Learning & Discomfort

“The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable…For it is only in such moments, propelled by our

discomfort, that we are likely to step out of our ruts and start searching for different ways or truer

answers.”

M. Scott Peck

EVIDENCE BELIEF

Worksite WellnessAt a Crossroads

Evidence vs. Belief

EVIDENCE BELIEF

Worksite WellnessAt a Crossroads

How successful do we want to be ?How seriously do we want to be taken?

WHATIF?

Lots of:• Questions

• Research

• Resources

A New Paradigm

What If…

Organizational Wellbeing and

Worksite Wellness are

“stuck” in 17th Century

science?

17th Century Science

• Mechanistic

• Reductionist

• Dualistic

• Patriarchal

whole = the sum of its parts

analysis = to break down

matter & spirit separate

aggression, competition and control

17th Century Science

The Purpose of Science:“to torture nature’s secrets from her so

she can be forced out of her natural state and squeezed and molded.”

~ Sir Francis Bacon

Patriarchy

17th Century Science

" Man is more courageous, pugnacious, and energetic than woman,

and has more inventive genius."

Patriarchy

~ Charles Darwin

“Congressional Birth Control Hearing Involves Exactly Zero People Who Have a Uterus”

17th Century Science: Organizations

• “Scientific Management:” Control the Machine

―Human nature to “goof off”―Job tasks broken down to component parts―Pay for production―Micro-managing

Patriarchy Still Alive & Well in Organizations

• Gender Biases

• Success = Masculine Traits:―Money―Power

“Stuck”- The Old ParadigmWorldview — Mechanistic

Science — Reductionist(Whole = sum of its parts)

Culture — Control oriented(hierarchy, patriarchal)

Health — Biomedical(fix the machine)

Traditional Approaches to ChangeExtrinsic (controlled) Motivation

Outdated Outdated

“Stuck”- Worksite Wellness

• Reduce and analyze

• Measure and quantify

• Scare, cajole, pressure, persuade

• Behavior modification

• “Get” people to change

Fear

}Risk Factors

} Control

What If…

Worksite Wellness has

been hijacked by the

Biomedical Model?

Roots of the Biomedical Model

“I consider the body as a machine ...my thought...compares a sick man and an ill-made clock with my idea of healthy man and a well-made clock "

~Renes Descartes

" There is nothing included in the

concept of the body that belongs to

the mind; and nothing in that of the

mind that belongs to the body "

~ Renes Descartes

Roots of the Biomedical Model

Traditional Worksite Wellness

“I believe you have to address the things that matter most

– and those core programs will be pretty much the same

from worksite to worksite. These include physical activity,

proper nutrition and preventive screening…”

Aaron Hardy, The Power Of Incentive Campaigns, WELCOA Absolute Advantage, 2008

To Whom?

Traditional Worksite Wellness

• Health Risk Assessments

• Biometric Screens

• Weight Loss / Nutrition

• Exercise

• Smoking Cessation

• Stress Management

What If…

We’ve been “trapped”

inside the 20th Century’s

“Skinner’s Box”?

Why We Do What We Do

Autonomy & Authenticity:• Actions come from true sense

of self

Control & Alienation:• Actions come from being pressured• Acting without sense of personal

endorsement• Behavior isn’t expression of self

Source: Deci, E. (1995). Why We Do What We Do: Understanding Self-Motivation

Extrinsic Motivation

• Does not produce long-term behavior change • Diminishes performance• Diminishes creativity• Fosters short-term thinking• Encourages cheating, lying, shortcuts, etc.• Becomes habit forming• Reduces or extinguishes intrinsic motivation

Realities of Motivation

1995 2009 20101993

Incentives ??

Curry, Wagner., J.Consult Clin Psych. 1991;59(2):318-323)

Windsor, 1988, J.Behav.Medicine;11:407-21

Matson et al., AJHP 1993;7(4):270-80, 295

Koffman DM , et al., AJHP 1998;13:105-111

Redmond et al., Center on Budget and Priority Policies, June 2007

Cochrane Database of Reviews,Cahill & Perera, 2008, Issue 3

Kevin Volpp et al., Randomized Controlled Trial of Financial Incentives, JAMA 2009;360:699-709

Kramer et al., Behavior Therapy 1986:295-301

Obesity Reviews 2007;9, 355-367

Volpp, Financial Incentive-Based Approaches for Weight Loss, JAMA 2008;300, 2631

Geller, Rudd, et. al. Journal of Safety Research 1987;18:1-17.

Gingerich SB, et al. Impact of financial incentives on behavior change participation and risk reduction in worksite health promotion, American Journal of Health Promotion 2012;27(2)

25 years of workplace research:

Top 13 Reasons Not To Use Incentives

Competitions & Incentives for Smoking Cessation, Kate Cahill and Rafael Perera - April, 2011

Trapped 17th-20th Century

“Words are the most powerful drug used by mankind”

• How do we manage human resources?

• How can we “maximize” human capital?

• What’s best way to “drive” participation?

• How do we “get people” to change?

Rudyard Kipling

What If…

Participation and

Engagement are NOT

the same thing?

Participation & Engagement

• Participation - the act of taking part in something • Engagement - how employees feel about their work

Engaged employees are committed to and excited about their work and willing to go the extra mile to make a

difference

• Incentives increase participation

• Claim improved engagement

Bribing employees to participate may increase the numbers who do. But it says nothing about how they feel about their work.

Participation, Engagement and Incentives

The Penn State Fiasco (2013)Fiasco

“a thing that is a complete failure,

especially in a ludicrous or humiliating way.”

The current proliferation of

worksite wellness programs is

based on faulty research?

non-existent

What If…

The “Safeway Amendment”

“Safeway figured out how to incentivize

people to take better care of themselves, and

they have flat-lined their health care costs for

200,000 employees in the last four years.”

The Rhetoric

Sen. Thomas R. Carper, Democrat, Delaware, Senate Finance Committee, September, 2009

“Safeway designed such a plan in 2005 and

has made continuous improvement each

year. The results have been remarkable, our

health care costs for four years have been

held constant.”

The Rhetoric

Steven A Burd, Safeway CEO, Wall Street Journal, June 12, 2009

The “Safeway Amendment”

The “Safeway Amendment”

“You know, there’s a guy who has

become pretty famous lately, and he’s

the CEO of Safeway… Safeway’s health-

care costs have gone down. Why can’t we

adopt that on a national scale.”

The Rhetoric

Sen. John McCain, Republican, Arizona, Town Hall Meeting, August, 2009

The “Safeway Amendment”

“It’s a program that has helped Safeway cut

health-care spending by 13 percent and workers

save over 20 percent on their premiums... And

we’re open to help employers adopt and expand

programs like these.”

The Rhetoric

President Barack Obama – June – American Medical Association speech

David S. Hilzenrath, Washington Post

“Misleading claims about Safeway wellness incentives shape health-care bill”

Washington Post: Sunday, January 17, 2010

The “Safeway Fiasco”The Reality

• Costs declined by 12.5 % in 2006

• Program was not implemented until 2009—(only 28,000 out of 200,000 employees)

• 1st year of the program costs rose steeply

•

http://ilovebenefits.healthcarebenefitsnetwork.com/?p=3284

What If…

Tying employee health

outcomes to

rewards and punishments

is a mistake?

The “Safeway Amendment”The Reality

“Although it may seem obvious that charging higher premiums for smoking

(body mass index, cholesterol, or blood pressure) would encourage people

to modify their habits to lower their premiums, evidence that differential

premiums change health-related behavior is scant. Indeed, we’re unaware

of any insurance data that convincingly demonstrate such effects.”

Volpp, et. Al, Redesigning Employee Health Incentives, NEJM 2011;365:388-390

The “Safeway Amendment”The Reality

“We also have a pretty good idea of what doesn’t work, and

heading the list are strategies that tie individual employees’ share

of health insurance premiums to health-related behaviors and/or

meeting benchmarks.”

Workplace wellness regulations: First do no harm. The Prevention Institute, The Greenlining Institute, 2013

WELLNESS OR ELSE !

By 2016 the % of employers who will punish employees for not participating in their workplace wellness program is expected to triple.

• Now - 22%• End of 2013 - 36% • By 2016 – 61%

2013 Staying @Work Report from Towers Watson & Company

??

WELLNESS OR ELSE !

Health professionals of all persuasions Punishing employees who don’t comply:

• Something you believe in?

• What you went into your field to do?

• Something that will improve their “wellness”?

Or have we really lost our way?

WELLNESS OR ELSE !

CEO’s, managers, HR, benefits professionals Punishing employees who don’t comply:

• Likely to improve engagement?

• Help employees want to bring their best selves to work each day?

• Enhance employee “wellness”?

Or have we really lost our way?

The “New” Sciences

• Quantum Physics

• Chaos and Complexity

• Psychoneuroimmunology

• Neuroscience

Getting “Unstuck”

Quantum Physics

• Key Learning: - Universe bears little resemblance to a machine

- Vast interconnected living web

- Parts exist as both matter and energy at the same time

- Universe made up of relationship not things

- Parts are difficult to quantify without knowing their relationship to each other and the whole

- Whole can be misunderstood by focusing on the parts

Complex Systems: Nonlinear Causality

• Small changes in a variable can produce huge outcomes

• Everything effects everything

• “The Butterfly Effect”

Chaos & Complexity

0.506

0.506127

Complex Systems: Nonlinear Causality

• Cannot know all initial conditions exactly

• Small errors grow exponentially over time

• Limits ability to predict the future

• Most living systems are complex

• Includes human behavior

Chaos & Complexity

0.506127

0.506

Chaos & Complexity

Prediction

Control

Chaos & Complexity

Psychoneuroimmunology (PNI)

• Matter & spirit are not separate• Thoughts feelings, and emotions

powerfully influence our health• Psycho• Neuro• Immuno

Mind, Body, Spirit Science

Neuroscience

Prefrontal Cortex Basal

Ganglia

Limbic System

Nucleus Accumbens

“Unstuck”- The New ParadigmWorldview — Organic-Living

Science — Holistic (Whole > sum of its parts)

Culture — Relationship-oriented(equalitarian)

Health — Bio-psycho-social-spiritual(holistic, ecological)

Re-Thinking Approaches to ChangeIntrinsic (autonomous) Motivation

Organizational Wellbeing

• Organizational Health Defined:”An organization is healthy when it is whole, consistent, and complete, that is, when its management, operations, strategy and culture fit together and make sense.”

―Minimal Politics―Minimal Confusion―High Morale―High Productivity―Low Turnover

Source: Patrick Lencioni, The Advantage (2012)

Employee Wellbeing

5 Universal, Interconnected Elements:• Career Wellbeing• Social Wellbeing• Financial Wellbeing• Physical Wellbeing

―Emotional Wellbeing

• Community Wellbeing

The 7 Points of Transformation

TP #1: Survey the Land

• Reality Check of Current State:

―Organizational Wellbeing Data

―Employee Wellbeing Data

• Dynamic Complexity / Holistic View

TP #2: Create the Blueprint

• Beginning the Journey…

―Strategic Thinking > Strategic Planning

―Include EVERYONE!

―Telling Your Wellbeing Story

TP #3: Pour the Foundation

Framework for Developing Quality Leaders:1. Enhancing Self-Awareness

2. Building Effective Thinking Skills

3. Developing & Fostering Quality Relationships so Others Can Grow

4. Growing the Organization

TP #4: Frame the House

• Create a Supportive Climate:―Leaders Intentionally Living Values & Desired

Culture―Clear Purpose & Direction for Culture Change―Communication―Wellbeing = Platform for Employee Experience

TP #5: Wire the House

• Rethinking Change - 2 Types of Challenges:

Technical

Adaptive

Ronald A. Heifetz & Donald L. Laurie (December 2001). The Work of Leadership. Harvard Business Review, p. 131-141

TP #6: Decorate the House

• Are Your Programs…―Addressing the issues that have the greatest

impact on employee well-being?―Addressing the issues that have the greatest

impact on organizational health?―Promoting engagement? …or Inhibiting it?―Evidence and experience based?

TP #7: Maintain the House

• Continuous Quality Improvement―Meaningful Evaluation―Engagement > Participation―Course Corrections

Final Thoughts…

It’s a JOURNEY, not a destination!

Our Recommendations

1) Read outside of your profession:• Not just trade journals and vendor research

• PNI, quantum physics, chaos and complexity, neuroscience, motivation

• Leadership and “culture” – not “wellness” culture but real organizational culture.

• Research design and statistics

Our Recommendations

2) Make sure what you are doing is evidence based:

• Can’t do that effectively without spending considerable time doing #1.

• Lack of evidence of efficacy = proceed with great caution.

• Evidence of lack of efficacy = don’t proceed at all.

Our Recommendations

3) Please keep this in mind:

The only way to achieve the goal of having employees act

like creative, thinking, responsible, autonomous adults is to

treat them as if that is exactly what they are.  

How To Build A Thriving Culture at Work

• Rosie and Jon • One-Day Workshop • Tampa, Florida• February 10th or 11th – 2015• More information to follow – SOON !

Featuring: The 7 Points of Transformation