Permanent Lifestyle Change
Corporate wellness programs are a $6 billion industry in the United States. Much to the shock and surprise of company owners and the wellness industry, a federally mandated study, released by the Rand Corporation, reported that they do not work.
The Rand study further found that these programs could be expensive with an average annual cost of $521 per employee and a questionable positive return on investment (ROI). Based on the experience of many healthcare professionals the Rand study was not a surprise but a predictable outcome, since lifestyle change is very difficult to achieve on a long-term basis.
My 40-year experience in the trenches of clinical medicine plus my exposure to numerous attempts trying to get seriously ill patients to change lifestyle, help me deal with the Rand study conclusions. Additionally, I will suggest a game plan based on this experience and the role of the corporate culture that may very well produce the outcome that is so desperately needed.
A healthy corporate culture creates a positive attitude among all. Managements and workers together become part of the corporate team, sharing and suggesting ways to improve. They all are concerned with productivity and helping the organization become more successful.
The healthier the culture, the happier the employee, the better the performance, the more profitable the company.
At the risk of over simplifying the establishment of the culture of health, I must confess that it sounds easier than it really is. Even the happiest employee has difficulty in changing habits. The employee comes to his or her workplace with a programmed behavior, and changing that is very difficult. I have spent the greater part of my professional career as a Family.
Doctor and one of my great frustrations was getting my patients to change their bad health habits and lifestyle. Obesity and cigarette smoking are two examples. The classic obese patient is often described as a Yo-Yo. They spend the majority of their lives dieting and then gaining back the weight.
They go up and down as a Yo-Yo. The wellness world has to accept that this behavior will find its way back into their programs and employees will return to their previous lifestyle. Success may be short lived as the bad habits with their programmed comfort, start to find their way back into the employees life and the incentive motivation fails to get the results needed for a positive return on investment.
All of us are the products of programming. We come into this world with a brain that needs to be programmed, just like a computer. We have to learn social graces, behavior and thousands of other responses. To some extent, we fit into the classic description of "Pavlov's dog."
If you recall Pavlov rang a bell and then fed his dog. After a while, all Pavlov had to do was ring the bell and the dog salivated. It is termed a "conditioned response." We all react as conditioned responders and it is very hard to "unlearn" the response.
Plan of Attack
The big question and challenge is how does a wellness program establish a successful, permanent, culture of health. Employers are spending large amounts of money to try to decrease healthcare costs by stimulating employees to change their lifestyles and develop healthier habits. The problem they are having is trying to quantify their ROI (return on investment).
There is no question that the costs of healthcare are increasing rapidly. Company managers are very anxious about the potential increased costs that will be associated with the Affordable Care Act (Obamacare). Many companies are having problems monitoring the ROI with wellness programs over time.
Do in fact, the dollars spent over several years, come back in the form of employee productiveness. Many companies are having difficulty demonstrating this. What does a CEO do when ROI is so important in establishing any program? Current thinking is that perhaps the common ROI should be replaced with VOI (value on investment). VOI focuses on intangible benefits, rather that the traditional tangible ones. Examples are:
- Reinvention of various business processes
- Increasing capabilities of employees
- Developing and encouraging leadership
- Establishing more efficient productive techniques
- Improving the value of the organization by decreasing employee turnover and decreasing costs of training new employees. In addition, companies with a healthy corporate culture gain a reputation in their community that attracts talented and skilled workers.
To Encourage Long Term Success
1. Corporate wellness studies have demonstrated that as a primary motivating factor, employees need to feel that any wellness program has to fit their personal comfort level and lifestyle and they are involved in establishing the program. Studies done at Yale University demonstrate the importance of feeling in control.
This perception of not being in control, whether real or imagined, will lead to a loss of interest. Describing the long-term outcome desired, rather than dictating specific actions and allowing the employee to suggest ways of accomplishing them ultimately improves the outcome. This is why a positive corporate culture is so important. A company with a happy corporate culture and happy employees as members of a team will find success with a wellness program.
2. The program should target those employees at high risk. This group includes those with elevated blood pressure, diabetics, cigarette smoking, obesity and chronic low back problems. From an economic standpoint, the dollars spent to establish this program are better spent on high-risk employees because they are the ones raising the health care costs.
It is estimated that medical costs for obese employees are about 120% higher than for normal weight employees. That does not mean that not all individuals are included. The opportunity should be given to everyone, those at risk, as well as healthy employees.
3. Educating your employees on health issues, is another area that is widely recommended. The problem is that in today's world of television and internet health and wellness programs, it is difficult for anyone not to already know the health hazards of a poor lifestyle.
Lecturing may arouse some interest, but generally most are not interested in hearing another lecture. My years in health education have taught me that lecturing or frightening these individuals does not work. They hear the information, but they do not identify with it or they just turn it off. Their programming tells them it will be the other person who has the problem, not them.
4. My suggestion for a more positive response is to combine educational sessions with peer group meetings. It is amazing how peer pressure can stimulate someone to adapt and change a bad lifestyle. They look at those in the group and start to identify their health risks with those surrounding them.
One only has to look at the successes of interpersonal relationships as in weight watchers or AA to realize that. I have had many alcoholic patients tell me that if it were not for their daily group meetings and the ability to call a fellow AA member, they would be back drinking.
5. Great success has been reported with patient group therapy sessions. Instead of trying the traditional one on one office visit type of approach, bring together a group of co-workers with the same medical problem. In addition to being a cost saving experience, hearing peers describe the same problem you are having and the difficulties they are experiencing trying to solve it, is very effective as a motivator.
6. Workers also feel better about joining a program if they know that they were involved in its creation. Individual counseling also plays a very important role in getting the employee to stay motivated. There also should be follow up sessions in which the employees should be able to discuss their response to the program.
Employee satisfaction surveys are also very important in establishing lifestyle changes. The Center for Disease Control survey reported that 75% of health care successes are based on these surveys. If they get bored or do not like the programs being offered or find other reason to complain they will revert to their old habits and lifestyle and change will not occur.
7. Continuous, validated, health risk assessments also have to be performed to keep the employee in the system. Many programs report that with time they lose contact with the employee. They are also important for giving the employer and employee the ability to see how they are progressing. In addition, it gives the employer an opportunity to give rewards in the form of incentives to those who show improvement and signs of change.
8. Incentives can take many forms; income bonuses, time off, increased vacation days, contribution to health insurance fees, sharing gym dues fees are a few of those offered. The problem with incentives is that after a while, if the employee is unhappy with the activity, as described above, they will no longer participate and their health risks will re-occur.
This has been a major problem reported by many companies. Employees start to label the programs as boring, not fun. To try preventing that from happening new incentives have to be constantly added. This could be the primary reason for companies describing their wellness programs as failures.
In summary, understanding that establishing a culture of health is vital for corporations anxious to decrease their rapidly expanding, bottom line health care costs. The Rand analysis suggests that over 100,000 companies with 50 or more employees have wellness programs in place. Employers seem committed to control their rapidly increasing health care costs. The problem is that many of the organizations offering these programs do not address the problem of the difficulties of maintaining a lifestyle change over the long term.
The employer must accept the fact that time may be the enemy when it comes to ROI. Many of the programs do not include methods of dealing with the difficulties of permanent lifestyle change. In addition, we all will be entering a new era as traditional doctor patient relations are also changing.
The economics creating these changes will also create an environment where employees will have to become more pro-active in their healthcare. The Affordable Care Act will also play a role in how wellness programs are funded, and will mandate many economic controls.
With any wellness program comes the continuing responsibility of keeping the employees interested and involved. Never forget that it is easier to resort to previous bad habits, than to aggressively change them.
In conclusion, I cannot overemphasize the importance of the role your corporate culture plays in establishing a "Culture of Health" in your company. It might not be as easy to measure the VOI, as it is the ROI, but never forget a healthy corporate culture with an integrated Culture of Health will add significant value to your organization. Additionally, in the end, it will improve your bottom line resulting in happier, healthier and more productive employees.
About the Author
Dr. Jerry Kornfeld is a graduate of the University of California Schools of Public Health and School of Medicine and serves on the clinical faculty of the UCLA School of Medicine, He is one of the top rated speakers for Vistage International, a worldwide organization of CEO's. He travels the world educating corporate executives and their employees about wellness issues. He can be reached at. kjbkorn@aol.com and www.askdoctorjerry.com.
