Ah, we hear it all the time. So, you're a corporate wellness company? Yes and no. W3RKWELL is, as far as we know, the only health-related consulting company in the country rooted in behavior analysis. We take our work miles past corporate wellness programs to consider all aspects of health-related behaviors within a company. Do you know the top ten workplace variables associated with the degradation of health (one of them is a lack of control over job duties)? How about ways in which leadership and performance management factor into employee health and business metrics? Don't worry, we'll cover it all. This begins our series on taking a deep-dive into what we do here at W3RKWELL, starting with reviewing an article on ineffective corporate wellness programs. We believe in educating clients on what's out there in addition to creating Corporate Health Heroes. Below is a blog written by our resident Assessment Guru, Miguel Flores.
We have all heard the buzzwords “corporate wellness program”. But, what does that mean? Are they effective, or is this more “science vs sales”? The truth is that changing our behavior is an extremely involved process that includes considering a complex web of variables. As Board Certified Behavior Analysts, we analyze why behaviors occur through a functional analysis, modify specific behaviors using what we know to be true about human behavior, measure that change to ensure effectiveness and then create a generalization plan to ensure sustainability. Here we review the benefits and potential downfalls of employee wellness programs from our behavior analytic perspective.
Employee wellness programs typically include a several components to produce results, from health screenings to daily health regimes. Ron Goetzel, a scientist at the Institute For Health & Productivity Studies at John Hopkins University notes that there are surprisingly few wellness programs that offer a comprehensive approach that incorporate crucial behavioral elements. However, forward-thinking leaders are changing the game. A model for the modern, health-centric culture, Aetna provides a wellness program to their employees that includes three different levels based on needs and budget. The first level, covered by insurance, begins with a health assessment, health coaching program, health record, and medical & disease management. The second level includes those previously mentioned and adds biometric screenings, fitness challenges and incentives for healthy behaviors. The last level extends to provide individualized coaching to the employees. Those who have seen the largest results incorporate behavior-based components and see sustained changes in their mental and physical health. Aetna has reported a savings of $1600 per employee, per year, which they attribute to employees missing less work due to illness and burnout.
Most of the research leads to successful findings (e.g., Parks & Steelma, L., 2008) but other literature paints a different picture. An article review written by Rebecca Greenfield of the SF Gate provided information on a study conducted at The University of Illinois at Urbana-Champaign. The study included 3,300 employees who were enrolled in iThrive, a wellness prgram similar to many corporate wellness programs, where almost half of the employees belonged to a control group that did not receive the program, while the other half did. The iThrive program consisted of a biometric health screening & wellness activity ranging from 6 to 12 weeks, financial rewards of $50-$350 and classes on topics like chronic disease management. The study sought to answer the questions “Does money influence participation?”, “Do wellness programs produce results?” and “Who is likely to participate?”.
As behavior analysts, we identified a critical variable absent in the iThrive program- meaningful reinforcement for health-related behaviors. The money provided to participants in the program, similar to many corporate wellness programs, was not a strong enough incentive to encourage participation, much less actual behavior change. Here, the program developers could have conducted preference assessments to identify more meaningful items or activities to incentivize individuals, like comp days from work, to produce a stronger motivation. Reinforcement is extremely important for behavior change and, depending on the individual, the wrong kind of reinforcement can actually have the opposite effect (ever had someone give you inauthentic praise?). A more efficient option to consider here would have been to provide meaningful reinforcement to participants throughout the program to improve engagement and maintain behavior change. The program could have also included a self-management package to allow employees to develop and track their goals and share progress with others. The employees might have also been provided with options for alternative health behaviors to increase buy-in, autonomy and flexibility. Although in many cases it is likely that money will influence people to participate in a wellness program, behavior change is sustainable over time when it helps the individual access less material reinforcement. For example, in the absence of money- which is a temporary consequence- individuals might experience improved energy or focus, weight loss or increased flexibility. All of these benefits allow individuals to more closely align with their values like playing more easily with their children or experiencing improved productivity at work. A solid, effective corporate wellness program should provide ways for individuals to track and change specific behaviors, the results of which they can tie to meaningful changes in areas of life important to them.
Overall, it’s best to obtain information directly from the employee. From a behavioral perspective, a survey to generate some ideas on what may be more motivating to the individual would increase the likelihood that implementers of this program hit the mark and gain participation. This survey could be split among different types of incentives (e.g., monetary, leisure, self-care, tangible items, etc.) and then be given individually to employees to gather a pool of potential reinforcers. Then, the company might monitor the performance associated with those reinforcers and ensure that what has been chosen is working. And if the chosen reinforcer is not working (i.e., we see a downward trend in healthy behaviors) then reinforcement could be reassessed and modified.
Greenfield also mentioned that “the medical spending habits of the employees who did not have access to the program were almost identical to those of the workers who did”, meaning that those who were enrolled in the program were still spending as much as those who were not enrolled. This calls for further analysis, as data can be tricky to interpret without knowledge of all variables. Perhaps the individuals had unhealthy lifestyles over a long period of time; this would make it more difficult to see immediate change. Or perhaps the effects of such programs take longer to identify, such as sustainable changes in weight loss or the slowing of chronic disease. Moreover, if all participants were people who are generally healthy anyway, we would not expect significant changes between groups.
Something we consider when creating health-centric cultures is to choose specific behaviors known to improve health in measurable ways, like number of vegetables consumed, amount of time spent on tasks before becoming distracted, performance metrics divided by hours worked or even perception of control over job tasks (named one of the top variables involved in employee health!).
Employee wellness programs are on the rise. As more research is done outlining the benefits, additional research might analyze 1) the components with the best outcomes and 2) the overall cost of sustainability over time. While some corporate wellness programs integrate effective components, important behavioral gaps still exist.
(Parks, K., Steelma, L. (2008) “Organizational wellness programs: A meta-analysis. Journal of Occupational Health Psychology. 13(1), 58-68)