In tEWN
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| Last year, I ran a series of blog posts about stress. I appreciate the opportunity to share with readers the "demand control" model of stress, which is embraced by the National Institute for Occupational Safety and Health, but in the US has fallen on deaf ears. Too often, employers' only solution to employee stress is to provide simplistic behavioral programs. While these programs have value, they overstate the role of individual control over stress, and they substantially understate -- in fact, ignore -- the fact that the workplace itself is at the root of most employee stress. Here's an infographic -- courtesy of the innovative folks at Visual Loop and Infographic World -- that depicts the dynamics of workplace stress: |
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| "More than two-thirds of American smokers say they want to quit but only a fraction actually do," reports today's Wall Street Journal. This paints a dreary picture of a smoker's chances of successfully quitting tobacco. But it's a picture that is not entirely accurate. Of course, quitting tobacco (not just cigarettes, but chew and snuff) is one of the hardest things you can do. But let's not overlook the fact that most people in the US who have ever smoked...have quit! "Only a fraction actually do?" Sure. The fraction is one half. The WSJ reported their article based on the newly released MMWR from the Centers for Disease Control and Prevention, which included a summary of tobacco prevalences and quit data for 2001 - 2010. The third sentence of the report reads, Since 2002, the number of former U.S. smokers has exceeded the number of current smokers. Yet the WSJ flavored their article (the online version, at least) with the headline: "Smokers Who Try to Quit Dogged by High Failure Rate." The basis of the WSJ headline (echoed in numerous other media outlets) are three key CDC findings:
So the term "high failure rate" is not quite incorrect. It just neglects to tell the fully story, which is that while the vast majority of smokers will not quit in any given year, most will quit in their lifetime. We need to understand, and let smokers know we understand, how hard it is to quit. But our cessation campaigns also need to promote the fact that most smokers have quit. It's a message that, when properly delivered, is inspiring and motivational. In the hours since the CDC released its report, the online news media are reporting  that smokers want to quit and most of them can' -- they are "dogged by failure" -- and the Comment sections are populated largely by readers talking about how disgusting smoking is and how anyone who really wants to quit just needs to do it. The messages we should be sending, if we really want more people to quit, are:
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[We've been discussing "giving employees what they want." Click here for the previous posts.] Sometimes, what employees want conflicts with what other employees want.In the late 90's, I worked for a small consulting company in northern California. We had eight or nine employees working in a beautifully refurbished old house, and we all took pride in being nontraditional. At some point, the Vice President of Operations (half the employees were VPs) decided she wanted to bring her dog to work, so she adopted a dogs-at-work policy. And she started bringing her coonhound, Dirgo, to the office almost daily. Our vice president of Client Services adopted a nervous 11-month-old boxer, named Bedelia, and this energetic pup also became a standard presence at our workplace. At the time, pets-at-work was considered the ultimate employee benefit at all the cool northern California companies. And you certainly can make a case that pets-at-work promotes wellness and work/life balance. When we had our company meetings in the living room, inevitably Dirgo or Bedelia would try to get everyone's attention, running around, barking, plopping rawhide toys at our feet, or adorably resting their snouts on our laps, which, in Bedelia's case, inevitably left a twin trail of drool on your lap. Some employees were annoyed by this, but more than half  seemed perfectly okay with it. I think some of them just loved dogs so much, and really needed to cup Dirgo's or Bedelia's sweet doggy faces in their hands and tell them in baby tones how "skoochy" they were. You may be thinking, "Bob hates dogs." Not so. I love dogs. But I do get frustrated with dog owners who can't control their pets, or who assume that everyone thinks everything their pet does is just darling. We were nontraditional, alright, and even had a meditation room tucked away on the second floor. The room was fully carpeted with an off-white carpet and had a low slanted ceiling. There wasn't any furniture, just some meditation cushions and an altar-like structure with an incense holder and fake flowers. This room was a cherished workplace benefit, which we felt helped define us. In the early days of the company, we'd occasionally meditate together in this room. Some of us still occasionally found some time to slip away into the meditation room for some solo practice. Not much was held sacred at this workplace, but most of us believed in maintaining sanctity in the much-appreciated space. My office was just outside the meditation room. One day, Dirgo and Bedelia were chasing each other around, causing a racket, as usual. But, suddenly, things got quiet. And after a few minutes, I smelled something rank. I got up to investigate and, sure enough, there in the meditation room, perfectly centered in the middle of the off-white carpet, was a giant pile of fresh, stinky dog poop. Behind me, an ashamed Dirgo, head held low and tail between his legs, was skulking away toward the stairs. Bedelia stood looking at me from an adjacent office, front paws slightly pointed out, breathing hard, eyes wide open and looking like she'd say, "Wow, man. That game got, like, totally out of control. Did you see the giant pile of poop?!" The meditation room became known as the poop room, and immediately lost its allure. The poop room eventually became the office of the Vice President of Marketing (the only one short enough to stand up in there, because of the low slanted ceiling). My Human Resources tweeps will say that this was simply a matter of people (dog owners) needing to be managed. And my Training friends will say it needed some skillful crucial conversations with "I" messages ("I feel like throwing up when your dog poops on the spot in which I expected to achieve nirvana.") But in the real world, where most of us go into a workplace every day and work with a lot of other people, "what employees want" often -- in fact, almost always -- conflicts with what other employees want. One employee's pet-at-work is another employee's poop-at-work. |
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| When I dashed off my video response to Carol Harnett's "Give Employees What They Want" video blog, I vacillated quite a bit. Of course, I want to give employees the wellness programs they want.  But I also want to give them evidence-based wellness programs, which stand the best chance of helping employees improve their health. Let's use, as an example, hydration programs. (If you can't get your mind around the fact that dehydration is not a common health risk among employees in the US, I'll offer up a more readily acceptable example in a future post.) Promoting hydration isn't important, but it's not harmful, either. So why not just give employees what they want and offer hydration programs? You can offer water-drinking tracking tools on your intranet, create 6-week challenges to see which teams of employees can drink the most average glasses of water per day, offer free bottles of water in the lobby, have a chiropractor come in and do a lunch-and-learn on how important it is to drink at least eight 8-0z glasses of water a day, and launch a fun, multi-faceted communications  campaign so that, everywhere employees look, they'll be reminded that drinking a lot of water is one of the most important things they need to remember to do maintain a vibrant, healthy lifestyle. Your employees will love it! They've been convinced that drinking more water is essential, and this is just the type of thing they want. Here's the problem: None of it is true. With just a few exceptions, people don't need to worry about how much water they drink. Thirst can be their guide, and they'll be fine. As a health educator, I believe I should help propagate truth about health. Sometimes, this means dispelling myths. Certainly, I can't see a role for propagating myths. [caption id="attachment_148" align="alignleft" width="150" caption="Beyond the scope of this post: The water fad is an environmental health disaster. In the US in 2005, 25 billion used bottles were landfilled, littered or incinerated."]  [/caption]When we offer programs like hydration programs (and, yes, such programs are out there, and they are popular), we undermine our participants' health literacy, when our responsibility is to promote health literacy. Here's my shocker: I can't say that you shouldn't offer hydration programs. Just like I can't say you shouldn't do "Peep-eating" contests or hot-dog eating contests (though, I wouldn't), or whatever it is your employees want. I'm vacillating again, because my main point remains that giving employees what they want is a noble value but more complicated than it may at first appear. And understand that giving employees what they want will not always coincide with your company's wellness goals. If you're dedicated to chasing after a return-on-investment, rest assured that -- relative to your health care costs -- offering employees programs like hydration campaigns will be all investment, no return. Proceed with eyes wide open. [In my next post, "Give Employees Dog Crap in Their Meditation Rooms?" we'll take a look at what happens when employees' "wants" collide.] |
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| A couple of months ago, Carol Harnett and I engaged in a video dialog about "giving employees what they want." I think I inadvertently took the discussion off-topic, relative to Carol's main point about giving employees the benefits they want. I talked about giving employees the wellness programs they want. As an example of programs employees want, I mentioned programs that promote hydration. As soon as I uttered the hydration example, I regretted it -- but I posted the video anyway. I've seen a lot of unpublished data demonstrating that employees want hydration programs. And I personally receive this feedback from employees frequently. Â In fact, wellness vendors commonly have integrated "hydration tracking" into their exercise and nutrition tracking software, and some have explained to me that they do so because drinking at least 64 oz of water per day is a fundamental element of a healthy lifestyle. So why not use it as an example? [caption id="attachment_143" align="alignleft" width="300" caption="Click thumbnail for full-size mind map. Info provided in text format, below."]  [/caption]The problem is that most people believe that employees -- and everyone else -- not only want hydration programs, but need them. And this is not true. With the exception of employees doing strenuous labor, or those working in hot environments, most are perfectly well hydrated. The idea that dehydration is a significant problem in the U.S. is one of the most tenacious legends of health. And drinking 64 oz of water a day is not, as far as we know, an important part of a healthy lifestyle. The fact that your chiropractor may have told you to drink more water, or your nutritionist has, or your physician -- or the fact that your friend lost 80 pounds drinking water, or that your headaches feel better when you drink a lot of water -- does not mean that most people need to drink more water. Â These sorts of phenomena, indeed, are typical substrate upon which urban legends take root. I'll address in a separate post the pros and cons of promoting a behavior that probably doesn't enhance health, but probably doesn't hurt it either. In the interim, recognizing that this health myth is now deeply ingrained in our society, I understand that you are skeptical. So I've assembled, below, some of the most common myths about hydration and compared them to what the evidence actually shows (I've also included a mind map-ish diagram).
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| Tweet chats and mind maps were made for each other. Below is my first real effort at a mind map -- based on October 19th's CoHealth Tweetchat, "Making Workplace Wellness Social." Click on the thumbnail for the full-sized image. Read a recap of the tweet chat on Greg Matthews' blog. Find out more about CoHealth tweet chats on Fran Melmed''s blog. Fran tells me that the next tweet chat, on November 16, will be about giving employees what they want. I'll be participating and hope you will, too.  |
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| If you've chatted with me lately, or followed my tweets on Twitter, then you probably know that I've gone gaga about mind mapping. Not Lady Gaga -- the old fashioned kind of gaga. I first tried mind mapping three years ago -- using Mindjet to plan a family vacation to Oregon. But I'd jumped straight to the software, bypassing a real understanding of mind mapping, and I got bogged down in the details. Then, last year, I tried using new mind mapping software to illustrate a project I was working on at work. That attempt may have helped me, but when I showed it to team members, it was greeted with profound silence, bewilderment, and polite smiles. I still hadn't even tried to educate myself about mind mapping. But intuitively I recognized its value. Now I've started to understand the Why and the How of mind mapping, and I see tremendous potential: For problem solving in the workplace, for communicating, and, personally, for learning, memory, and unlocking creativity. This weekend, I collaboratively mind mapped, with my family, an upcoming trip to California. It was a huge success, but I'm not going to share the final mind map here because...well...you really don't need to know about my California plans (and dreams!). Besides, I've got something better to share.  I was fortunate enough to come across the work of Jane Genovese, of Learning Fundamentals in Australia. As part of her mission to help make learning more effective and fun, Jane has created beautiful and engaging mind maps on a broad range of topics. She was kind enough to allow me to re-post here her mind map on Behavioral Change Programs. Click on the map to open the full-sized version. Jane's map is extraordinary in the thoroughness with which it depicts the elements of successful wellness programs, and I would recommend it to any health promotion professional -- especially newcomers to the field. I hope you enjoy and learn from Jane's mind map as much as I have. (And please be sure to visit her site. Lots of great mind maps and other innovative resources.) I'll be writing more about mind maps, and publishing my own, and hope to explore with you how we can use mind maps and other visual thinking tools to advance employee wellness (and, beyond that, human resources and organizations overall). I think we are just getting started and the possibilities are endless. What do you think? |
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 Have you been enjoying the recent brouhaha about social networks and health, or "social contagion"? In case you missed it, statisticians and other scientists are in a flap over the analytical methods of Nicholas Christakis and James Fowler, authors of Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives (in which the summarize their research which, they say, shows that components of health such as obesity, tobacco cessation, and happiness spread through networks of "friends"). Carol Harnett did a fine job of deconstructing both sides of the issue in layperson's terms on Fran Melmed's blog. Read it here.Why should those of us in employee wellness care about this? Several reasons, including the fact that social network theory has been advanced as a potential underpinning of successful employee wellness programs -- and products.
So, you can see that social network theory has been permeating the wellness landscape. As such, the credibility of the research is important to us. I am not prepared to dismiss Christakis and Fowler. And assessing the credibility of their work is not the only reason employee wellness professionals should care about, and even participate in, this discourse. We should care because this is how good science is conducted, and we can learn from this critical process, which has been woefully absent from wellness research. In our profession we cite research, or theories that we think of as proven, every day. Yet most of what we consider proven -- wellness ROI, stages of change, health coaching, extrinsic and intrinsic motivation, health risk appraisals, 10,000-step programs -- would probably collapse like a house of cards if they received anything near the scrutiny Christakis' and Fowler's research is receiving. In a New York Times article describing the social networking controversy, Fowler is quoted as saying: “This is how science proceeds. ... We published our methods. We published our data. We said, ‘Look, we think this is important. You should help us figure out how to do this better.’ †This is the spirit we need in employee wellness. Instead of glomming onto weak, biased studies and planting a stake in the ground, we need to criticize and be open to criticism, and always seek to improve. It will make us better, it will serve our program participants, and it will help earn us the credibility that we so desperately seek. "This is how science proceeds." |
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| About a week ago, my friend and colleague Carol Harnett posted a video blog called "Should We Give Employees What They Want?" in her Work.Love.Play.Daily series. Carol is one of America's leading voices in employee benefits, health and productivity management, and performance innovation. Her video struck a chord with me, because it touched on a topic I ponder every day. Ultimately, whether to "give employees what they want" is the pivotal question before HR, Benefits, and Wellness professionals today. So I created a video reply with my own thoughts on the topic, especially as it relates to wellness. The videos are below -- first Carol's, then my reply. Â I'll have more to say about it in an upcoming blog post. In the interim, feel free to add your comments below, or create your own video response! http://www.youtube.com/watch?v=PZlv4rE8tGw&feature=channel_video_title http://www.youtube.com/watch?v=DAuF_PLdy8I&feature=watch_response |
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| In their disjointed but best-selling book, Nudge, Richard Thaler and Cass Sunstein promulgate a trendy school of thought known as behavioral economics. The gist of their position is that bureaucrats are smarter than the rest of the "mindless Humans" (to use their term) and therefore obligated to manipulate our decisions to save us from our hopelessly irrational selves. The manipulation is called a nudge -- "shove" doesn't sell books. The bureaucrats, those creating the nudge, are "choice architects." Of course, truth be known, choice architecture has been around as long as Phillip Morris -- longer even. Thaler and Sunstein spin a web to persuade us that a hodgepodge of existing or proposed social initiatives have a common behavioral economics thread. Men's-room hygiene, substance abuse, fast driving, organ donation, popcorn consumption, and 401(k) enrollment get lumped together as the playthings of choice architects who, for some reason that's never made entirely clear, possess greater powers of reason than the rest of us. The absence of any obvious connection between the various behaviors the authors choose to tackle makes the whole mess difficult to dispute. Inevitably, some of their tactics will serve us well. But does "nudging" men to aim for the center of a urinal qualify as behavioral economics? Is it really comparable to the complex problem of obesity? Is it anything at all? Biometric IntrusionsMeanwhile, corporate-benefits-managers-gone-wild have taken the popularity of behavioral economics -- and its zeal for financial incentives -- as license to do whatever they want, brandishing their copies of Nudge like the torches of an angry mob. In employee wellness, this is most readily visible in schemes that offer financial rewards (often in the form of cheaper health insurance) to employees who reduce their body mass index -- by whatever means possible (starvation, dehydration, and fad diets are known to work well) -- lower their cholesterol and blood pressure, quit smoking, or excel in the employer's or insurer's notoriously flawed disease management programs. Employees' failure or success is carefully monitored with blood draws, swab tests, and other biometric intrusions. With a hubris that would make even Thaler and Sunstein blush, the human resources and benefits elite have dubbed their programs "outcomes-based wellness," pressing home their point that true wellness does not manifest from behaviors like physical activity, healthy eating, and stress management, but by snatching some of your blood and shipping it off to the lab. (In fairness, it's not all their fault. Employee benefits leaders have been worked into a frenzy by being assigned to control something -- health care expenses -- beyond their control. Desperation does not foster rational choice architecture.) In fact, paying employees, or risk-rating their health insurance, for achieving pre-determined medical test results, is not an outcomes-based wellness program any more than paying a high schooler to increase his SAT score makes him a genius. No, these are not wellness programs at all. They are medical surveillance initiatives. Scant EvidenceEmployers are quick to point out that, in the insurance world, premiums have long been tied to levels of measurable risk. You pay more for homeowner's insurance if you live in a flood plain, more for auto insurance if you're a young male, and even more for life insurance if you smoke cigarettes or have out-of-range biometrics. But, then again, when your life insurer samples your blood, they don't call it a wellness program. It's risk-rated insurance -- plain and simple. Wellness professionals should vehemently resist the euphemism "outcomes-based wellness," as it undermines years of hard work genuinely promoting healthy lifestyles and achieving positive outcomes in an environment that respects employees. Don't be fooled. There is scant evidence that paying employees to achieve healthy outcomes, or penalizing them for unhealthy outcomes (Nudge's preferred approach), is an effective strategy for improving health or controlling health care costs. Certainly there is not enough evidence to overshadow the research that suggests that incentives do not work either to motivate sustainable behavioral change or to improve health outcomes. Incentives may even reduce motivation. In the words of The American Cancer Society, The American Diabetes Association, and the American Heart Association, published in their joint issue brief, Financial Incentives to Encourage Healthy Behaviors: Based on evidence to date, ... offering health promotion services such as smoking cessation programs, fitness centers, weight loss programs and exercise classes on-site, and offering healthy vending and food choices throughout the workplace environment will be more effective in improving employee health – and reducing employer health care costs – than applying financial incentives through their employer sponsored insurance plan. Recycle your copy of Nudge -- it will better serve society reincarnated as an eco-friendly fast-food container -- and read the brighter and more evidence-based Drive (by Daniel Pink), or even Punished by Rewards, by Alfie Kohn, for the other side of the story. Don't Nudge. Drive.Behavioral economics, formerly the darling of the Obama administration and, more recently, the Cameron administration in the UK, is gradually being nudged out of government. Only time will tell if this leads to the long overdue recognition of behavioral economics as the "Emperor's New Clothes." There's nothing there at all. Compare Nudge to Drive. Then you can make an informed decision about which approach (if you feel compelled to choose one) is truly most likely to evoke sustainable health behavior change. And, while you're at it, consider which underpinnings -- Nudges's "libertarian paternalism" versus Drive's "autonomy, mastery, and purpose" -- are most likely to support other important business goals, such as employee engagement, trust, retention, and, ultimately, productivity. |
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