What Small Businesses Need to Know About Employee Wellness Programs
Everyone seems to be talking about employee wellness programs, but figuring out what exactly these programs should include can be confusing. You may be wondering what they are, how to build one, if they work, and if small businesses should be considering them. On this episode, we speak with Michelle Berg of Elevated HR Solutions and Dr. Paul Terry of the Health Enhancement Research Organization (HERO) to answer these questions, guide you in creating an employee wellness program that works, and help you take steps to improve your overall workplace culture.
Michelle Berg: I do see a massive reduction of unplanned sick days and in fact, I don't know if we've had one this year, for example.
Morgan Berna: Wow.
Michelle: They take time off, don't get me wrong.
Michelle: But they are planned and I love that.
Morgan: You're listening to the Small Business Mastermind, a podcast created by Olympia Benefits to help small businesses juggle business, finance, health, and wellness. I'm your host Morgan Berna.
While they're not an entirely new concept, employee wellness programs have been receiving mix attention from employers, researchers and the media over the last couple of years. On the one hand, they're promoted as an avenue to a healthier and more productive workforce but on the other, some suggest these programs have little impact with some going as far as to claim that these programs lead to discriminatory hiring practices.
As an employer, it can be confusing to determine whether you should be creating this type of program at all and if you have one, whether or not it's effective. On this episode, we'll speak with Michelle Berg, who's the CEO and leading lady of Elevated HR Solutions, as well as Dr. Paul Terry, who's a Senior Fellow at HERO and the Editor-in-Chief of the American Journal of Health Promotion, to sort through some of the confusion regarding the effectiveness of these programs and to give you actionable advice to either start a program from scratch or improve on the one you currently have. We'll talk about what an employee wellness program is, how to create one that works for your unique company and what realistic outcomes you can expect from the program.
Our conversation begins with Michelle Berg.
Established in 2010, Michelle Berg has been the leading lady and CEO of Elevated, an organization that helps attract, develop and retain top talent by designing workplace strategies and programs where employees and employers thrive. In 2015, she won the notable award in Calgary for Entrepreneurship. In 2016, she was selected as 1 of 20 top leaders in Calgary Business in Calgary Magazine, as well as headed up the HR team of the year from the Human Resources Institute of Alberta. She was named a finalist for women of inspiration by Canadian Business Chicks in 2017 and in 2018, she won the HR Firm of the Year by Canada Law Magazine. In prior to starting Elevated, she was the Senior Vice-President of HR for a land development company and was responsible for flying around the world, terminating people. That's when she quickly realized her soul needed a massage and it was time to build something greater than herself. She credits her success to an amazing husband and five year old, along with pivoting quickly through bad decisions and total transparency through her own mental wellness journey.
When I began my research I was initially thinking, I don't work in HR, I work in Marketing, I've never done anything like this. To me, thinking about an employee wellness program I thought, free lunches, yoga, that sort of thing.
Michelle: [laughs] Okay. Yeah.
Morgan: Just very very basic and as I was researching more, I was finding that most people say there's really five elements of a comprehensive program: health education; a supportive social and physical environment; integration of the program into the organization’s structure; linking employees to related programs; work-site screenings and education, so it's a lot more into the culture and the overall climate, I suppose of the business. Is that the angle you would take when discussing this with someone or what angle do you kind of come from to give the scope of a wellness program?
Michelle: I think that when I usually start-- I certainly don't start-- again, our employee base is typically the small five to a hundred and so when it comes down to analytics and things that organizations are looking at especially that size. When people come to me and say, "Hey, we need a new wellness program." Or "We'd like to do something around wellness." Some things happened in their organization to usually kick it off or start it off. I think it was as recent as yesterday, we actually had-- one of our clients had somebody who self-harmed over the weekend and I had been talking about wellness and doing something around wellness because the way we approach it is usually as health and wellness, a lot of organizations will say it's health and safety, we look at it as health and wellness, so I'd been talking to them a lot about it and some various programs that they could do. But until something real had happened on their site, it was one of those things that were a back burner thing for them. So, for me, when we look at it, it's a real-time and this is what most small businesses do, it's a real-time, in-the-moment thing going, "Okay wait, I don't want that to happen again." So, how do we prevent that from happening again? That's typical.
Michelle: But in general, because again, when we take a look at a full HR program, health and wellness is part of it. We start doing little things that will drip campaigns around what wellness is and it can be as little as these five tips are better for you, all the way through to Fitbit competitions and so on and so forth. So, I think for me, we certainly don't look at it with-- because it is a small business, we don't look at it with a principled framework, we look at what is one small pivot that we can make today that can make a difference.
Morgan: What got you initially interested in employee wellness?
Michelle: I think what interested me originally in wellness was just I know for myself, I've had my own individual issues. I was an entrepreneur, it's probably the hardest thing to do is a balance of business, a balance of family and so for me, it's always been something that's really near and dear to me. I suffered a lot from post-partum after having my daughter 5 years ago and I knew that there just had to be a different way to do wellness or approach wellness, that's where I've always known. It's something that's important to have in an organization from that perspective. Prior to that, when I was running HR for larger organizations, that was in 2010, I would say that it wasn't even on the radar yet, wellness in 2010.
Michelle: But as soon as I went through my issues and I had so much more empathy, then, for other employees and what I used to get prior to 2010 was, "Oh, they're sick again, they're faking." Or that kind of thing or the biggest wellness program I think that we had was smoking cessation programs back in the day because then, their benefits programs would go down.
Morgan: Yup, right?
Michelle: So that was the precipice, how can we save money? It wasn't about being proactive at all, it was a completely reactive thing. For me, though, when I went through post-partum, I was thinking, "Okay, how can we fix this for other employees?" And so for me, it was I guess, my own individual experience and then we've played around with different wellness programs and again, having the experience we've had, serving 60 different clients across Alberta, we've had to get creative with what wellness looks like. And because I'm usually given very small budgets, we've had to get really creative within it and I really enjoyed that creativity piece and what it came down to for me was really just talking about it and if we can get organizations feeling safe about talking about it. It's one thing to say, "Hey, you can come and talk to me." But then, do the other side of people with what to say back when someone comes to you with something. If we can build programs like that, we're going to get it-- we're going to move wellness and the whole idea, specifically mental wellness further ahead and so, yeah.
Michelle: And I guess, wellness isn't just about mental wellness either, there's everything as it relates to-- I mean, it can be your health fitness, it can be-- what's the other side, I mean I actually also think financial wellness is a big part of wellness, in general.
Morgan: Oh, absolutely. Absolutely.
Michelle: It leads to tons of stress so, I think I've always just wanted to be creative within the space and do something different, knowing that it actually will impact the long-term effects.
Morgan: And that's a good point you make, that companies look at it, sometimes from one dimension so maybe just looking at how can we reduce our sick days or how can we reduce spending on benefits, something like that. What are companies risking by looking at it with such a one-dimensional lens?
Michelle: Well, I think long term employee engagement, first and foremost; loyalty to the company, I know that, intuitively, I think we all know that if an employer cares about their employees and they demonstrate that they care, chances are they're going to show that back even within customer care. An employee is going to be much less likely to leave if they know their employers care, so that's one, I mean I think they could save a ton on costs even just from a recruitment perspective. When I look at it from- "I want to reduce my sick time--" I don't know if that's actually-- we usually say, "Well, no." Actually, what if we looked at the opposite way? And what if we reduced the reactive reasons why people are using their sick days and look at it? What about planning proactive wellness stays and the use of those, knowing that people do have a lot of issues with just getting their life together and so, if we can count it saying, "Hey, actually, if people are proactively scheduling their time to go handle their stuff, they're going to be a much more productive employee." So, I think organizations who aren't thinking about wellness in that way are actually really suffering in terms of productivity or reducing that productivity, which means that they are reducing overall revenues that they would have access to, too.
Morgan: Do you believe that wellness starts with getting buy-in from the leadership team? Is that typically where you would start with the company?
Michelle: I think with any program, for it to be super successful, you definitely do need leadership buy-in. I mean, that's intuitive but to say, "Ugh, my leader doesn't buy into this so I can't do anything." I think that's a really victim-like mentality and I think the best is when-- sometimes when leaders are skeptical, just starting off small. Like again, you don't have to go out there and spend a ton of money on any of these programs. It is as simple as having a conversation, bringing in a speaker at lunch. One of our clients simply put a- "This is my wellness goal for the year." At the bottom of their performance reviews and that's as far as it went because as soon as that they make it known and actionable what their goal is and they tell somebody, the chances of them actually making that goal is that much higher and we didn't make it-- it wasn't mandatory. If you just want to try certain things out and see where they land, I mean at least even just starting the conversation is such a good thing and it opens up to new possibilities but again, you don't have to have total buy-in, you just even start a run group, start a book club, those are all ways of actually supporting wellness in general and you don't leadership buy-in to do that either and once you have some data or some metrics, let's say "Hey, actually, I think that this is really supporting us." Leadership will probably buy in more but again, it is always easiest when you do have leadership buy-in.
Morgan: Yeah. We'd ideally have it, but don't be afraid to take care of yourself.
Morgan: [crosstalk] Maybe not getting the buy-in. Does the size of the business matter? So you say you work from businesses, sort of all sizes when you're working with a smaller company, do they ever say, "Are we too small for this kind of program?" Does that come up?
Michelle: I would say that the smaller you are, the easier it is to build any kind of program and then, just build it so that you can scale and grow with it. The smaller you are, the more inexpensive certain things are.
Morgan: It's true.
Michelle: I mean, when we first started and I bought a Fitbit for every single person in the office and when we started, we were six people big. I have another story about the Fitbit program, I wouldn't actually recommend it but the things is-- so whatever that was $90 at that time, well for 5 or 6 people, that was not a big deal, didn't hurt my budget, it's certainly what have had we grown, right, for example? But it is easier to try things out and kind of innovate and pivot as required when you are smaller but being open to it when you're smaller, means that the conversation continues as you grow.
Morgan: [laughs] Do you want to share that story? I know you've got lots of examples of things that have worked, and we'll get more into that, but you told me a bit about that. I think it's really funny.
Michelle: [laughs] Well, yeah, so the point was, I thought if we could get everyone walking, this was a good thing and I'm highly, highly competitive and so, I mean that's an easy buy-in for me as well and so-- but what I didn't know when I first started the program is that there's literally this thing that you can go into on Google to see how to get steps with your Fitbit. If you go and you google it, it will say "Put it in the laundry." "Put it on your dog." "Put it on…” and then you get all these steps. And it was actually even geared towards Fitbit, "Oh, you're in a competition with your work? This is how you can win." And I realized after I had done something like 35,000 steps in Chicago and I still wasn't winning, somebody has read that Google site as well on our team and yes, so basically when I didn't win it, the whole competition after that, I decided that this was not for us and then we did something more fair if you will.
Morgan: It's so true, though. I feel like I'd look for a way to scam it, too. I wouldn't think of doing the laundry though, that's smart. [laughs]
Michelle: Yeah, I mean, I have to give it to them for that. [laughs]
Morgan: So, of course, there's going to be a little bit of trial and error with any of these. Is this something that you'd recommend every company is focusing on?
Michelle: Yeah, one of the things-- actually, by the end of November as well, every single one of our employees will have what's called First Aid for Mental Health and even just that investment in itself, for people, are going to feel more armed and better about talking about their own wellness, as well as others wellness and it's not just because we are-- obviously, we're a Human Resources Company but I'm getting every single person to go through it. And I think, just that investment of them knowing that: a, we care and that stuff happens, that we're open to that, I think if we can be a really good example for our other organizations, that's what was really important to me. I do see a massive reduction of unplanned sick days and in fact, I don't know if we've had one, this year, for example.
Michelle: They take time off, don't get me wrong.
Michelle: But they are planned and I love that. For us, putting that investment has been-- I can see the return on investment. It's probably not a perfect line but I intuitively know it. I think all companies could consider it, it certainly is again an inexpensive way to support trust initiatives, communication initiatives, which leads again to higher engagement.
Morgan: Well, it makes me think of a lot of the-- I've been reading a lots of blog articles and things kind of about this topic and almost none of them mention issues with mental health, a lot of them just talk about, like you said, sick days, nutrition, this and that and there is a lot of fun in wellness, there's tons of fun you can have with the programs, but that's a good point that it really is, it's people's health at the end of the day. It's a big component of it and there's a tremendous benefit from really taking a look at the different areas of your employees' health.
Michelle: Yeah, and I think it's a full circle so whether it is, yeah, exactly nutrition or whether it is weight management or whether it is family dynamics can hurt employee's health at times. It doesn't matter what it is, at the end of the day, you have to look at it holistically and look at them as a person and when now we're connected and far more connected than we've ever been in terms of technology, yet people are feeling that much more alone than ever before, clearly we need to do something to help reconnect and whatever that looks like, you can do it in lots of different ways and you can have lots of different fun with it but it is important, I think to just keep going at it and not sweep it under the rug like we typically see.
Morgan: Absolutely. I'm curious if you get when you're talking to a new company about their wellness and maybe you're talking to them about their culture, is there any push-back you typically get to people get defensive about putting these programs in or do they deny needing it?
Michelle: Oh, we get lots of push back and definitely, lots of denying it or denying needing it and in fact, if people are going to have mental health issues, there's still a lot of conversations around, I just wish they wouldn't tell me or if they know before it gets too far, maybe we should just let them go. I mean, they care about their benefits and, "Oh, our benefits cost going to go through the roof." And all these things and they think that the costs are too much to have someone on your team like that. But the truth is, there are more people that are struggling with certain things than you will ever know, you'll look at someone and you can't tell whether or not they've got problems or they're going through things and so again, building a culture that is based on trust and you have to have vulnerability in order to build trust, as long as they know that you're going to take care of them, nine times out of ten, that employee is going to take care of you too. People aren't inherently evil. Yes, I've got stories there too. But in general, people are not inherently evil and so as long as you are working toward taking care of them because again, they take their work home and it isn't just this place that you go to anymore, nine to five. They've got to know that you see them as a whole person, not just the person that shows up for work everybody.
Morgan: And I think too, for employees sometimes, they don't know when things are going on with themselves. Sometimes it can be hard to recognize in ourselves. We did a previous episode about burnout, for example, and me doing that interview gave me some insight into times in my life where I felt like that and I've talked to other people who've listened as well. And I wouldn't have been able to point out that that's how I was feeling but having a culture at work where we kind of talk about that sort of thing and we set an expectation that we want people to feel good and motivated and if they're not, it's okay but we have a plan, we can help you, that sort of thing. And that's very helpful because we kind of assumed also, that employees know why they're feeling bad and what's going on and they can deal with it on their own.
Michelle: Yeah, we've actually gone so far as to build out what we call mental health plans and so basically, it's a form and that every single employee fills out that when I'm stressed, this is what I look like, this is what I'm feeling and then we have two-way conversation of I've been told, I'm more erratic or I've been told I'm X, Y or Z and so, you paint this picture of what that looks like and then what we get the employee to do is actually give permission for their colleagues or their team members or their managers to-- it's almost like a safe word and to point it out, to say "Hey, I care about you. These are the things that I'm noticing." And there's an escalation piece that they've written out, they've bought into and again, this costs no money at all to implement but they've written it out and so in one case too, where we know that it actually gets-- we've got one employee who sometimes will go get off their meds when they feel like they're doing really well and so, they've given us permission to actually go call their husband when we're noticing these things because typically, that's what's happening is, when they are falling off the wagon, if you will. If we can get a team around them to show them that we care and put this into play, they've now given us permission when they are of sound mind and maybe not when things are going so bad.
Michelle: And it has just been-- I just know in that particular case, she feels safe because she knows that her team is looking out for her as well.
Morgan: As you say, it must feel wonderful to know that there are people watching--
Michelle: Completely. And caring.
Morgan: And caring.
Michelle: And genuinely caring. It's probably one of my favorites plans and we've done this similar thing where we've had employees go because of an addiction and so when they come back and they had come back a few times and they've gone through treatment a few times and it's very real that that's what happens if you fall off the wagon and so, in this case again, they wrote down the whole plan and now, we've had someone we can call, as soon as we start seeing some of those erratic behaviors happen. And again, as a team, that is both a family and work, we've been able to beat the addiction before it gets to that point where they're off to treatment again. Those are my favorite stories around this.
Morgan: Yeah, that's so great. Instead of people feeling like they have to hide it or yeah, just disappearing for who knows what and maybe losing their job.
Michelle: Exactly. Exactly. It comes down to trust and vulnerability and that very much has to live in the culture in order to build plans like this. But at the end of the day, I think it's something that if an organization can commit to, again they will see the return on investment with loyalty, productivity and all those great things that great employee engagement brings.
Morgan: At this point, I'm sure a lot of you are thinking, "Okay, but do these programs work?" There's been a lot of confusion online, particularly over these past couple of years with the release of two studies that gained popularity for their findings that employee wellness programs don't work. However, while well done, there were issues with the scope of these studies and a lot of assumptions were made based off of their findings. Dr. Paul Terry wrote an article titled "Workplace Health Promotion is Growing Up but Confusion Remains About What Constitutes A Comprehensive Approach." I was able to get Dr.Terry on the phone to help clear up the confusion about employee wellness programs and get his advice about creating an effective program.
Dr. Paul Terry is a Senior Fellow at the Health Enhancement Research Organization, also known as HERO, where he collaborates with HERO members and national experts in planning learning events and supports the HERO team in organizing the annual forum, think tanks and webinars. Terry preceded Karen Mosely as HERO's President. Before HERO, Terry was president and CEO at StayWell Health Management and before StayWell, he served as president and CEO at the Park Nicollet Institute. He earned his Ph.D. from the University of Minnesota and his Masters from Minnesota State University at Mankato, where he was honored with the Distinguished Alumni Humanitarian Award.
Terry is Editor-in-Chief of the American Journal of Health Promotion and is Past President of the Minnesota Public Health Association. He serves on advisory councils for the National Academy of Sciences, The American Heart Association, the Harvard T. H. Chance School of Public Health and the University of North Carolina, Gillings School of Global Public Health. Prevention programs that Dr. Terry developed when the C. Everett Koop National Health Award. Alongside his wife Gail and his children Anna and Will, Paul loves rowing, windsurfing, sailing, kayaking, camping, hiking, biking, and cross country skiing.
Morgan: I came across your article, "Workplace Health Promotion Is Growing Up But Confusion Remains About What Constitutes A Comprehensive Approach" when I was looking into some research about these Employee Wellness Programs and our company, we worked with primarily small business and so, this is something that we've heard clients and prospects expressing interest in, they want to do and they want more information about it. But when I was doing my research, I was finding a lot of the information was quoting a couple of studies that had come out these past couple of years, that either said these programs are just not effective at all or that they really have very diminished results for the companies. And I want to hear from you, what some of the main issues you've seen happening with the research being done around the effectiveness of employee wellness programs.
Dr. Terry: Yeah, you're probably referring to a couple of studies that were picked up by the media just in this past year. One by a gentleman named Song with a woman named Baicker both from Harvard and another by the University of Illinois. Both are excellent researchers, both are impressive in terms of the number of metrics that they were examining, the number of variables that they were interested in. Unfortunately, both in my estimation, don't really represent anything resembling a comprehensive approach to worksite health motion initiative. I just read your LinkedIn piece online, I've just reposted it.
Morgan: Well, thank you.
Dr. Terry: You did a good job of what I have argued, needs more attention to that. It's a social, ecological approach, doing more side well. You describe nice in your article how certainly providing a program is useful and providing some educational offerings are useful. That's the core of what these two studies examined was offering educational class, and offering an educational program but what you are argued so nicely in your LinkedIn piece is that there are many vast practices elements that have a lot more to do with their culture, in which these programs are offered, have a lot to do with the business strategy that your market has. It has a lot to do with whether or not the very way that you organize your company, in the very way that you organize your employee benefits has more to do with whether or not the employees in the large population, a population which does it large, will benefit from these approaches.
And the articles I write for the American Journal of Health Promotion are very aligned, Morgan, with the points you made about a comprehensive approach usually has multiple elements of these studies that you're referring to have two out of the five to ten elements that we talked about. The two elements that they usually study are taking a health screening, that the population levels are offering some health classes or health programs which is exactly what they studied. Anywhere between 15 or 20 and in one case, 35% of the employees took advantage of the education programs.
Unfortunately, most of them will only take advantage of one or two modules and then these researchers went on to do an extensive evaluation again of the whole population, so they have a whole population baseline set of measures and intervention that was relatively modest and targeted that individual volunteers who would want to show up for class and then they a year later, went and measure the health of the whole population. That's really not a comprehensive approach as a social, ecological approach that you argued for in your LinkedIn piece, so I think that's the issue. It's a missed opportunity in my view, Morgan, to help researchers with such impressive variables of metrics. It actually studies a program on the approach to health promotion and not get involved with the other things that you talked about which is a culture change and environmental support, leadership support. With that works, you did a good job of describing the importance of getting the employees and their voice and their values, into the mix of what it is that we have to work out together. So that's what's interesting in these studies.
Morgan: It sounds like it's pretty common for companies to really only look at one or two elements of the wellness. So say--
Dr.Paul: Yeah, well, you know what? There's a national survey that examines that very question. I was pleased to publish it in the American Journal Health Promotion, the journal that I'm the Editor-in-Chief for, the first author of that research is a woman named Laura Lannen. In 2004, she did a national survey of Worksite Health Promotion Programs. Hundreds of companies responded to her questions about, what is your approach, how comprehensive is it? Do you do strategic planning? Do you have leadership support? Is this integrated with other business elements? She found in 2004, that only 7% of companies in the nation do anything resembling a comprehensive approach to wellness. Gladly, she finally repeated that study in 2017, so 13 years later, she did the same study, she included more small companies and what she found is now we've grown in our approach to wellness but she found that vast 17% when she included all these small companies. She added to her new sample. We're doing the 5, in their case, they have 5 elements that they call a comprehensive approach. If you would actually compare it to the original sample that didn't have as many small companies, then I'm afraid it's only 12%. So we went from 7% to 12% of the companies in the nation, who in that survey do comprehensive approach.
So you're right Morgan that the usual work, you know, we're talking 85 plus percent of companies who say they do well in these programs had to do what I described early. They might do a screening, they might do some health education classes, and then they'll do a screening again, say, "Oh, did we move the whole population or not?" And of course, if that's your approach, it's unlikely the whole population's going to change because people who took some classes. The thing that qualifies there as a health educator by training, is that it's not to diss health education programs. In fact, I would say it's the best place to start to change your culture and start offering some education programs. Smokers quit in smoking cessation programs, people with stress learn stress management skills in health education programs, people who are struggling with their weight or nutrition, they actually make good healthy eating choices because of health educating classes. So then there's nothing wrong with that 20 or 30% of people who volunteer into these classes. The study by Song, for example, said, very robust improvements for those who took the classes. So that's great, we're offered classes. If you're going to say, we're trying to change the health of the whole population, you certainly could start with classes but that's not, as your article said, that's not for long to try to change the culture at large.
Morgan: And something you had mentioned in your article was some of the importance of leadership buy-in. How important is it for the leadership to be not only encouraging these programs but participating as well?
Dr. Terry: Yes. You know, I wish it wasn't so important, Morgan. I had a personal conviction that we have to, in this health promotion field, try to figure out like social movements in the country at large. We have to figure out how to build them more bottom-up. How they have more of a grassroots movement that can lift society because we all are backing a bare environment for example. Like our youth are doing-- they have a grassroots leadership movement going on to try to get the adults to wake up to the importance of saving the world. We don't have great examples of that in the works of the wellness movement. Unfortunately, our HERO scorecard, which is a free instrument that people can take to kind of evaluate best practices they are or are using in their approach, finds over and over that when you have strong leadership support, the other metric stands upon the place. You have a better job, you get better participation, you have better pretty much everything if your leaders are really behind it and enthusiastic about it.
Having said that, no one argues that that's not critical. But as I've already alluded to, I'm quite fascinated by those programs and initiatives that really spend a lot of time on champion networks at our conference for HERO. A couple of examples that we featured, the University of Michigan. They have a very robust-- they shoot for 5% of the whole population have employees getting involved with being champions for these initiatives. Mayo Clinic under Kaisa Anderson's leadership there also has a goal of 5%-- imagine that. A population of 40 thousand employees, let's say-- 5% is a big number. Still, more than 3,000 champions that they're training, cultivated and getting active at the department level and trying to be the person who's trying to get better food choices into the cafeteria, or trying to get better breaks, and people who take their breaks trying to kind of get people out walking. So grassroots movement, I think has not been tested as often as we like. And so the ideal scenario would be great leadership and great grassroots shift too.
Morgan: Sort of shifting the responsibility off of the individual to change their behavior and making it more-- it's the overall culture, the whole business is working toward it.
Dr. Terry: What you just described is what most health educators are studying and it's called a social-ecological model. And it certainly says in the sphere of influence, the individual does tend to be at the center in terms of whether or not they're changed and will change and can change and have a high likelihood of changing. But that changes likelihood by surrounded by these other circles of influence. By what the culture in your organization is. What your neighborhood is like, by what your state is like. By what your nation is like, and by what the world is like at large. So I think you're absolutely right that the tension that those of us with interest in health promotion always need to get right is the tension between individual and social responsibility for health. That's often I'm afraid, in the history of the works of health promotion movement, it's always has been at the individual behavior change level, and that's key. But if we don't also have an equal amount of energy into the social change and the environmental change stuff, I think it just makes it really hard for the individual to kind of bear all the weight of creating a healthy workplace.
Morgan: There were some comments on there around these articles that were saying that this could make our companies more inclined to hire people who are lower risk. What did you think about those comments?
Dr. Terry: Yes. That's a really troublesome, almost unnerving premise that the journalists actually, I think were a bit culpable in trying to advance. As well as the researchers. The one study you might be alluding to, the researchers happen to be an economist. And when I say happen to be, I don't think it's a coincidence that they did a lot of their thinking in their article discussion about the class shift in premise behind all these programs as you may have seen in the article I wrote. There's no evidence in their article itself that there's any plan for what many people would call it a regressive tax. Essentially making the incentive such that the less healthy employees would be paying more because they're not participating in these wellness programs.
So there's no evidence including within their study that there is class shifting that was occurring. And in fact, the Song study which was the next one, the Harvard study that got as much attention more so perhaps than the Illinois study, found no such difference between the participants and the non-participants. They didn't find any evidence that there was higher cost or health care utilization by participants versus non-participant. So they essentially negated the point that was trying to be made by the University of Illinois. I called it pernicious, that very premise is a pernicious idea that a wellness program could actually be designed to be a regressive approach. Not only is it illegal, class shift, it's just unethical. I mean, what program would put together a wellness program in their company with this sort of self-act of saying and let's essentially tax our overweight or our over-stressed or our lonely people or unhappy people, you name it. This is what we call as unnerving any risk factor you want to name. The idea that the employer would say, "Let's sack it to our less healthy people." It's simply-- is not the world I live in. So I don't know where people come up with these ideas.
But I work with hundreds of companies every year and they're all doing it for the right reasons, at least the ones I work with. There may be some bad apples around, but thankfully, I never have to deal with them. So it's just not in my experience, Morgan, to find anyone who put these initiatives together for anything but the right reasons.
Morgan: Yes. I found that to be really interesting, a kind of perspective that a lot of blog articles I was reading were kind of running away with. But that's good to hear in practice, people aren't doing that. I wanted to ask, for a company that feels like they don't have a very strong culture, do they need to fix their culture first before adding in wellness programs? Or should it kind of all happen together?
Dr. Terry: You know, that is a great question because there are folks who say fix the culture first, and I get at where they're coming from. Wouldn't it be nice if all the environments that we all work in are healthy enough that we-- it's easy for us to make the right healthy choices. Unfortunately, the world that I've worked in is not that way. And I always feel the opposite of those who say, "Fix the culture first before you try these health education programs." I've been a health coach, in fact as I was a CEO of a wellness company in years past, I thought it was important to actually get in the saddle and listen through our clients who are taking advantage of health coaching because my training isn't health education after all.
And I would find that often it was the case that some of the employees would mainly take advantage of a wellness initiative, like having free access to a health coach because the employer had put a financial incentive at place. And so there's an example where it's something of a culture play to say we think this is important enough that we're going to create some financial incentive for you. What people worry about, which I've written about this as much as anybody, the possibility that financial incentives can backfire and strip your intrinsic motivation can actually replace the right reason for doing it. And if you're doing it for the wrong reason, the sustainability of that behavior changes probably less likely.
What I found thankful in most of the time, was these folks, once they did have that nudge, and once they did take advantage of the financial incentive and sign up for example with a health coach, they found out with health coaches we didn't care about what incentive they had, we cared about what goals they wanted to accomplish. We cared about what they wanted to do differently with their lives and we were there to listen and to support and cheer them on. And so almost invariably as much as the incentive might have been, you got to stay on free calls to get your incentive. A good coach and a good relationship, we were saying, "You know, you want to keep working out on this stuff together?" And they'd say, "Yes. This is kind of a cool benefit." Free access to a health coach. How cool is that? When I started this field, health coaching would have been something only available to the top executives. They want things like health screening. If you told me thirty years into my career that all the stuff that used to be an executive perk would be available freely to all employees in these big companies, I'd say "Really? That's pretty darn cool."
So the answer back to your original question about-- is it about culture or individual behavior change, these are not competing elements. Health education programs or coaching programs are a part of the culture. In fact, I would argue that the easiest place to start in a culture is to simply offer up health coaching, offer up health education programs. It's not the end game, of course, as we've discussed earlier, but it's a great way to start. I found as a health coach that sometimes my most challenging and interesting and in many ways, successful health coaching participants work in toxic environments. That they were taking advantage of the health coach because they wanted to dump on me about how hard it was to be healthy in the place that they're working.
And I think, in our field if there's any shift change going on, I love that in the early decades of this work and worksite wellness, it really was about individual interventions and trying to help people change their individual health habits. As often as not-- and that will make them a better worker-- as often as not, the discussions we have in our think tanks, in our conferences, is how do you change the work itself? How do you change the work environment itself such that change is easier at the individual level? So, it's almost a big shift change flip. But it's one that I think in the end will get both of them going, good individual interventions, good environmental change interventions. And when we get both of those working equally well, I think we're going to be much more effective, and see fewer studies like the last couple we saw.
Morgan: Yes, absolutely. I wanted to ask - if there's a business, let's say a smaller business and they're looking to get started with some employee wellness, where would you recommend they start?
Dr. Terry: Well, I loved your article again. I recommend they read your article first, Morgan, because what you said, essentially my read on it was- start with the employees' needs and values. Let me tell you the Institute of Medicine's definition of patient-centered care that applies to person-centered health motion. It's care that is respectful of and responsive to patient preferences, needs, and values and assures that patient values drive all medical decision making. So, that definition's a mouthful but it essentially says what your article said that if you really want a robust approach to health and well-being in your workplace, start with the employees. Start with their voices, get them involved in strategic planning, get them involved as champions, and really get them to help tell you what you can do to help. And if that means, change part of my job, change part of my schedule, change part of my work flexibility, change part of how we do the work here, then get ready to hear that because that's what your job is. To be responsive to the employees and what the other culture's going. And it also would be, give us better food choices, give us more opportunities for cooking class, give us a farmer's market outside when we walk out the door. So they'll come up with great ideas.
Let me also answer your question by telling you the textbook definition of health education itself. So, the textbook says, health education is any combination of learning experiences designed to facilitate voluntary adaptations of actions conducive to health. That too is a mouthful, but you might have heard a couple of keywords in there. One is that it's a combination of learning experiences. Not one thing, it's not a class or a culture, or a change in the policy at work. It's all these combinations of things that you try overtime. You heard me emphasize the word voluntary. We got to a lot to do with this stuff. You can't put any incentive no matter how big to get me to quit smoking if I don't want to quit smoking. But so it's not one thing, it's a combination. We're throwing experiences, it has to be voluntary, they have to be ready and they have to find the thing that's ready in itself. I hope that's a helpful answer. But again, they want the real answer, read Morgan's article on LinkedIn.
Morgan: If you’d like to read the article Dr. Terry mentioned there, it is called “Do Employee Wellness Programs Actually Work” and you can find it at olympiabenefits.com/blog.
Okay so, knowing what an employee wellness program is, is a very important part of creating this type of program, but knowing where to start can be difficult. Michelle Berg helped us out.
Morgan: So, from that let’s naturally move into implementing one of these programs. So, if I'm a business owner, and I've never done something like this, I've just never thought about it. We have, say, like a health plan for our employees, we've never really thought of this wellness thing. I imagine from what we're talking about here, you'd want to start to look at your overall culture first and then determine some areas where you could work off of. Is that the approach you would take?
Michelle: Yes. Especially a smaller organization, I would probably involve them as a leader. I would say, "Hey, I really want us-- I've been noticing X. I really wanted to get to Y. Can we come up with some ideas together?" I know in some organizations, we've started wellness committees who have established what is our goals. So maybe it's just four events a year. But as much as leadership buy-in needs to be there, employee buy-in also needs to be there for it to continue. And so asking them their opinion is super important.
I had one client who loved yoga. She's the executive director of an organization. She loves yoga, she thinks yoga is everything. I think she could even be a yogi. And so she came in, guns a-blazing saying, "We're going to do yoga every week." And she thought that was a great benefit. But the buy-in, there are only two people that showed up every week. And in fact, some people said, "Actually yoga makes me feel really uncomfortable. I don't feel like I can actually-- I'm not flexible. I don't know how to do it. And then when the instructor comes around and they touch me, I don't like being touched." I love the idea of yoga too. Well, I personally don't love yoga-- but I love the idea that she had for her organization and thought it should go over well. But when it fell so flat, that really just taught me again, too, "Oh, man, yeah, we need to ensure that we incorporate the majority and what's going to work for them in that culture." Because it's not a one-size-fits-all kind of program.
Morgan: Yes. Because I think there's some concern there that if you just implement something, like you said, implementing just a yoga class, something, without really consulting all the employees and seeing what everyone wants, I imagine you risk alienating the people who might need these wellness programs more. Maybe someone isn't comfortable exercising in a group setting. Maybe someone does have some mental health issues they'd like to deal with, but they're not comfortable going to a seminar about it at lunch. So really being mindful of where your team's at.
Michelle: Yes. And being okay too-- on the flip side, I always say too, is maybe if you don't have buy-in right away, but you got to demonstrate that you're going to keep up with it, you're going to keep up the conversation, that helps too. So, we get a lot of false starts in a lot of ways, and then we also got the- "I just give up. I was trying to do something good," kind of thing. And, yeah, just make sure you know what your plan is and then you got to stick to it.
Morgan: Yes. Are there things that shouldn't be included in a company wellness program?
Michelle: I really struggle with the weight loss programs that I've been seeing. I think they are too because it's all predicated typically on sharing how heavy you are. And that's just a number. Just always think about the risk of alienation and what that looks like. And that can look like even from sharing around the circle, you have to have-- when you're sharing about mental wellness, you have to have a really safe organization where it's not going to be used or in place, could be targeted because of what they decide to share. Leadership has to really make sure that if they want to go down that path, there might be some things they don't want to hear. And again, I personally think that that risk is so small but it does come up. And employers need to be aware of those factors.
Morgan: Yes. So as a company is looking at their culture in, kind of, deciding what to do, make sure the things you settle on trying are things you actually would like to follow through with. Because, like you said, yes, something could be said, or something could come up that you might not have considered.
Michelle: Yes. And I mean for me, I feel like it's easy because again, I've talked a lot about my postpartum depression and how that has continued to affect me. I've been very vocal about it so it's easy for me to go down that path with my team. But I know that there is a ton of trepidation even for new employees when they join the organization, they always look at me and go, "Is this for real? Is this actually safe? We can actually say these kinds of things." And we're human resources company. So again, just understanding that not everyone feels comfortable to share, that's okay too.
Morgan: Would you say there's a risk-- we talked a little bit about mental health. Are there other areas, or is mental health one of the areas companies overlook more when they're looking into wellness programs?
Michelle: Yes. I think mental health is still very new on the scene as it relates to wellness. I think when you still hear about wellness programs it is very much the fitness side of things. That's what I see most. I think there's still so much trepidation and people are scared of mental wellness or having conversations around it. Because again, I don't think we're doing enough to equip people to have those conversations. So, I definitely still see that it's a lot easier to say, "I'm going to go walk around the block three times a week--" than it is to say, "I'm going to go see my psychologist once a week."
And I think even too where I still see like the finance side. I see such a stress on most people. But people are also scared to talk about that, too, especially in an open environment, especially with their colleagues. But I see that as a total picture. But yes, I think when people think wellness, "Oh, we've got a wellness program, we do something fitness related." That's typical and there's still a lot of work to be done on the mental wellness side.
Morgan: Can a company of quite a small budget implement an employee wellness program that is effective and is helpful?
Michelle: I do believe that a company of any size and any budget can implement a wellness program. Because at the end of the day, it really just starts with talking. Whether it's going for a lunch break walk, those are all things that just don't cost anything, but you need someone to spearhead and lead. And if no one's willing to take the reins, then it never happens. And so championing just that, who wants to come up with the best idea that's free and at the end of the quarter, we're going to vote on whose idea was the best. You go try out different things and you see which ones stick. But I think, again, the cost is really-- you can get so creative that any size of organization can implement a wellness program that actually does make a difference. Because it just simply starts with talking about it.
Morgan: Can and should a company be looking to measure results from these types of programs? And if they should, do you have any metrics in mind they could look at?
Michelle: So, let me start of actually with your question of should they? I think anytime you're doing any type of investment, you do want to know what your return on investment is. The thing with wellness programs is that there is still a lot of intangible results that are shown that you couldn't necessarily have a baseline, to begin with. I mean, a lot of wellness programs actually just bring about a culture shift and so were you less trusting? And how did you gauge that first and foremost?
I will say that those organizations that do invest in wellness, it's almost a feeling you get when you walk in. And again, because for really good wellness programs, holistic wellness programs to be working, trust and transparency is there. You do see it, you do sense it. But things like you know, certainly, things like how often are your benefits, your group health, and dental benefits? Are the costs rising? What were they before you started your wellness program and what are they afterward? And I think it's two-fold too, sometimes with health and dental benefits, people don't really want to tell you what it is that is in your plan so you don't use it. Which I think is the complete opposite reason for having a health and dental plan. But knowing where-- you can certainly look at where they're using things. And are they using more proactive things? Like I would love to see my drug costs go down and my massage and chiro go up. Because people are being proactive with their health.
Morgan: Yes, absolutely.
Michelle: So those are things that you can start to look at. Then, of course, like we said, the sick days. Do they start to drop? But instead of looking in it as less sick days, again, planned. Those days that are planned sick days. I know for myself, I have a team member that I have to push getting her to take vacation time off. She has to go-- it's one of her goals that I make her take one week every quarter off. And I have to push her to do it. Because if she doesn’t she gets really silly when she doesn't take that time away for herself. And so even looking at your vacation, and having people plan out their vacation in advanced and taking that time off, so you can look at productivity before and after those certain things--
Morgan: I imagine retention too?
Michelle: Retention-- I mean retention is just, it's more than a wellness program but it certainly could be one of the factors. Again that's one of the intangible results. Because you can't say that it's totally tied to wellness. But those are all analytics that you can be looking at that certainly support the need for wellness. And then even your engagement result. So if you're doing annual engagement surveys, you could even ask questions there before post and-- pre and post, with your wellness program to measure, "Hey, is this something that you actually like? And do you see a benefit in this?"
Morgan: Yes. Do you believe that employers have a social responsibility to keep their workforce healthy?
Michelle: Absolutely, I do. I think that social responsibility, in general, is going to be the biggest workforce trend in-- coming up in 2025. And you can't go out on a soapbox and say that social responsibility is something that you care about externally when you're not doing the same thing internally. So for me, I think it's absolutely imperative because it is going to, again, it is already becoming a big factor in why people are choosing to go work at certain organizations because they want to know what their stance on their corporate social responsibility is. And yes, I think that it is absolutely imperative to be thinking about the person holistically if you're expecting them to give you so much of their life to you.
How employees are treated and how they treat each other is a direct correlation to how they will treat your customers, as well. And again, Simon Sinek said it, but, "Your customers won't love you until your employees do first.” And in order to do that, you have to demonstrate just the basic caring, empathy, again, trust, transparency.
Morgan: Thanks for tuning in to this episode of the Small Business Mastermind. If you enjoyed this episode, please be sure to subscribe to this podcast. If you'd like to learn more about employee wellness programs, please visit olympiabenefits.com/blog where you'll find many articles on the topic including the one that Dr. Terry discussed on this episode, as well as a free eBook available for you to download. We have new episodes coming very soon so be sure to stay tuned. I'll talk to you again soon.
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