost increase associated with programme involvement 250% 200%

.6% = 12 ease r c n I al Annu

150%

= 4.2% Annual Increase

100% 50%

0 or 1 HRA (N=804) 1 or more HRAs (N=522)

0% 0

Programming Year Source: Edington, 2009

HMRC found similar results for absence. Non-participants in a wellness programme took up to 50% more sick days than participants.

Yearly average disability absence days by participation 23.3

25 21.2 20

Participant 17.6

Nonparticipant

12 14.1

8.8

15.7

17.2

10 6.6 8.7 5

The average annual increase in absence days (1995-2000) Participants: 2.4 Nonparticipants: 3.6

6.9

0 95 Pre-programme

Programme Years

Source: Edington, 2009

In practice, we found few organisations make significant efforts to measure ROI systematically. • Towers Watson has found little investment in quantifying the ROI associated with health and wellbeing programmes, or in linking these to worker effectiveness. • The CBI estimates only 25% of UK businesses even calculate their cost of absence.

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THE BUSINESS CASE FOR HEALTH AND WELLBEING

“About the best we can say in terms of evidence that health and wellbeing leads to happier, more productive employees is that, in some jobs, some of the time, there‘s probably a link.” Rob Briner, Professor of Organisational Psychology, Bath University School of Management

Many employers seem to prefer to invest money they might otherwise spend on measuring ROI, in wellbeing programmes themselves. They either take it on faith that such investments work, or rely on ‘normative‘ data gathered by public bodies and consultancies to provide a generic business case. Workplace wellbeing and resilience specialist Robertson Cooper finds: “The weight of research, both academic and practitioner led, means proving ROI is no longer the major barrier to action that it once was. While it is still important to make efforts to prove the impact inside your organisation, the sheer volume of evidence is starting to change the hearts and minds of decision-makers anyway.” For many organisations, the benefits are broader than simply financial. • Improved employee health and wellbeing can be a virtuous circle, leading to higher productivity and engagement, which in turn leads to better health and a greater sense of wellbeing. • Wellbeing links to a strong employer brand, a positive image in terms of corporate social responsibility, better employee attraction and retention, and a more highlyengaged workforce. HR professionals looking to convince senior management of the benefits of investing in health and wellbeing need to be prepared to discuss both tangible and intangible benefits. Anna Daniels, Managing Director of Daniels Fitness Group, thinks that sometimes senior executives use difficult questions on ROI as a barrier, because they fundamentally don‘t believe in the benefits of wellbeing at work. “You need to think about what their drivers are and what might convince them to think differently,” she advises.

How long to see a return on investment? Employers need to be patient and persistent, as it can take many years for investments in health and wellbeing to bear fruit. The experts we consulted for this research estimated that payback doesn‘t come for three to five years. “Most positive ROI results are reported only after a programme has been in place for three or more years.” (Goetzel et al) Distribution and outsourcing company Bunzl has built a sophisticated health and wellbeing plan in its North American business. The effort is now paying off, after eight years of putting in place a series of interconnected measures. Increases in Bunzl‘s healthcare costs have been significantly below industry comparators (3-4% against 7-10%), and last year the company was even able to return some contributions to employees. Large global organisations such as BP and Johnson & Johnson plan their wellbeing activities on a three-to-five-year planning cycle, recognising that they won‘t see results for a number of years.

In chapter 3, we look in more detail at how to evaluate the effectiveness of health and wellbeing programmes, in spite of the difficulties in proving ROI.

2.2 Wellbeing and employee engagement Employee engagement has become a major concern for employers, and growing numbers are seeking to understand the connection between engagement and wellbeing. Engage for Success‘s definition of engagement recognises the link between engagement and wellbeing, describing it as: “a workplace approach designed to ensure that employees are committed to their organisation‘s goals and values, motivated to contribute to organisational success, and are able at the same time to enhance their own sense of wellbeing.” So what is the evidence that wellbeing and engagement are connected? David MacLeod and Nita Clarke, co-chairs of the Engage for Success movement, have found the following. • Engaged employees enjoy better physical health than their less engaged colleagues, reporting higher levels of exercise and healthy eating and lower incidence of chronic health problems such as high blood pressure and diabetes. • Absence levels in organisations with highly-engaged staff are on average half those reported in low-engagement companies. • Organisations in the bottom quartile of engagement have, on average, 62% more accidents than those in the top quartile.

Corporate social responsibility A number of the organisations we interviewed link policies on health and wellbeing to their overall approach to CSR. For example, the BITC Workwell campaign has a mental health champions group, which encourages companies to sign up to the ‘Time to Change‘ pledge, to end discrimination against mental health in the workplace. An organisation‘s approach to CSR can be a source of pride for employees and can help develop meaning at work, particularly for those who work in mundane, repetitive jobs. Volunteering can also help improve wellbeing. Friends Life has developed a number of ‘strategic partnerships‘ with charities such as Macmillan Cancer Support, which provide opportunities for employees to ‘give something back‘.

• Engagement is associated with higher levels of psychological wellbeing: reported levels of job-related stress are lower in high-engagement than low-engagement companies. 19

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CORPORATE RESEARCH FORUM

THE BUSINESS CASE FOR HEALTH AND WELLBEING

“There is a compelling argument for organisations to be more explicit about the links between their CSR agendas and their wellbeing and engagement strategies as this not only helps them deliver their CSR agenda, but is also a driver of employee engagement and motivation.” David MacLeod and Nita Clarke, joint chairs, Engage for Success Impact on the employer brand

• Low engagement has been linked to increased absenteeism and presenteeism, and lower levels of performance and productivity.

A clearly articulated wellbeing strategy can be a key differentiator in the ‘war for talent‘. Our research suggests employees and potential recruits are placing greater emphasis on employment practices and policies – including health and wellbeing – when deciding whether to join and stay with an organisation. For many employers, a sophisticated wellbeing offering is fundamental to their desire to be an ‘employer of choice‘, and is a crucial element of strategies to retain key employees.

However, although engagement and wellbeing may be connected, it is not clear that there is a causal link. Does wellbeing lead to engagement, is it the other way round, or is it just coincidence?

• Websites such as Glassdoor allow employees to rate an employer on a wide range of criteria. This makes the real-life experience of employees – as opposed to corporate rhetoric – highly visible, and employers can‘t ‘edit‘ comments they don‘t like. • A leading sports brand and client of Dr Dorian Dugmore, CEO of the Wellness Academy, has found that people return, having worked elsewhere, because the quality of the wellbeing programme on offer sends a strong message that the organisation cares about employees. • Discovery Communications has found that winning a ‘Britain‘s Healthiest Company‘ award has enhanced its employee brand with the people it is seeking to attract. The quality of health and wellbeing offerings seems particularly important to the muchdiscussed Generation Y and Millennials now entering the workforce, who are motivated by employment policies such as flexible working, value good quality healthcare provision, and are also interested in opportunities to participate in philanthropic projects.

Rob Briner, Professor of Organisational Psychology at Bath University School of Management, cautions that there is little hard evidence of links between engagement, wellbeing and work performance. Part of the problem is a lack of definition: general descriptions of ‘happiness‘ or ‘satisfaction‘ tend to unravel when attempts are made to specify exactly which aspects of health or wellbeing make a difference. He finds that many employers get tied up in writing what can be a fairly unconvincing business case, because they don‘t clearly understand what problem they need to fix and have little evidence that their proposed solution will deliver what they hope. He concludes: “For many employers, the case for action is more of an ethical than a business case. If employers believe it‘s the right thing to do, they should go ahead, and not worry too much about the business case.”

IMPLEMENTING A HEALTH AND WELLBEING STRATEGY â&#x20AC;&#x201C; PRACTICAL CONSIDERATIONS

Topics covered

Introduction

3.1

Take a strategic approach

3.2

Set targets

3.3

Decide what to do

3.4

Encourage behaviour change

3.5

Rethink the physical environment

3.6

Provide early intervention and support when people become ill

3.7

Communicate well and continuously

3.8

Evaluate your health and wellbeing activities

In this chapter we consider the steps organisations can take to implement a health and wellbeing strategy. We review the different options available, and highlight examples of what organisations are doing in practice.

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IMPLEMENTING A HEALTH AND WELLBEING STRATEGY – PRACTICAL CONSIDERATIONS

“You need to make sure that everything you do is aligned with your strategy for health and wellbeing. Otherwise it‘s easy to go down blind alleys and waste money and effort.” Catherine Kilfedder, Head of Wellbeing, BT

Establish the baseline

3.1 Take a strategic approach

Whether your organisation already has a number of health and wellbeing initiatives in place, or you‘re starting from scratch, you have to understand the current state of health within the organisation before deciding which specific actions to take. This helps • work out your priority actions • set objectives and targets, including business goals such as absenteeism, productivity and customer satisfaction

Throughout this report we emphasise the importance of taking a strategic approach to health and wellbeing, focused on preventing illness through promoting healthier lifestyles and actively supporting those who are sick. Developing a more strategic approach means • linking the health and wellbeing plan to business strategy and corporate goals and objectives • building a portfolio of interconnected health interventions • tailoring the strategy to the health profile of the workforce

• form a basis for evaluation (discussed further in 3.8 below).

• engaging whole populations of employees and their families – not just individuals

This may involve

• making sure wellbeing activities tie in with the organisation‘s values, culture and norms.

• reviewing existing data such as absence figures, statistics on the use of private health and income protection insurance, and Employee Assistance Programme (EAP) data. • making comparisons with industry benchmarks

If your business strategy envisages significant growth, you may need to focus on how you can help employees handle stress and build resilience. If you are planning major change, you may need to think about beefing up your EAP provision and helping line managers to identify early signs of sickness among their staff.

• looking at employee demographic data to understand key risk factors • gathering the views of the senior management team and employees through focus groups • reviewing responses to employee surveys or conducting specific wellbeing polls. Dr Dorian Dugmore advises his clients to begin with a health audit, covering 12 key aspects of wellbeing including exercise, nutrition, sleep, hydration and cardiac risk. This audit will often flag up differences between the views of the senior leadership team and employees as to what they think is important and what is likely to work. Dugmore recommends playing back what employees are saying to the senior team, because if there‘s a disconnect, simply imposing what the senior team thinks will work is unlikely to succeed.

Segmenting the employee population may flag up a need for significantly different solutions to the health issues of different employee groups. For example, British Airways‘ two key populations – ground staff and airline crew – have completely different needs. For staff members who fly, issues such as being away from family, managing life in different time zones and nutrition are the most significant concerns. For ground staff, musculoskeletal conditions, shift working and diabetes are bigger issues. Dr Dorian Dugmore, CEO of the Wellness Academy, who advises organisations on developing wellbeing strategies, advocates taking a top-down and a bottom-up approach to strategy, combining strong senior management support with grass-roots champions. “It‘s important to get the top team to define direction and visibly champion the strategy, but if you don‘t take account of what‘s important to employees, your strategy won‘t succeed,” he warns. Bunzl, for example, has a cross-functional wellness and healthcare committee of senior managers in its North American business. The committee decides what the focus of the wellbeing plan will be each year. BITC Workwell model Several of the companies we talked to have built their wellbeing strategy using the Business in the Community (BITC) Workwell model, which provides a framework for thinking about what actions to take around health and wellbeing (see figure on page 26). According to BITC Workwell: “The model outlines actions that employers can take to provide a context for their people to flourish.” The model focuses on five ‘ways to wellness‘ that can contribute to employees‘ emotional and personal resilience.

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“We believe that individual freedom is a hugely important part of wellbeing. There are occasions when individuals make choices they later regret, [with] a possible consequence that the State has to step in. A much better outcome is to ‘nudge‘ individuals to [make the right choices].” O‘Donnell et al

BITC Workwell Model

‘Nudge‘ – lessons from behavioural economics

EARNING

BETTER PHYSICAL & PSYCHOLOGICAL HEALTH

Create an environment that promotes healthy behaviours

OT IC

ION

BETTER WORK™

Create a happy and engaging work environment

WORKING WELL BETTER RELATIONSHIPS Promote communications and social connections

Provide interventions to manage health and wellbeing

EN TAK ETE

BETT

BETTER SPECIALIST SUPPORT

TT EN DA NCE

BE ACTIVE

BETTER BR

L EP

“We want our approach to be more about nudging than nannying.” Research participant, UK Financial Services Organisation

CT NE

AN DI

E AG

HER PRODUCTIVI HIG TY

GEMENT NG A RE OTHERS TE WITH ET

An integrated strategic approach

TE N U GIVE / VOL RA TE

ECRUIT ENT M

BET

Business Benefits Employee actions recommended by Foresight Mental Capital Reports Employer actions recommended by BITC

3.2 Set targets As well as establishing the baseline, it‘s important to be clear about the aims and objectives of the wellbeing plan.

Behavioural economics has enjoyed a high profile in the field of health and wellbeing over recent years. Understanding how people can be encouraged – rather than coerced or bribed – to make healthy choices has been a key focus. The concept of the ‘nudge‘ – rearranging the context in which people make decisions to steer them towards better choices – has been applied in many settings, including encouraging people to pay taxes on time or take prescription medicines. In their book Nudge, Thaler and Sunstein describe how ‘nudges‘ were successfully deployed to increase the consumption of healthy foods in a school cafeteria by 25%. Other potential nudges include placing the bins at one end of the office to encourage people to get up and walk around, selling junk food in smaller packets to reduce consumption, and changing the lift signage to encourage people to use the stairs. Thaler and Sunstein have faced criticism that nudging is paternalistic. They argue that nudge theory accepts that people will not always choose what is in their long-term interests, but the ‘nudge‘ approach is non-coercive rather than paternalistic. “By properly deploying both incentives and nudges, we can improve our ability to improve people‘s lives, and help solve many of society‘s major problems. And we can do so while still insisting on everyone‘s freedom to choose.”

• As we‘ve already noted, research shows that programmes rarely deliver their full benefit in the first year, and can take three to five years to make a difference. It is therefore important to consider multi-year targets. Johnson & Johnson, whose health and wellbeing programme has been running for more than 30 years, breaks the programme down into five-year periods, with targets also covering five years, and a detailed evaluation at the end of each five-year period. Targets need to focus on measurable outcomes, such as improvements in health assessment scores and participation rates, or a reduction in absence. • There is a considerable body of evidence around the types of health interventions most likely to work. It‘s important to target these interventions, to ensure that money is well spent.

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IMPLEMENTING A HEALTH AND WELLBEING STRATEGY – PRACTICAL CONSIDERATIONS

“Waiting for people to get sick, and then working to make them better, is a failed health strategy. That approach is like waiting for manufacturing defects to occur and then trying to fix them.” Dee Edington, University of Michigan Health Management Research Center

Case Notes – BT

3.3 Decide what to do

BT has had comprehensive health and wellbeing programmes in place for many years. However, the focus has changed. Initially safety was the main target. This has shifted through physical health and stress management, and today there‘s a more holistic focus on building resilience, particularly mental resilience. The roles of employer and employee in health and wellbeing management have evolved too. Catherine Kilfedder, Head of Wellbeing, says there‘s been a shift away from depending on the employer to advise employees what to do, towards a more ‘interdependent‘ mindset. Individuals are encouraged to take responsibility for their own wellbeing and make good choices to look after themselves, within a framework where the organisation helps them to do this.

Employers can choose between a huge variety of interventions, providers and delivery options. Throughout this chapter we highlight some of the programmes in place in organisations we interviewed for this research, while the figure below demonstrates the most commonlyoffered employee benefits in the UK.

Employee benefits that the organisation where you work currently offers Pension schemes

76%

Flexible working

68%

Private medical insurance

50%

BT‘s strategy for health and wellbeing distinguishes between three levels of intervention.

Life insurance

47%

Staff discounts

46%

• The primary level focuses on health promotion and prevention activities.

Cycle scheme

42%

Health promotion initiatives

38%

• The secondary level provides for early detection of health problems and intervention to stop them becoming more serious. • The tertiary level offers support and services to deal with ongoing health conditions. The company has developed a portfolio of services covering each level. Kilfedder says that the proportion of effort the company spends in each of these has shifted towards the primary and secondary levels, and the longer term aspiration is that effort would be split 60% primary, 30% secondary and 10% tertiary.

Company car

36%

Occupational health service

35%

Employee assistance programme

30%

Season ticket

26%

Income protection

13%

Workplace nursery

Other

None of these

3% Source: Management Today

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IMPLEMENTING A HEALTH AND WELLBEING STRATEGY – PRACTICAL CONSIDERATIONS

“An investment strategy of maintaining good health avoids the otherwise ‘natural‘ progression of a significant proportion of the employee population from low-health-risk to medium- and high-risk groups, which incur high treatment costs and show reduced productivity through sickness absence and presenteeism.” Wolfgang Seidl, Partner and Head of Health Management Consulting, Mercer We suggest keeping some key principles in mind. Maintain a strong focus on prevention. It is important to meet the needs of the 5-25% who are sick, which may take up the greater proportion of spend, but you also need to consider the needs of the 75-95% who are currently ‘well‘, to help them maintain good health. Budget should be allocated to both populations. Evidence suggests it may be more cost-effective to prevent serious conditions developing than to treat them once they become advanced. Don‘t do things in ‘ones‘. Single-issue campaigns – for example, running ‘No Smoking Week‘ once a year but doing nothing else – may tick a box but rarely lead to significant behaviour change. There needs to be a rolling campaign of events, activities, promotions and so on, which underpins the programme targets and reinforces key health messages. Adopt a blend of wellness and health promotion activities. We distinguish between ‘wellness‘ programmes, which are ongoing integrated programmes with targets and measurement, personalised to individual needs, and ‘health promotion‘, which involves more generic communications and education. Many organisations start with health promotion and develop wellness activities as they become more sophisticated. We found that the most effective programmes combine aspects of both. Health promotion is often easier to do, but unless it‘s focused and well-designed, it is not necessarily effective. For example, ‘brown bag‘ lunches, where an expert such as a nutritionist presents on health topics, are very popular. But are the people who attend those who most need to hear the messages?

Who‘s the target audience? Organisations need to ensure that the programmes they implement appeal to the employee groups that most need support. People earning between £10,000 and £29,000 per annum are the most likely to suffer ill health, but many of the programmes in place appeal to higher-earning and often more highly-educated staff, who understand the need to eat healthily and can more easily afford to do so. Companies need to think of ways to appeal to less advantaged groups – like subsidising healthy food in the canteen, for example. “Most wellbeing programmes and work-life balance initiatives are aimed at middle-class, white-collar workers. The people who most need this – the low paid – are not necessarily those who get most attention.” Rob Briner, Professor of Organisational Psychology at Bath University School of Management

Ensure actions support behaviour and lifestyle change. Health promotion can raise awareness, but sustaining behaviour change requires co-ordination, repeat messages and follow-up. Health-risk assessments – questionnaires employees complete to determine their current state of health – have become very popular, and they are a good way of making people aware of their key health risks. But regular follow-up and repeat tests, ideally every year, are important to sustain interest over the long term (see the PepsiCo case study below). Policies and practices may need to be updated. This can be as simple as painting a stairwell to encourage people to walk upstairs. Swiss Re, the global reinsurer, encourages its people to choose options for client and team-building events that do not revolve around drinking alcohol. Bunzl‘s North American business always schedules some sort of wellbeing or fitness activity at company away-days and sales conferences. Offer a variety of delivery options. Health and wellbeing programmes need to reflect the different ways that people are likely to engage. For some, a mobile app might be the best answer. PepsiCo brought health kiosks into UK factories to make it easy for people to measure their key health metrics. Some programmes involve mass participation – involving large numbers of staff in physical activity challenges, for example. Invest in good quality programmes. Bring in experts with a track record in delivering the outcomes you are looking to achieve: cutting corners is unlikely to pay off. For behaviour change to stick, you have to invest in regular events over a long enough time period to develop good habits. For example, Standard Life has introduced free Allen Carr smoking cessation classes, and over half those who attended have given up in the longer-term.

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“For us, the biggest impact has been around bringing people together across departments and levels, getting to know each other through participating in sport together.” Christian Hug, Director, LifeWorks & Inclusion, Discovery Communications

Case Study – PepsiCo UK & Ireland The global drinks and snacks business employs around 5,000 people in the UK, spread across 13 UK sites – from Walkers Crisps in Leicester, to Copella apple juice in Boxford and Quaker oats in Cupar. Roles include Research & Development, Logistics, Manufacturing, Marketing, Sales, HR and Finance. In 2010, the company launched a long-term plan to improve the wellbeing of its UK workforce. There were a number of internal and external business drivers, which included • Increasing absence levels (driven by long-term absence). • Staff were often recruited from areas of poor health. • A stable but ageing workforce. A major element of the wellbeing programme was health screening for all factory-based operations staff. Each employee took 15 minutes off-shift for tests, administered by nursing technicians, to measure key biometric markers such as blood pressure, BMI and body fat content. In the first year, 95% of frontline staff took part in the screening. • A sizeable proportion of employees had at least one measurement outside the 'safe' range for factors such as weight, blood pressure, BMI or body fat. • Some also achieved scores that required immediate referral to their GP. The company has since run annual follow-up screening. This is now done by mobile kiosks, which are moved around sites on an annual cycle. They measure the same factors as nurse-led assessments, but at around one-third of the cost. Individual and aggregated test results are compared to government and third party-recommended levels. In the second and subsequent years of testing, participation levels have remained steadily high at around 65%. • The primary purpose of PepsiCo’s programme was to build awareness through helping employees ‘know their numbers’. However, the company has introduced a number of other initiatives to help its employees live healthier lives. The ‘PepsiCo Challenge’ was launched in 2011 with the aim of getting at least 25% of employees doing regular exercise. Around 1,000 employees take part, forming teams of four over the annual 12-week campaign. The company gives participants pedometers to measure their activity levels and teams work together to increase their activity. • Improving availability and labelling of healthy food in the canteen. The company’s philosophy is to make it easier and more attractive for people to make good choices. • Weight Management campaigns to support weight loss. • Subsidised gym membership. The company has found that charging a nominal amount led to higher usage than making it free, and usage increased even further when all charges were refunded above a certain usage level. For PepsiCo, the benefits of investing in this programme include the following. • Financial – reduced absence and health-related costs such as ill-health early retirement and death-in-service; improved retention. • The internal approach is consistent with broader business strategy, including positioning on public health policy. • Improved engagement of current and future employees. Matt Freeland, Senior HR Director, Europe Snacks SC & Labour Relations, PepsiCo, summarised the key lessons he has learned from PepsiCo’s experience. • Make data collection a participation event. PepsiCo achieved such a high level of participation in health screening by running marketing and education activities in advance of the programme and encouraging employees to participate together in teams. • Don‘t underestimate how long it takes to form new habits. The annual 12-week PepsiCo Challenge is longer than similar activities run by other organisations in recognition of the time it takes for exercise to become a habit. • External awards and recognition build engagement. PepsiCo‘s programme has won a number of wellbeing awards, which help to build credibility with employees and reinforce key health messages. • It‘s impossible to know when someone is ready to make a lifestyle change. It‘s therefore important to have the right support in place, with infrastructure readily available. For example, when someone decides to stop smoking, they should have immediate access to occupational health and smoking cessation programmes.

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“The really forward-thinking employers get all their suppliers together in one room to talk about the issues, so everyone can agree how we get the best care to employees.” Neil Southam, Head of Operations, Friends Life Group Protection

3.4

Engage vendors

Encourage behaviour change We return repeatedly in this report to the theme that employees are more likely to enjoy good health if they adopt a healthy lifestyle, characterised by good nutrition and hydration, effective stress management, quality sleep, regular physical exercise and maintaining a healthy weight. For many people, adopting and sustaining such a healthy lifestyle requires significant behaviour change. We discuss above the types of health promotion and wellness activities organisations can deploy, but what other actions can they take to help employees sustain healthy behaviours? Make it fun, social and competitive. One of the most popular activities is mass exercise programmes or workplace challenges, open to anyone in the organisation. Most of these are based on walking a certain number of steps (often measured by pedometers or accelerometers, which companies provide free to participants). Many of these programmes employ two highly engaging elements – competition and social engagement with peers. Swiss Re‘s programme has even involved clients. Some organisations are not prescriptive about the activity involved. BP‘s ‘Run A Muck‘ challenge runs for four weeks every year and encourages people to take part in any activity that raises the heart rate. Some employees attend Zumba classes or play football, for example. Friends Life has established a ‘Bike Buddy‘ scheme to team up less confident riders with more experienced colleagues. Discovery Communications has set up a volleyball tournament with other media companies. Mercer recently ran its second annual ‘Teamwork Challenge‘, where employees visit Center Parcs for the weekend and participate in various sports activities. Approximately 20% of the UK workforce took part – a high participation rate for such an event. Many organisations we interviewed also take part in the Global Corporate Challenge (GCC), a workplace health and engagement programme that improves the performance of employees around the world.

Activity programmes and competitions appear to be effective in encouraging people to do some form of exercise for a period of time. But organisations also have to think about how to sustain activity levels once the challenge has ended. “Competitions and the like have a limited life. People tire of them. The only way you can get people to be more active is if it becomes part of their everyday lifestyle,” says Dean Hovey, CEO of Digifit, a digital health and fitness solutions provider.

Understand the role of incentives. The use of incentives to encourage participation in wellbeing programmes is extensive in the US, but fairly limited elsewhere. Research by Towers Watson shows heavy usage of financial incentives in the US and Canada, but very low usage in other regions – only 9% of European employers have health participation incentives in place, for example. See the figure below.

We found that the most enlightened employers are highly engaged with their health and wellbeing service providers, and use them to support and reinforce their wellbeing strategy. • It‘s important to build a partnership with vendors. They need to understand the company‘s management processes, internal triggers and handoffs if they are to operate as an effective interface with employees. • Some organisations gather their vendors together regularly – maybe once or twice a year – to brief them on upcoming wellbeing activities, share insights and gather feedback on the types of issues they are dealing with. Such meetings typically include providers of private health and group income protection insurance, occupational health providers, EAP providers, wellbeing, reward and healthcare consultants, and internal specialists. • Employers should consider what processes and handoffs need to be developed between different providers and disciplines. For example, one employer we interviewed deals with musculoskeletal conditions through a combination of on-site treatment by an osteopath or physiotherapist and a rehabilitation programme with the fitness team in the company gym. • Some companies are building formal referral pathways between different external providers, so cases don‘t have to be referred back to the employer at every stage. Others are using their EAP provider to conduct an initial triage of issues and refer on to other providers as needed. • Vendors can play a key role in communicating with staff about the wellbeing services available to them. Research by Friends Life found that one in five employees don‘t understand what wellbeing benefits they are entitled to. Ceridian Lifeworks, the EAP provider, runs on-site staff fairs to promote the EAP service to its customers‘ employees. Bupa has developed a series of toolkits to help its corporate customers brand their wellbeing programmes effectively and use proven techniques to communicate and engage with employees. • Some vendors also help to educate line managers about how to handle sensitive situations such as an employee suffering from stress and anxiety, explaining what actions they can take to manage the situation well and what support is available.

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Incentivising Health and Wellbeing The key points that emerge from our review of incentives in the health and wellbeing area are as follows. • Focus on positive reinforcement – carrot not stick – as employees can lose trust if they feel forced to act against their wishes. • Make incentives big and attractive enough to make a difference. Giving away a t-shirt or a branded stress ball is unlikely to encourage participation in activities that require significant effort and willpower. • Focus on the types of incentives that are proven to result in higher participation. Buck Consultants has found a correlation between the amount of incentive on offer and levels of participation in the programme, but also reports that incentives for participating in one-off events such as biometric screening or completing a health questionnaire are more likely to work than incentives to participate in initiatives that require longer-term lifestyle changes (such as exercising more or working with a health coach). • Use incentives in tandem with other actions – including addressing the organisation culture, communicating effectively and changing the physical work environment – to help increase participation and embed change. • Incentives being used include discounts, giveaways, gift cards, reductions in premiums, points-based rewards and time off, as well as purely financial inducements (see the column opposite for more detail).

Global use of financial rewards as incentives for health programme participation 0% 20% 40% 60% 80%

100%

United States 71

Canada 25 Mexico 12

Brazil 42 Europe 9 3 Asia Pacific 14

In place in 2013

Planned for 2014

Considering for 2015 or 2016

Source: Towers Watson, 2014

As we discussed in chapter 2, the employer‘s role in healthcare in the US is unique, and any improvements in employee health risks benefit the bottom line by reducing the employer‘s health insurance costs. So, if an employer can achieve higher savings than the cost of the incentive, there is clearly a business case. In other parts of the world, financial incentives are seen as something of a blunt instrument, and employers are wary of being perceived as ‘coercing‘ employees. Make it personal. Some organisations use individual health assessments as the foundation of their approach to health and wellbeing. These allow people to understand how the generic messages around health promotion affect them, and what their individual risk factors are. Some assessments assess ‘health age‘ compared with an individual‘s chronological age, which can be a spur to action. Following up an assessment with support from a health coach can help people tailor a programme that suits them, and this, combined with ongoing support from the coach, gives them a greater chance of following the plan. Engage families and the community. Wellbeing programmes increasingly include family members so that changes made at work are more likely to be sustained at home. Roya Bartlett, Wellness and Health Promotion Manager, Johnson & Johnson, comments: “Wellness has to go outside the walls of the factory. People need to take what they‘ve done at work and make it a habit in every aspect of their lives.” Buck Consultants estimates that 62% of programmes include spouses, 52% domestic partners, and 43% children. For many people, the sources of ill-health may be unrelated to work (mental health issues may be triggered by a combination of a relationship breakdown and financial worries, for example). However, we found that the best organisations want to deal with the health issue and its consequences at work, regardless of the source of the problem, recognising that it is in their interests to do so.

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3.5

Case Notes – Incentives

Rethink the physical environment PepsiCo

A high-quality work environment can reinforce health messages; conversely, a poor workplace can undermine a good wellbeing programme. • The working environment has a significant impact on employees‘ wellbeing, and can also affect productivity and creativity. • The workplace can also support key wellbeing messages, such as taking more exercise or eating more healthily. • Many changes can be implemented relatively easily and cheaply. • Our research found that on-site provision of services such as occupational health is increasing, and companies are also broadening the range of services available on-site. The following are key areas of focus for companies we interviewed. Nutrition. Many companies have redesigned their canteen menus, improved labelling, changed the presentation of healthy food to make it more attractive, and offer subsidies for healthy choices. It is also important to ensure that healthy choices are available in vending machines and on-site cafés. The canteen at Technogym‘s Italian HQ serves locally sourced, seasonal, healthy food, which is reviewed on a monthly basis by a dietician, and is heavily subsidised by the company. Discovery Communications runs cooking demonstrations by a well-known chef at some sites, to encourage employees to cook healthy food. Encourage exercise. Providing showers, lockers, secure bike parking and gyms can help make it easier to exercise during office hours. Many companies now offer on-site personal training, yoga, Pilates and running clubs. Ergonomic work environment. Given that one of the top two causes of absence is musculoskeletal disorders, organisations need to set up workstations properly, provide spaces for rest breaks and encourage people to move around and take breaks during the day. Some companies provide standing and treadmill desks and stability balls, which have been shown to help with musculoskeletal conditions. On-site services. The range of on-site services provided by large employers has increased in recent years. See the column on the next page.

3.6 Provide early intervention and support when people become ill

• PepsiCo’s US program offers employees and spouses / domestic partners enrolled in the company sponsored health plan rewards up to $500 for completing both a biometric screening and a personal health assessment (PHA). • Participants who pass 3 out of 4 measures on a biometric screening receive an additional incentive of $75. Participants who are high risk on two or more of the four biometric screening measures receive an incentive of $75 if they engage with a health coach and complete at least 4 phone-based coaching sessions. • The company is also trying to move towards results-based rather than participation-based incentives. So employees who achieve ‘healthy’ ratings for three out of the four levels measured receive a $75 credit. Bunzl • Bunzl‘s North American business has a financial incentive scheme to encourage physical activity, but experience showed that the amount on offer had to be significant to have a meaningful impact. • Initially, it offered employees a $100 reduction in health premium costs for participating in a walking programme, but take-up was low. Participation has increased significantly now Bunzl has raised the incentive to $500 for individuals, $1,000 for couples and $1,500 for families who complete a confidential Health Risk Assessment and participate in a wellness activity such as a walking programme.

While we have noted a marked shift towards more preventative models of corporate health provision, leading employers are also providing good support when someone is absent or sick. Early intervention is key. Statistically, it is unlikely that someone who has been absent for longer than six months will return to work. Through active case management and early intervention, employers can ensure employees receive the support they need in order to return to work as quickly as possible. This requires good co-ordination between the employee‘s line manager, HR, occupational health and external partners such as private health and income protection insurers.

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“It‘s commercially sensible to pay for services such as counselling at work, if it gets people back to work quicker.” Research participant, UK Financial Services Organisation

On-site wellbeing services In addition to occupational health, on-site services include GPs, nurses, midwives, physiotherapists, counsellors and cognitive behavioural therapists, along with mole, breast and prostate screening, massages and smoking cessation programmes. Discovery Communications even arranges for medication to be delivered to employees‘ desks. A number of our interviewees have also tried to introduce slimming clubs such as Weight Watchers, but such offerings are not currently tailored for the corporate wellness market. One of the financial institutions we interviewed offers emergency on-site childcare, and Discovery Communications has on-site childcare in larger offices. A global financial services organisation we interviewed surveys its employees to find out what services would be useful. As a result it now provides a number of on-site classes which are designed to help staff avoid injury including preparation for skiing holidays, improving running technique and caring for their backs. The main reasons employers cite for providing such on-site services are convenience and a desire to keep people healthy, but there are undoubted productivity benefits in minimising time away from work for appointments. One interviewee said: “It‘s not about getting every last ounce of performance; we believe healthy people will be our top performers, and we will all reap the benefits.”

Income Protection insurance providers have a key role to play. Anna Spender, Head of Group Protection Proposition at Friends Life, described how the insurer‘s processes have changed. “Our focus has shifted from good claims management towards early intervention, designed to get people back to work in the earliest possible time. Each claim is assigned a clinical case manager who guides the employee through a combination of self-help and treatment as required. The case manager continues to provide support once the employee is back at work to make sure they are coping and there is not a relapse. Our research shows that 88% of people return to work as a result of early intervention.” Care pathways. Some organisations have taken this a step further and have developed care pathways for their top health problems. These describe the key steps involved in identifying early that someone is at risk of developing that condition, implementing preventative measures and using best practice to manage the condition. Employees are referred quickly for necessary treatments. For example, a care pathway might involve screening, early assessment, ongoing contact with a specialist case manager who is empowered to refer for further treatment, specific treatment plans and a well-defined return-to-work process. Line managers and HR need to be made aware of care pathways and know how to invoke them when necessary. The most common care pathways cover the most prevalent health concerns – mental health issues such as anxiety and depression, musculoskeletal conditions and coronary heart disease. Wolfgang Seidl, Partner and Head of Health Management Consulting at Mercer, thinks that care pathways will become more prominent over coming years, and will begin to emerge in areas such as cancer and to manage early signs of Alzheimer‘s.

3.7 Communicate well and continuously Failing to tell employees about the health and wellbeing services on offer is like pouring money down the drain. Well-crafted communications plans boost participation in activities and encourage sustained behavioural change. Research by Towers Watson has found that only 24% of employees surveyed report that their employer communicates with them regularly about the importance of healthy lifestyles, and only 17% believe such communications have encouraged them to live more healthily. Either communication is not happening or the message is not getting across.

But communications is about more than just telling people about the services on offer. • If the aim is to build a ‘culture of health‘, employees need to understand what ‘well‘ (as opposed to ‘not ill‘) means. • The communications plan needs to be integrated with other features of the programme, such as incentives to participate, if it is to help people to adopt healthier lifestyles. Our research considered the features of an effective wellbeing communications strategy.

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“You need to treat health and wellbeing like a consumer product: you need to ‘sell‘ and ‘market‘ it through multiple channels, using simple, memorable messages that you repeat at every opportunity.” Matt Freeland, Senior HR Director, Europe Snacks SC & Labour Relations, PepsiCo

1 Stimulate awareness, interest and uptake. People need to understand what‘s available. You may have an initial launch event, but you have to communicate continuously to remind people of what‘s available and encourage them to participate. It‘s a good idea to find out which internal communications channels are the most effective and piggy-back them. Make sure you build in feedback loops because employees‘ experiences and opinions may prompt you to change the design of the programme or services on offer. 2 Branding. Employers with the most sophisticated wellbeing programmes have usually developed a brand with a distinct identity to badge all their health and wellbeing activities. Sometimes organisations build on existing internal brands. Communications under the brand all have a consistent look, feel and tone of voice. ‘Healthy Me‘, ‘Happy, Healthy and Here‘ and ‘Work Fit‘ are a few examples. 3 Use multiple communications channels and media. See the column. 4 Segment the audience and tailor messages to them. You may need to pay particular attention to certain high-risk groups. For example, a home energy supplier with a large population of engineers, who spend all day travelling between jobs in their vans, provides sessions at the depot offering tips on how to eat well, avoid junk food, stay hydrated and maintain energy throughout the day. Because line managers play a key role in supporting their teams to be healthy and to seek help where necessary, this is a key communications audience that you need to address separately. 5 Use internal health champions. A popular low-cost technique for spreading awareness and encouraging participation is appointing voluntary internal ‘health champions‘. They can perform a number of roles, including co-ordinating local communications, signing people up for campaigns, acting as role models for activities or healthy-eating programmes, and providing feedback. While most health champions are unpaid, they are often rewarded in other ways – receiving discounts or prizes, for example. 6 Tell stories and celebrate success. CRF‘s 2014 research report, Storytelling – Getting the Message Across, describes how organisations use storytelling to communicate in a highly engaging and memorable way. Telling stories about how people have used the services on offer to transform their health can be a good way of spurring others to action. It‘s also important to celebrate success. For example, Standard Life, which participates in the Global Corporate Challenge, holds a celebration event at the end and presents awards to the most engaged participants. The company also shares stories of people who have lost weight through engaging in company programmes.

3.8 Evaluate your health and wellbeing activities Employers need to evaluate the outcomes of health and wellbeing programmes and determine whether they provide value for money. But evaluation is hard to do. Buck Consultants found that only 52% of companies they surveyed measure the outcomes of healthcare programmes. A 2014 survey by HR Magazine found that only 4% of respondents had worked out how to measure return on investment (ROI) in health and wellbeing initiatives, a further 35% were working on it, and 61% had made no attempt to measure it.

Communications media and channels Getting the message out and keeping it alive requires a variety of approaches. It‘s particularly important to consider how to reach employees who don‘t have access to email and web portals, as they are often the lower-earning employee groups with the greatest health risks. Some of the mechanisms available are as follows. • Fairs, seminars, briefing sessions. For example, Friends Life realised two years ago that, despite offering many high-quality wellbeing services, usage was lower than expected because people were unaware of what was available. Roger Cotton, Corporate Responsibility Manager, championed the introduction of annual wellbeing fairs – run like trade fairs – across six UK offices to raise awareness. This, along with other communications activities, has led to increased participation. • Campaigns. Many organisations run campaigns such as ‘Mental Health Awareness‘ or ‘Stop Smoking Week‘, which bring together a series of activities. • Regular e-newsletters or emails. Many organisations have a regular ‘health and wellbeing‘ slot in their internal corporate communications. Catherine Kilfedder, BT‘s Head of Wellbeing, describes the company‘s approach to communications as being a ‘drumbeat‘ that goes on throughout the whole year. • Posters, leaflets and desk drops. • Web portals and mobile apps. (See the box below on technology). • Webinars. BT runs webchats and podcasts featuring senior managers talking about situations they have faced. • Facebook, Twitter and internal social media such as Yammer. BT is experimenting with getting people to share videos of their experiences.

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“Regular, consistent, simple messaging is key. You can‘t do it once and think: OK, that box is ticked. You have to keep it going over and over.” Catherine Kilfedder, Head of Wellbeing, BT

PepsiCo‘s approach to evaluation There are four levels to PepsiCo‘s evaluation of its UK health and wellbeing programme. Level 1: Activity, participation and engagement

In considering evaluation, we think it is important to distinguish between: • measuring results, whether through attempting to quantify ROI, or by using other data; and • evaluating the quality of the wellbeing programme and whether it has delivered the desired results.

• How many participants are there in events? • What percentage of staff uses the facility? • How engaged/satisfied were participants? Level 2: Change in behaviour • How has behaviour changed, both as reported by the employee, and as evidenced by the data collected? Level 3: Change in health outcomes

Measurement In some ways, it is easier to measure the results of health and wellbeing initiatives than it is other HR initiatives such as coaching and leadership development, because you can build a picture using both internal and public information. Below are examples of data that different organisations collect and compare over time. • Trends in clinical markers such as cholesterol and BMI. • Behavioural data, such as responses to health questionnaires.

• How have health metrics changed?

• Absence data.

• How do metrics compare to national/ regional/socio-economic group norms?

• Employee performance data, such as call rates in customer service centres.

Level 4: Change in business metrics (ROI)

• Data from insurers and other third parties on trends in presenting issues (although privacy issues make this difficult to obtain in some countries).

• What has been the impact on absence? What is the cost saving? • What impact has there been on healthcare/benefit costs? PepsiCo underpins its evaluation by seeking opportunities to have initiatives accredited or recognised externally via third party schemes and awards. This lends credibility to the programme and motivates the employees who are involved. “Every time we win an award it allows us to make an internal announcement, which we can use to promote something new or reinforce the right message to our employees,” said Matt Freeland, Senior HR Director, Europe Snacks SC & Labour Relations, PepsiCo.

• Trends in healthcare costs – are premiums reducing?

• Responses to employee surveys. • Participation rates in wellbeing programmes. Taken together, these data can paint a broad picture of organisation health. However, it is more difficult to build this into a robust assessment of ROI. • How do you quantify spend? What do you include? • Health markers may be improving, but is it possible to put a monetary value on this? • If you simply look at trends in healthcare costs, are you missing out on other benefits? • Can you rely on data that are self-reported by staff or recorded by managers? • Are the data you need available in a joined-up way? In theory it is possible to record and put a monetary value on absence, and monitor this over time. But good absence data relies on people – especially busy line managers – recording consistently and accurately. It‘s easy to overlook the add-on costs of absence, such as the costs of replacement staff, recruitment and training, and administration. As a minimum, absence statistics should be able to help you identify the extent of a problem and help you to focus resources on priority areas and employee groups. But getting different systems to talk to each other to build a complete data set – especially when an organisation has grown through acquisition – can be tricky. Another option is to run a proof-of-concept study on a smaller scale. BP recently undertook a small scale study in the UK. Employees completed a health questionnaire and those who showed certain risk factors were offered six months of telephone health coaching. The pilot ran on a very small sample size, so it is difficult to extrapolate the findings for the whole workforce, but the results were encouraging. This result might provide justification for rolling out the programme more widely.

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“It‘s surprising how little monitoring of results companies do, and they forget to measure the baseline before they start.” Andy Davidson, Sales Director, Technogym

Some organisations use employee engagement surveys to track compound measures such as ‘happiness‘ or ‘employee satisfaction‘. For example, Discovery Communications‘ German office has seen its ‘happiness‘ score improve by 28% over the past two years, which has coincided with a 13% increase in the uptake of wellbeing services. However, while encouraging, it is difficult to prove causality between employers‘ actions and employee scores (or, indeed, business performance). Rob Briner, Professor of Organisational Psychology at Bath University School of Management, cautions that lots of surveys measure ‘satisfaction‘ without establishing a direct connection between this and other factors such as wellbeing and engagement.

Measurement is possible, but it‘s difficult to come up with a complete picture. The key points are to make sure you understand the baseline you‘re measuring against, identify which measures you want to track, and follow up.

How often should you measure? It will probably depend on what indicators you are tracking. If employees complete an annual health check, you can compare this year-on-year. Some of the larger, more experienced, organisations we spoke to, such as Johnson & Johnson, track key indicators regularly but conduct a more detailed assessment every five years, which ties in with the five-year planning cycle for health and wellbeing programmes. Evaluation Even if it‘s not possible to complete data-driven programme assessments, you can still evaluate their effectiveness. • Is there a plan for evaluating the programme before it‘s implemented? Have you established the baseline before you start? • Does the programme have clear objectives, and is it meeting its goals?

Case Notes – Boots The retailer and pharmacist has recently redesigned its health and wellbeing strategy and taken a more commercial view. It began with a thorough assessment of what was and wasn‘t working in order to identify and build on activities that had a high impact and represented most value for money, and to pare back interventions that weren‘t meeting the requirements of the business. The Colleague Health team gathered as much data as possible, including in-store customer surveys, call centre performance data, absence and productivity data, and feedback from store managers and key functions such as Logistics, in order to determine where to focus its investment. One of the key themes of Boots‘ new approach is to be ‘present and proactive‘. This means building closer connections with employees and managers in-store, and delivering services in the workplace. Areas of focus now include nurse-led clinics in high priority inner-city stores, physiotherapy support for Logistics, and early intervention. Patricia Lakin, Colleague Health Lead, expects that it will take at least three years to implement the strategy in full, but, after a thorough review, the team is confident that it is now focusing on the right actions.

• How does it compare with best practice, and what are your peers and competitors doing? • What‘s the evidence that a particular intervention works? Do those who are delivering the service have a good track record?

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Employee Assistance Programmes (EAPs) Health and wellbeing technology Some 71% of employers have an EAP, and EAPs now cover 47% of the UK workforce, according to the UK EAP Association. EAPs can be a cost-effective way of providing support to employees: the average cost per employee is £14 a year for an organisation with 100 employees, and the costs are lower for larger organisations. EAPs are often among the wellbeing services most valued by employees. EAP coverage has tripled since 2005, and the range of services has also expanded. Some providers offer courses of CBT and counselling alongside advice on legal and employment issues, emergency childcare or help with a broken boiler, for example. Increasingly, employees can get advice on simple problems via a web portal or mobile app, which frees up EAP staff to deal with more complex issues. EAPs can also provide support through organisation change or life events such as going on maternity leave. Communications around these events can also include a reminder of what EAP services are available to employees. Iain Campbell, Head of LifeWorks at EAP provider Ceridian LifeWorks, says that mental health is a much bigger element in EAPs and represents a much higher proportion of EAP calls than five years ago – even though, as we noted earlier, "the workplace is not always the main source of stress and anxiety." What‘s coming over the horizon for EAP and other wellbeing service providers? Campbell sees the responsibilities of the ‘sandwich generation‘, who have to balance the demands of childcare and elder care, as a growing area of concern.

The use of technology has transformed the health and wellbeing industry in recent years. In particular, the combination of affordable wearable technology and mobile apps has given individuals easy access to key health information and allows them easily to set goals and monitor their progress. Organisations are also tapping in to these trends. Many of the employers we interviewed have provided Fitbits or similar activity-measuring devices to employees, either free-of-charge or at minimal cost. Some of the most popular wellbeing initiatives are activity challenges, which involve recording activity either automatically via a Fitbit or similar, or by logging activity online. Some companies are also using heart-rate monitors to help individuals better understand their sleep and stress patterns and identify potential health concerns. Desktop web portals that provide health information have been around for some time, but their uptake is very low – only around 0.5% of employees uses them, estimates Patrick Watt, Corporate Director, Bupa. Dean Hovey, CEO of Digifit, a digital health and fitness solutions provider, explains why: “By the end of a long working day, people have had enough of computer time. The last thing they want to do is sit down and view a web portal or watch health videos.” The real game-changer is mobile. Watt anticipates a growing trend of employers providing information and services to employees through mobile apps and social media. Some organisations have developed a mobile app that employees can use instead of the intranet, allowing them to access information on the move or when using a tablet at home, for example. Hovey‘s Digifit product, which taps into the increasing personalisation of technology via mobile, is a good example of the sort of technology that‘s emerging. Whereas activity monitors are fairly dumb, simply recording steps or distance, the new breed of technology is designed to bridge the gap between activity recorders and expensive personal trainers. It helps users set goals and provides ongoing motivation and virtual coaching to keep their progress on track. It also engages the social element, allowing users to share their goals and progress with others. “It‘s like having a personal trainer sitting on your shoulder, spurring you on,” says Hovey. There are concerns that organisations may misuse the growing amount of individual health data. Some employees fear that ‘failing‘ a health assessment could earmark them for redundancy, for example. But the organisations we interviewed are keen to use the available data for positive ends – building their understanding of their workforce health profile and improving the services they provide. Hovey thinks employers have an opportunity to ‘curate‘ best-of-breed technology, providing or recommending different products and services from which employees can choose. He explains: “You need to provide choice. You need to find what sparks the interest of each person, and work with what they want to do.”

BUILDING A ‘CULTURE OF HEALTH‘

Topics covered

Introduction

4.1

What does a ‘culture of health‘ look like?

4.2

The role of senior leaders

4.3

Engaging line managers

4.4

How the nature of work affects wellbeing

In this chapter we explore the concept of an organisational ‘culture of health‘, and consider its distinguishing features and how it can be developed.

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BUILDING A ‘CULTURE OF HEALTH‘

“We recognise that if we truly believe that people are our greatest asset, we need to provide access to services, information and tools in order to create an environment that enables employees to thrive, be effective and feel supported.” Research participant, Global Financial Services Organisation

Case Notes – Bupa Healthcare provider Bupa has put its desire to build a culture of health at the heart of its wellbeing strategy. Bupa‘s health and wellbeing framework is shown in the figure below.

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At any one time, 5-25% of staff are at high risk of developing a disease requiring significant medical intervention. Focusing on a ‘culture of health‘ means doing something for the remaining 75-95% who are essentially healthy, but could do better. The evidence suggests that helping this group reduces the chances of them moving into higher-risk groups later. The previous chapter described some of the building blocks towards an integrated, proactive health and wellbeing strategy. Here we will explore in more detail what a culture of health is and what steps employers can take to develop one.

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A key concept emerging from our research was that leading employers do not simply provide health and wellbeing services for their employees; they also focus on developing a ‘culture of health‘ – essentially an environment where it‘s easy to make healthy life choices.

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“For us, it‘s really important that people become healthier as a result of working at Bupa,” says Julia Simms, Employee Health and Wellbeing Consultant. However, this is extremely challenging when low-paid care home staff – one of the population groups most at risk of obesity and smoking-related illnesses – account for half the workforce. It‘s not easy to reach these groups with technology either – they aren‘t allowed to use smartphones at work, for example. For Bupa, the gateway to the highest-risk groups is care home managers, who are respected by their teams. So it focuses actions on

4.1 What does a ‘culture of health‘ look like? Presuming an organisation has adopted the good practices discussed in chapter 3, such as having a strategy for health and wellbeing, focusing on prevention and taking a robust approach to communication, we find there are four key determinants of a culture of health. See the figure below.

Work environment and nature of work

Actions and attitudes of senior leaders

Culture of Health

• educating care home managers • helping them engage their staff • shifting perceptions around using health services on offer – for example, getting people to accept that using the EAP is not an admission of weakness.

Communications style

Role played by line managers

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“You need a senior voice within the company to give you a ‘platform‘ to support this kind of work, someone who‘s highly respected in the organisation, and visibly committed.” Catherine Kilfedder, Head of Wellbeing, BT

4.2

Communications style

The role of senior leaders A recurring theme of our research, raised time and again in interviews, was how critical the attitude and commitment of senior leaders is to developing a culture of health. A well-crafted health and wellbeing strategy will not succeed if it is undermined by leaders who fail to support it or whose actions create an unhealthy environment. Yet leaders who are strong advocates for health and wellbeing appear to be in the minority: a 2014 Towers Watson survey found that only one-quarter of employees felt their leaders visibly supported a healthy work environment. Leaders can demonstrate their commitment to health and wellbeing in many ways. • Act as role models by making time for exercise and encouraging others to do the same. For example, one of Discovery Communications‘ senior team set herself a goal to run a half-marathon, and encouraged others to sign up with her. The CEO of Standard Life takes part in the Global Corporate Challenge. Technogym has a two-hour lunchbreak so staff have time to exercise. • Be prepared to ‘front‘ events such as health fairs. For example, Bunzl‘s North American CEO hosts an annual wellness lunch at each of the company‘s top three facilities, and also emails colleagues to ask why they‘ve not enrolled in fitness programmes. • Talk about health and wellbeing in general communications to staff. • Make sure people are given active support – especially time – to take part in wellbeing activities. • Be careful not to let their personal preferences act as a barrier to others. One interviewee talked about trying to persuade a marathon-obsessed CEO that there was more to health and wellbeing than running.

A culture of health is rooted in trust. Leaders are transparent about what they expect, and keep people informed. Employees know that they can raise issues without fear of being judged unfairly. This implies a particular communications style. • People treat each other as ‘adults‘. • They feel able to have open and honest conversations. • They feel comfortable raising health concerns, especially in relation to mental health, and are confident they will be treated sensitively without fear of reprisals. • Leaders are able to talk openly about mental health issues they have experienced. • Managers are sensitive to when people work best, and are sufficiently flexible to accommodate different work styles. • People have choices around things like working long hours. • Managers flex policy to suit individual circumstances, rather than sticking rigidly to the rules.

• Help to spread responsibility for health and wellbeing beyond HR – by encouraging other senior executives to sponsor programmes, for example. HR may play a key role in facilitating the debate and co-ordinating activity, but the impetus has to come from the top. For example, Friends Life‘s Chief Risk Officer actively champions mental health initiatives. An interviewee described how a new CEO has transformed the profile of health and wellbeing in the organisation. “The environment is completely different. Communications are much more transparent, the new CEO championed the building of a staff restaurant, which we didn‘t have before, and he talks about health issues all the time. We‘ve seen a significant improvement in engagement scores too.”

4.3 Engaging line managers For many people, the most significant relationship at work is with their line manager. In the same way that senior leaders define corporate culture, line managers shape ‘micro-cultures‘ within their teams. They are the critical link in terms of how wellbeing strategy works on the ground.

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“The onus is on the line manager to build a picture of what motivates their team member, their work style, and what is ‘normal‘ behaviour, so you can pick up when something is not right.” Sally-Anne Etienne, Market Head L&H UK & Ireland, Swiss Re

Supporting line managers to improve health and wellbeing

Line managers are often appointed on the basis of their technical skills rather than innate management capability. Many find it difficult to have sensitive conversations with staff about health, or lack the empathy required to spot that something is wrong.

So what can organisations do to help this critical population of line managers?

Good managers can make the difference between someone returning to work quickly and successfully, and failing to return at all. In our research we heard stories of managers who had applied company policies sensitively and flexibly to get the best outcome for their team member, or who had managed the ‘noise‘ when someone was off sick or having a phased return to work. See the column for more detail.

• When thinking about how to implement and communicate the wellbeing strategy, work out how to engage line managers as a specific population. For example, Boots‘ revamped health and wellbeing strategy is heavily focused on engaging line managers. Nurses work with store managers on-site to deal with staff issues, all new line managers receive training on health and wellbeing, and an intranet site (‘How Do I…?‘) provides information to managers.

Line managers may feel uncomfortable having unsolicited conversations with people who they think might have a problem. Line manager training needs to show them how to handle such situations with empathy. HR has a critical role to play in educating line managers about the sorts of situations they may face, explaining how their response can create either a positive or a negative outcome, and holding their hands when a situation does arise. This should be part of an ongoing dialogue between HR and managers.

• Educate managers in the links between wellbeing and productivity. • Train line managers to identify signs of stress within their teams, and give them the tools to deal with situations as soon as they arise, and before they result in absence. For example, Discovery Communications has created a special EAP line for managers to call for advice on sensitive staff topics. • Educate managers on the tools and services available to support employees with potential health issues. • Build their awareness of policies and support when someone is off sick – such as care pathways and EAPs. • Encourage managers to work in partnership with specialists such as case managers, to keep in contact with employees who are sick, and to figure out the best way of getting someone back to work. Many employers are also now training line managers in how to build resilience and develop stress management techniques for their teams. For example, GSK has a programme called ‘Managing for Resilience‘, which is part of its core development for people managers.

4.4 How the nature of work affects wellbeing Although people often complain about work, the evidence points to it being generally good for health and wellbeing. People in work typically enjoy better physical and mental health than those not working. However, certain conditions enhance wellbeing, while other work characteristics can lead to a ‘toxic‘ and stressful environment. At the very least, people need to be safe at work and able to do their job without risk of injury. But beyond that, what are the factors that come together to create ‘good‘ work that sustains wellbeing? Workplace wellbeing and resilience specialist Robertson Cooper has developed a model that describes the six essentials of workplace wellbeing, the impact of these factors on psychological wellbeing, and how these play out in terms of individual and organisational outcomes. Many organisations use the 6 Essentials model to provide leaders, managers and employees with a common framework and language for discussing the often difficult issue of psychological wellbeing.

6 Essentials

Organisational outcomes

• • • • • •

✓ ✓ ✓ ✓ ✓

Resources & communication Control Balanced workload Job security & change Work relationships Job conditions

Psychological Wellbeing • Sense of purpose • Positive emotions

Source: Robertson Cooper

Productivity & performance Attendance (sickness absence) Retention (turnover) Attractiveness to recruits Customer/user satisfaction

Individual outcomes ✓ ✓ ✓ ✓ ✓

Productivity & satisfaction Morale & motivation Employee engagement Commitment Health

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“If I could wave a magic wand, the one thing I would do is to improve the relationship between line managers and employees. Good line management can promote better health and wellbeing and improved performance.” Dame Carol Black, author of the 2008 review of UK workforce health

The former UK Cabinet Secretary Gus O‘Donnell and his colleagues set out in Wellbeing and Policy what they found to be the four generally agreed features of a workplace that provides for high wellbeing. • Workers have a clear idea of what‘s expected of them and how it relates to a wider whole. • Employees have reasonable freedom over how they do their work. • They get support and recognition, and feel personally valued by their employer. • There is a reasonable work-life balance (see the column). If an organisation invests in health and wellbeing activities without addressing the environment in which a person works, the benefits of any wellness programme will not be sustained.

So what can employers do to improve the quality of work? • As an absolute minimum, make sure the working environment is safe and comfortable. • Ensure people have adequate resources to do their job, an appropriate level of autonomy, and support. • Be clear about goals and expectations and how performance will be measured, and don‘t move the goalposts. • Design jobs so people have a clear line-of-sight between what they do day-to-day and its impact on customers, business results and the wider community. Particularly in large organisations, there is often little obvious connection between what individuals do and broader business outcomes. • Design jobs with an appropriate amount of challenge – enough to be engaging, not too much to create high stress – balanced with the right level of support. • Provide opportunities for stretch and development. • Encourage the development of supportive social networks. • Tackle any perceived imbalances between effort and reward. • Minimise job insecurity, and handle any necessary redundancies with dignity and transparency. • Give people a sense of the social value of the organisation‘s work, ideally by giving them opportunities to ‘give something back‘ to the local or wider community as part of the organisation‘s CSR activities.

Work-life balance Work-life balance is a complex topic, as there is no single answer that suits everyone. For many people, work is their life, and their self-esteem and sense of identity are inextricably linked to the job they do. If people choose to work hard, at the expense of other aspects of their life, that may not be a problem. Research suggests that wellbeing increases as the number of hours worked rises – but only up to a certain level, beyond which additional hours have a negative impact. This threshold differs for different people. What‘s more, it only holds true in certain cultures. Data from South Asia show no correlation between hours worked and life evaluation, for example. We can perhaps conclude that it is the relationship between hours worked and the individual‘s preference that influences their perception of work-life balance, rather than the absolute number of hours worked. But the evidence suggests that employees who feel they have achieved a good balance are less stressed and more satisfied at work. Mental health issues such as stress and anxiety can arise when people feel they have lost control over their working hours. The difficulty is that modern, technologyenabled work practices mean organisations expect more from their employees in terms of working unsociable hours and being ‘alwayson‘. However, there are things companies can do to mitigate the negative effects on their employees. • Facilitate flexible working, which is increasingly the norm and, in some organisations, is the default option. • Minimise weekend and out-of-hours working. • Enforce digital ‘shut-downs‘ during holidays, such as German car maker Daimler has recently implemented. • Foster a culture of open dialogue between managers and teams regarding preferences and expectations. For example, managers who like to send emails at antisocial hours can make it clear to their teams that they don‘t expect an immediate response.

BUILDING RESILIENCE AND ENERGY

Topics covered

Introduction

5.1

Resilience

5.2

Case Study â&#x20AC;&#x201C; GSK

In this chapter we consider the growing interest in developing a resilient workforce, what this means and how organisations can achieve it. We also review the role of sleep in wellbeing, and how mindfulness and positive psychology are shaping HR practice.

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“An essential element of resilience is that there should be space for recovery and downtime. That simply doesn‘t happen in practice.” Claire Genkai Breeze, Co-founder, Relume

5.1

Sleep

Resilience Resilience and ‘energy management‘ have become hot topics in the field of health and wellbeing in recent years. Some organisations have moved the conversation on from health as ‘an absence of disease‘ to health as ‘vitality, energy and resilience‘. We believe there are a number of factors behind employers‘ growing interest in resilience. • The relentless pressure on public companies in particular to improve results every year, even during hard economic times, is reflected in their expectations of employees. • The always-on nature of work today means there is less downtime and space for recovery. • Coping with pressure is now seen as a critical skill in organisations. • Job insecurity, particularly through the recent economic crisis, along with the (sometimes associated) rise of mental health problems, have increased the pressure on employees. What is resilience? Resilience is often defined as the ability to ‘bounce back‘ from setbacks, recover from stressful situations, adapt to challenging circumstances, sustain high performance over time, or simply not become ill when faced with challenging situations.

We would highlight the following points about personal resilience. • Resilience varies from person to person: a positively challenging situation for one person may be highly stressful for another. • Personal resilience levels can vary over time: the same person may react differently to the same situation at different times. • Resilience is about both an individual‘s personal resources and the environment in which they operate (see 4.4 above for a more detailed discussion on healthy working environments). Jill Flint-Taylor, co-author of Building Resilience for Success, says resilience should be viewed as a process. An individual‘s personal resources are the start point, but they build resilience by learning how to prepare for, and manage, difficult and stressful situations. “Resilience goes beyond recovery from stressful events, to include the sustainability of that recovery and the strength that builds through coping well with such situations,” she explains. Can resilience be developed? The experience of organisations including GSK (see the case study on page 43) and Johnson & Johnson suggest resilience can be developed. Human performance consultancy Lane4 has developed a model summarising how the different resources individuals have at their disposal interact to determine their response to pressure and stress. Working on these factors can help build resilience.

Dr Tara Swart, a neuroscientist and psychiatrist who advises companies on wellbeing, considers sleep to be the most fundamental aspect of wellbeing. She explains: “Most humans need six to eight hours of good-quality uninterrupted sleep per night for proper brain recovery. One night of sleep disturbance means you will be operating the next day on an apparent IQ that‘s five to eight points below your normal level. Losing a whole night‘s sleep means you will be operating at one standard deviation below your normal IQ level.” Sleep deprivation has many negative effects on our ability to function effectively. • Executive functions such as multi-tasking, innovation, assessing risk and complex decision-making are particularly affected by sleep deprivation. • Emotional intelligence capabilities such as self-awareness, self-control and empathy are also negatively affected by fatigue. • Seventeen hours of sustained wakefulness has been shown to have the same effect on some behaviours as drinking two glasses of wine. • Going without sleep for 24 hours is the equivalent of having drunk four glasses of wine, and affects speech, motor function, impulsiveness, aggression, memory and decision-making. • Having only 1.5 hours less sleep than normal, for just one night, can reduce someone‘s alertness during the day by nearly one-third. Ashridge Business School conducted a study of 339 managers to determine their sleeping patterns. On average, this group slept for less than seven hours a night. The amount of sleep decreased as the managerial level (and associated complexity and requirements for considered decision-making) increased. Dr Vicki Culpin, Dean of Faculty, who ran the study, said: “The results indicate that managers not only have a restricted quantity of sleep, but also suffer from poor quality, with 80% of the sample reporting waking at least once, and 30% feeling ‘bad‘ in the morning.”

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“In many organisations, people wear exhaustion as a badge of honour. It‘s as if you haven‘t done a good job unless you get to the end in a state of exhaustion.” Rowan Gray, Consultant, Relume

• An attitude change is required: senior leaders in particular need to set an example by making sure they get enough sleep and don‘t boast about how little sleep they need to function. • Just as it has become acceptable to take exercise during office hours, perhaps attitudes need to change towards taking a nap or meditating too. • Travel policies need to be rethought to allow people to recuperate after long flights. Companies need to weigh up any cost implications against the cost of reduced performance through fatigue. • Staff should be educated about the need to get good quality sleep. Bupa provides its staff with an online coaching tool to improve sleep quality. Some companies have built nap rooms and sleep pods, but it is important that people don‘t use these as an excuse for working even longer hours in the office.

Performance Mindset

Resilient Character

Focus & Emotion Control

g ein llb We

It is surprising that corporates haven‘t done more to ensure staff get enough sleep. It has become increasingly frowned upon for people to drink alcohol during office hours, yet companies tolerate sleep-deprived managers making important decisions. Most organisations have policies on smoking or sexual harassment, so why not sleep?

Success Strategies

h& alt He

The effects on sleep of electronic devices in the bedroom have been extensively reported in the media. But one of the biggest sleep disrupters is intercontinental travel, which is an occupational hazard for many senior executives. Nothing in nature crosses several time zones in a day, and it takes time for the body to adapt to a new time zone. Yet it is common – even expected – for people to take an overnight flight, attend meetings, then take another overnight flight home, thereby missing two nights‘ sleep.

Lane4 Personal Resilience Framework

Bounce Back Thriving on Challenge Dedication Drive Self Belief

Per for ma nce En vir on me nt

Sleep (continued)

1 Success strategies. Approaches from performance psychology can be applied to teach individuals skills and tactics that they can deploy to deal with the sources of pressure and manage stress. 2 Performance mindset. This determines how individuals appraise and interpret highpressure situations. People can learn to re-evaluate how they interpret potentially stressful situations through self-awareness, training and practice. 3 Resilient character. Personal characteristics such as drive and self-belief determine how naturally prone to stress an individual is. Character is more ingrained than the other two factors, but can evolve over time through self-discovery and practice. 4 Performance environment. Creating a performance environment involves building understanding of the factors in the working environment that either support or undermine personal resilience. 5 Health and wellbeing. Understanding the current level of health and fitness and how to build physical and mental resilience. Jim Loehr and Tony Schwartz of the Human Performance Institute (now owned by Johnson & Johnson) developed the Corporate Athlete® programme, which provides the theory underpinning many of the resilience programmes available today. In a 2001 HBR article (see references), Loehr and Schwartz contend that • each of four types of energy – physical, emotional, mental and spiritual – need to be in balance for high performance • effective energy management is achieved by rhythmic movement between energy expenditure (stress) and energy renewal (recovery) • through learning to build routines that enable them to move between stress and recovery, individuals will be able to sustain high performance over time.

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“Choice is key: if you‘re choosing to work long hours, that‘s ok, but if you feel you have no choice then that‘s going to have an impact on wellbeing.” Dr Vicki Culpin, Dean of Faculty, Ashridge Business School

“The real enemy of high performance is not stress, which … is actually the stimulus for growth. Rather, the problem is the absence of disciplined, intermittent recovery. Chronic stress without recovery depletes energy reserves, leads to burnout and breakdown, and ultimately undermines performance.” Loehr and Schwartz, Harvard Business Review, 2001 Training for resilience Training programmes designed to improve resilience are becoming popular in organisations, whether they are stand-alone or integrated into other development activities. Jill Flint-Taylor, who has worked extensively with organisations on designing resilience programmes, has found that successful programmes have a number of features. • They are tailored to the individual and the context in which they work. Generic resilience programmes are likely to be much less effective. Some organisations get attendees to wear a heart-rate monitor for a period of time before the programme, and ask them to keep food, sleep and exercise diaries, so they can be given advice and feedback that‘s tailored to their physiology. • They give attendees time to work out what their particular style of resilience is, and how they can develop it in a way that works for them in their particular business context. • They allow time and space for people to start to make changes to the way they operate. A two-hour resilience workshop is not adequate. • They allow space for practice and follow-ups after the event. A note of caution The reasons employers have for investing in resilience are generally noble – to help employees build the capability to withstand the stresses and strains of work. However, some employees and commentators are understandably sceptical. Is it fair to expect people to give ever more over time? Is building resilience just a way of getting employees to work even harder? And alongside building people‘s capacity to take on more, should organisations be making more space for recovery and downtime? Claire Genkai Breeze, co-founder of research and advisory firm Relume, is concerned that some organisations see building resilience as a ‘quick fix‘ to deliver higher performance without addressing underlying cultural issues that act as barriers to wellbeing. She explains: “Instead of using resilience programmes to get employees to endure more, perhaps organisations should be focusing on changing the working environment to reduce stress factors at work.”

5.2 Case Study – GSK GSK, the global healthcare company, has been running resilience training programmes since 2006, when it introduced the Human Performance Institute‘s Corporate Athlete® programme, run internally under the name ‘Energy for Performance®‘ (E4P). The catalyst for introducing E4P was GSK‘s recognition of the increasing everyday pressures that employees are facing both professionally and personally. ‘Respect for People‘ is one of the company‘s core values, and building a focused and energised workforce in a healthy and safe environment is part of that. GSK has also made explicit its expectations of the role of leaders in building resilience. One of its six Leadership Expectations is ‘Releasing energy: creating a healthy, engaged and inclusive working environment that is sustainable over time.‘

Mindfulness Mindfulness meditation is one of the hottest topics in health and wellbeing today. Even Rupert Murdoch, CEO of News Corporation, recently tweeted that he had taken it up. However, there is a danger of it being seen as a panacea, so it is important to distinguish between scientifically proven benefits and hype. Research into the effects of mindfulness meditation on the brain has shown both short- and long-term effects. • During meditation, there‘s a change in the brainwaves that process information, allowing the brain to enter a state of deep relaxation. It appears that even short sessions of meditation can aid rest and recovery. • In people who meditate regularly, the parts of the brain involved in regulating emotions, building memory, solving complex problems and making decisions have been found to be larger than in people who don‘t meditate. Regular meditators also seem to have a higher pain threshold, are less anxious and manage stress more effectively than non-meditators. We found a great deal of interest in how to apply mindfulness in corporate settings. Some organisations are offering mindfulness courses at work, or providing facilities to help employees practise mindfulness. • GSK offers ‘Time for a Moment™‘, an online training module that helps staff to practise meditation and mindfulness at their desks. • Bupa is trialling a mindfulness app, ‘Headspace‘, with its staff. • The US Navy teaches its troops mindfulness to help them combat the stress of military operations. • Google has even built a labyrinth on its Silicon Valley campus to aid walking meditation.

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Compassion There is growing interest in compassion at work. Dr Amy Armstrong, Research Fellow and Member of Faculty at Ashridge Business School, who recently completed a doctorate on this subject, suggests that compassionate cultures are work environments that are characterised by high levels of trust; integrity; care and support for one another, making them very similar to the ‘cultures of health‘ we describe in chapter 4. Dr Armstrong says that compassion is particularly important in caring and customerservice-focused professions. Indeed, some parts of the NHS have introduced programmes to help embed compassion in the light of recent reports into failings in care. We found an example of compassion in practice in a company we interviewed that had to deal with a number of staff being arrested. The organisation took the view that, as these individuals had not been convicted of an offence, it still had a duty of care to look after their wellbeing. It set up a ‘shadow’ programme of wellbeing services to support them while the legal process continued. To counter concerns about trust while it was co-operating with the police investigation, the company appointed a trusted long-standing employee to liaise with the affected employees on its behalf. The programme had to take account of the individuals’ reactions to events, which varied widely, and help them deal with the psychological fallout of suddenly being removed from the normal working routine. The services provided included counselling for the individuals and their families, and opportunities to fill their time with activities like cooking courses, yoga and volunteering projects. The company also made arrangements for people to be fasttracked into treatment for acute mental health problems, should this be necessary. Each individual also had an appointed person from the company who would regularly check in to make sure they were coping. The Group HR Director says the company made a conscious decision to focus on what was best for the individuals concerned, rather than worrying about liability, or being judgmental. In such exceptional circumstances the company had to be flexible, and accept that it had to relinquish some of the traditional controls to ensure people could access the help they needed.

The aim of E4P is to help employees ‘focus their physical, emotional, mental and spiritual energy on the things that matter most to them so they can reach their full potential.‘ The programme involves five key stages. 1 Articulation of ultimate mission. Participants are encouraged to connect with their personal values, beliefs and assumptions and to focus on what is most important in their lives. 2 Facing the truth. Through 360-degree feedback (which includes family members) and results from biometric tests measuring cholesterol and body fat, participants build awareness of how much or how little their ‘energy investments‘ are aligned with their ‘ultimate mission‘ and the ‘old story‘ they are telling themselves that keeps them in the same place, whether at work or in other aspects of their life. 3 Building a 90-day training mission. Participants focus on a specific area of their life in which they want to be more fully engaged, and are encouraged to make new training missions every 90 days. Participants write a ‘new story‘ that supports their training mission and builds commitment to making the changes needed. 4 Action planning. Participants create a plan to support the new story and training mission. This involves designing ‘rituals‘ which, through intention, self-discipline and practice, become habits over time. 5 Accountability. Positive changes taught in the programme are linked to organisational support, in order to sustain behaviours in the workplace. For example, teams that attend E4P together might agree to change how they run meetings, or reframe how they view breaks – not as ‘downtime‘ but as ‘productive time that allows for recovery,‘ for example. To date, nearly 10,000 GSK staff have attended E4P and every year the top 200 global leaders, who have not already experienced it, are invited to attend. As well as the flagship E4P programme, which runs for 2.5 days, the company offers a portfolio of online and face-to-face resilience programmes for individuals, teams, managers and leaders. According to Jeannie Jones, Director, Energy & Resilience Centre of Excellence: “Our objective is to engage 50% of our global workforce by 2018 with tools and training to help improve energy and resilience.” And the programmes seem to work. Research by Dr Julia Brandon, Senior Director of Environment, Health, Safety & Sustainability, and her colleagues, found evidence that participants in the E4P and other personal resilience programmes have significantly improved their personal energy, recovery, positivity, mindfulness and adaptability to change. And these changes appear to be sustainable: there is a slight drop a year after the courses, but the improvements continue to be statistically significant. (Source: Brandon, Joines, Powell, Cruse, Kononenko, Developing fully engaged leaders that bring out the best in their teams at GlaxoSmithKline, Online Journal of International Case Analysis, Volume 3, Number 2, 2012.)

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“Employers can make the biggest difference by focusing on the nature of work, job design, supervisory training, ways to recognise and reward employees, and integrating all of these activities into their core values and core way of doing business.” Dee Edington, University of Michigan Health Management Research Center Building a culture to support resilience GSK is supporting the principles taught in the E4P programme in the day-to-day working environment. Some examples follow. • ADP, GSK‘s equivalent of the Six Sigma continuous improvement framework, includes principles that relate to sustaining energy. For example, ADP‘s principles for running meetings include assigning an ‘energy monitor‘ whose role is to check when energy is flagging.

Positive Psychology Positive psychology uses scientific understanding to help people achieve a meaningful and fulfilling life. Research by Shawn Achor, reported in Harvard Business Review in January-February 2012, found that

• In some of its flagship offices, facilities are being redesigned to create open spaces with bright colours and areas for collaboration, balanced with quieter areas for concentration and reflection. Some workstations allow people to work either sitting or standing up, and ‘walk stations‘ allow people to walk slowly on a treadmill while working.

• people with a positive mindset are more productive, creative and engaged at work than those with a more negative mindset, they perform better in the face of challenges, and are better at handling stress

• The company has a ‘Healthy, High Performance‘ category in its global CEO Environment, Health, Safety and Sustainability awards.

• employees with low ‘life satisfaction‘ scores have more time off work than those who are more satisfied with life.

GSK‘s commitment to developing and sustaining a healthy, resilient culture has been recognised through various awards, including being identified as one of five lead companies in the BITC Workwell Public Reporting Benchmark 2014.

Achor found that you can develop a positive mindset in a similar way to building physical fitness by attending the gym. Exercises such as jotting down the most meaningful experience of the past 24 hours, or sending a positive message to a colleague, when performed daily over a few weeks can have a lasting impact.

CONCLUSIONS AND RECOMMENDATIONS

Topics covered

Introduction

6.1

Conclusions

6.2

Recommendations

In this chapter we summarise the conclusions of our research and outline some recommendations for implementing a health and wellbeing strategy.

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CONCLUSIONS AND RECOMMENDATIONS

“Although the penny has dropped about the importance of investing in health and wellbeing, many large organisations don‘t really know what to do next. They don‘t know how to host and structure the conversation, who to involve, how to define the aims and scope of strategy, how to roll out, and how to play back to the organisation so they get support and buy-in.” Ben Moss, Business Psychologist and Managing Director, Robertson Cooper

6.1 Conclusions • Health and wellbeing is a topic of significant interest to organisations today. Around onethird of the companies we spoke to for this research were in the process of developing a new health and wellbeing strategy, and many others are revisiting theirs. • There is a move away from simply helping sick people get better, towards preventing sickness and helping people to strengthen their personal resources, function to the best of their ability and have a positive overall experience of work. • Investments in health and wellbeing require patience. Most experts say it can take three to five years to see the benefits, and it is necessary to plan activities over a similar timescale. • It is possible – albeit not straightforward – to demonstrate a business case for investing in health and wellbeing. However, in addition to financial benefits such as reduced absence and lower healthcare costs, there are qualitative advantages in terms of productivity, engagement and employer brand. • It‘s not sufficient just to roll out a number of wellbeing programmes – what one interviewee described as ‘random acts of wellness‘ – and hope some will stick. Organisations need to adopt a co-ordinated strategy that takes account of the health profile of the workforce and links to business objectives. Adopting a set of ‘off-the-shelf‘ solutions is unlikely to lead to the best outcomes. • A good health and wellbeing strategy needs to strike the right balance between supporting good health and healthy lifestyles, helping people to avoid future ill-health, and treating illness effectively to minimise absence. • The choice of wellbeing activities needs to be founded on good evidence. • It is also important to consider the company culture into which wellbeing programmes are to be introduced. This means paying careful attention to the level of engagement in programmes by senior leaders and line managers, the working environment and types of work people are asked to do, and the way the programmes are communicated. • Employers also need to think about how to evaluate health and wellbeing activities before designing and rolling out programmes.

Where does responsibility for employee health and wellbeing lie? We found that expectations on both sides are higher than ever. Employees expect their employer to back up the rhetoric around employees being their ‘greatest asset‘ with tangible actions, including a framework of support and good quality services. In return, employers expect their people to engage with the programmes on offer and take responsibility for looking after themselves as best they can.

Who‘s responsible for health and wellbeing? Implementing an integrated health and wellbeing strategy requires co-ordinating a disparate set of activities across different functions, geographies and external providers. HR, Health & Safety, Occupational Health, Corporate Communications, Compensation & Benefits, Learning & Development, Corporate Social Responsibility and many others may be involved. We observed a few trends. • Some organisations – including British Airways, BT and Discovery Communications – have brought together health and wellbeing and diversity and inclusion activities. This is an interesting development, and perhaps reflects a desire to develop a more ‘healthy‘ culture overall, where individuals have the opportunity to maximise their potential. It also reflects the overlap between certain aspects of inclusion and health – addressing the needs of an ageing workforce, for example. • Health and wellbeing is increasingly emerging as a discrete function within HR. Ben Moss, Managing Director of workplace wellbeing and resilience specialist Robertson Cooper, says he now encounters more ‘Heads of Wellbeing‘ and fewer ‘Heads of Occupational Health‘ across the organisations he works with. • Moss believes organisations need to be clear about who ‘owns’ the wellbeing strategy and who needs to be involved in rolling it out. “You need a strong network of people who will hold the different elements for you. There are so many influencers and sponsors you need to involve, as well as people who will implement the strategy on the ground.” • Some organisations have put in place a wellbeing steering committee or similar, comprising senior leaders from both HR and business functions, to direct the strategy. • HR is likely to play a leading role, but senior business leaders must take overall responsibility.

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“If a person successfully changes a health risk, but then returns to the environment where it was created, the chances of sustaining the change will be greatly diminished.” Dee Edington, University of Michigan Health Management Research Center

The challenge of developing a global strategy Given that local healthcare markets and data protection rules – among many other factors – vary considerably across different countries, how do global organisations develop a consistent approach to health and wellbeing? Many global organisations have a long way to go: research by Buck Consultants found only 56% of the multinationals in their sample have a global strategy for health and wellbeing. Our research suggests that the key point is to have a consistent global philosophy and strategy, which can then be tailored to local market characteristics and nuances. For example, GSK has identified four key themes for its health and wellbeing approach, which help direct activity and resources. These are • healthy leaders • healthy minds • healthy bodies • healthy facilities. These underpin actions taken in local markets and allow for shifting priorities. For example, a recent area of focus for GSK is internalising its external mission by ensuring its employees around the world have access to all the medicines they need. BP‘s health and wellbeing strategy is aligned with the Company‘s philosophy that healthy people, in healthy plants/places adopting healthy processes lead to healthier performance. This philosophy underpins actions taken in local markets. Somehow, global organisations have to find ways of joining up the dots and linking activities to business priorities. BP has chosen to facilitate this by developing a global health information system and global health-risk questionnaire, which has allowed it to start gathering data consistently across the group.

6.2 Recommendations We suggest employers consider the following points when thinking about how to implement an effective health and wellbeing strategy in their organisations. 1 Does your organisation have a clear definition of what health and wellbeing means in your context? Who‘s responsible? Where is it written down? How is it communicated? How often is it reviewed? What is the purpose? 2 Have you identified the key stakeholders and engaged them in the wellbeing strategy? How do you know they are bought in to the programme objectives? Who‘s responsible for signing off the strategy? Are the right people involved in conversations? Are the different functions that are involved in delivering health and wellbeing services aligned, and do they have compatible objectives? 3 Are you clear about the goals and objectives for health and wellbeing within your organisation? How do you define the goals and get buy-in from key stakeholders? Who decides what the goals should be and on what basis? Are they written down? How are they communicated? 4 How do you check whether the stated goals have been achieved? How do you communicate the outcomes of your investment in health and wellbeing? 5 Do the goals and objectives of your health and wellbeing strategy link to business outcomes? Do you know what the investment priorities are and why? 6 Have you done enough groundwork to understand the specific needs of your workforce? What actions have you taken? Who have you spoken to? What data and evidence have you gathered? Which experts have you consulted? Is your health and wellbeing strategy linked to an overall people strategy and workforce plan? 7 Does your strategy take account of the needs of different population groups within the workforce? Does it strike the right balance between prevention and sickness management? 8 Are your HR policies consistent with your stated aims for employee health and wellbeing? For example, if you are looking to build resilience, does your travel policy allow people sufficient time to recover from intercontinental travel? Does your email policy give people a chance to switch off? 9 Does the physical and cultural environment help or hinder wellbeing? How do colleagues and senior people react when someone takes time off work to learn, exercise or meditate? Who‘s responsible for ensuring the wellbeing of key people and educating senior leaders in the importance of employee health and wellbeing? 10 What is your approach to evaluation? Do you have a dashboard of measures that tell you whether your plan is working? Who is involved in evaluating your activities? Do you consult independent experts? Who sees the results of your evaluation? 11 What successes have been achieved? How can you share those stories to build momentum and support for the programme?

REFERENCES AND FURTHER READING

Achor S, 'Positive Intelligence', Harvard Business Review, January-February 2012 'Can you afford not to take employee wellbeing seriously?', The Ashridge Journal, Ashridge Business School, Autumn 2012 Brandon, Joines, Powell, Cruse, Kononenko, Developing fully engaged leaders that bring out the best in their teams at GlaxoSmithKline, OnlineJournal of International Case Analysis, Volume 3, Number 2, 2012. Berry L, Mirabito A, Baun W, 'What’s the Hard Return on Employee Wellness Programs?', Harvard Business Review, December 2010 Working Well: A Global Survey of Health Promotion, Workplace Wellness, and Productivity Strategies, Buck Consultants, July 2014 Business in the Community case study: Better Specialist Support – GSK, found at http://www.bitc.org.uk/ourresources/casestudies/better-specialist-support-gsk Absence Management: Annual survey report 2013, Chartered Institute of Personnel and Development, 2013 Cooper C, Flint-Taylor J, Pearn M, Building Resilience for Success: a resource for managers and organizations, Palgrave Macmillan, London, 2013 Culpin V, Whelan A, 'The wake-up call for sleepy managers', The Ashridge Journal, Spring 2009 Working for a healthier tomorrow: Dame Carol Black’s review of the health of Britain’s working age population, Department of Work and Pensions, 17 March 2008 Dugmore L D, Cardiac Rehabilitation and Wellness in the Corporate Setting, in Joep Perk et al (Eds), Cardiovascular Prevention & Rehabilitation, Springer-Verlag, London, 2007. Edington D, Zero Trends: Health as a serious economic strategy, Health Management Research Center, University of Michigan, Ann Arbor, 2009

Goetzel et al, 'Do Workplace Health Promotion (Wellness) Programs Work?', Journal of Occupational and Environmental Medicine, Volume 56, Number 9, September 2014 Flint-Taylor J, How to build resilience in your team, Ashridge Insight, February/March 2014 'Dropping the health bomb', HR Magazine, June 2014 Loehr J, Schwartz T, 'The Making of a Corporate Athlete', Harvard Business Review, January 2001 MacLeod D and Clarke N, The Evidence: Wellbeing and employee engagement, Engage for Success, May 2014 Management Today, Healthy Business Special Supplement: Why Employee Wellbeing is Moving up the Agenda McGrane K, Whysall Z, James W, Rising to the Challenge: Raise the Bar on your Personal Resilience, Lane4, 2013 Well-being at work: A review of the literature, New Economics Foundation, 2014 O’Donnell G, Deaton A, Durand M, Halpern D and Layard R, Wellbeing and Policy, Legatum Institute, 2014 Wellness in the Workplace 2012: An Optum Research Update, Optum Health, 2012, www.optum.com Britain’s Healthiest Company, Sunday Telegraph Special Supplement, 20 July 2014 Building a culture of health in the workplace: Engaging employees in wellbeing programmes, Towers Watson, 2014 Towers Watson Staying@Work Survey Report 2013/2014, Towers Watson, 2014 Seidl W, Evidence-based & Data-driven Approaches to Corporate Health Management, Mercer, 2014 Vaughan-Jones H and Barham L, Healthy Work: Challenges and Opportunities to 2030, Bupa, 2009

Employee Assistance Programmes 2013 Market Watch, EAP Association, 2013

APPENDIX

Dr Amy Armstrong, Research Fellow and Faculty, Ashridge Business School

Georgie Hart, Trainee Solicitor, Bird and Bird

Alison Atkins, Senior HR Manager, Supply Chain, PepsiCo

Dean Hovey, President and CEO, Digifit

Lisa Baggaley, HR Business Partner, Mercer

Christian Hug, Director, LifeWorks & Inclusion, Discovery Communications

Greg Bartick, Director, International Benefits, PepsiCo

Ian Hunter, Partner, Bird & Bird

Roya Bartlett, Global Health Services Wellness & Health Promotion Manager EMEA & Asia Pacific Regions, Johnson & Johnson

Jeannie Jones, Director Energy & Resilience CoE, GSK Dr Catherine Kilfedder, Head of Wellbeing, BT

Julia Brandon, PhD Senior Director, Environment, Health, Safety & Sustainability HR Centres of Excellence, GSK

Nick Laird, Formerly Chief Commercial Officer, Ceridian

Claire Breeze, Co-Founder, Relume

Kathy Lawrence, Wellbeing Coordinator, BP

Professor Rob Briner, Professor of Organisational Psychology, School of Management, University of Bath

John Lyday, Senior Vice President, Human Resources, Bunzl

Patricia Lakin, Colleague Health Lead, Boots

Janet McKenzie, Reward Manager, B&Q

Iain Campbell, Head of LifeWorks, Ceridian LifeWorks

Ben Moss, Managing Director, Robertson Cooper

David Clifford, Independent Consultant

Catherine O‘Connell, Head of Occupational Health & Safety, Standard Life

Roger Cotton, Corporate Responsibility Manager, Friends Life

Ann Paul, Organisation Development Director, News UK

Derrick Crowley, Group HR Director, News UK

Heather Peet, Engagement and Communications Manager, Imperial Tobacco

Dr Vicki Culpin, Dean of Faculty, Ashridge Business School Anna Daniels, Owner, Daniels Fitness Group Andy Davidson, Sales Director, Technogym Dr Dorian Dugmore, Chief Executive, Wellness Academy Sally-Anne Etienne, Market Head L&H UK & Ireland, Swiss Re Dr Jill Flint-Taylor, Director, Rusando; Associate Faculty & Research Fellow, Ashridge Business School. Matt Freeland, Senior HR Director European Snacks Supply Chain & European Labour Relations, PepsiCo Dr Philip Gibbs, Director of Product Development, QA & Insights, Global Energy & Resilience CoE, GSKRowan Gray, Consultant, Relume Nick Green, Trainee Solicitor, Bird & Bird

Nia Harris, Colleague Health Nurse, Boots

Sam Perry, Mindfulness & Meditation Trainer, Mind Zone Dr Wolfgang Seidl, Partner & Head of Health Management Consulting EMEA, Mercer Marsh Benefits Julia Simms, Employee Health and Wellbeing Consultant, Bupa Anna Spender, Head of Group Protection Proposition, Friends Life Neil Southam, Head of Operations, Friends Life Group Protection Dr Tara Swart, CEO, The Unlimited Mind Helena Territt, Wellbeing and Inclusion Manager, British Airways Patrick Watt, Director – Corporate, Bupa Dr Zara Whysall, Research Director, Lane4

A number of interviewees preferred to remain anonymous. The report also includes input from a Roundtable organised by Technogym on 8 October 2014.

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