Amazon Shows the Way on Wellness — Treat People like Adults

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Since 2000, the government and healthcare industry have sold Americans a bill of goods called workplace wellness, which turns out to have been a colossal waste of billions of dollars.

Most of this money was spent bribing employees to do things that they don’t want to do, such as submit to biometrics, answer intrusive health risk appraisals, and get preventive medical care.

The marketing pitch that wellness makes people healthier and lowers medical care costs, and thus, produces a return on investment for the employer, isn’t true. Wellness also allowed companies to position themselves as employee-friendly, even while wages stagnated and employees morphed into fungible widgets, instead of vital assets in whom employers invested for years or decades.

However, it looks to us as though at least one major US company is treating economic reality seriously, and, consequently, asking its employees to act like adults.

Let’s look at wellness by Amazon.com, which has apparently avoided conventional wellness whole cloth. Despite our best research efforts, we find no evidence that the company makes conventional wellness programming a priority for employees.

It’s a bit ironic that they don’t given the recent spate of tough publicity about the company’s employment practices.

Amazon has been lambasted lately for the plight of the warehouse workers who animate its backroom operation, where constant video surveillance, productivity demands, and getting your bag searched before you go home are the norms. Message boards also detail the pressure-cooker atmosphere of the company’s white collar space, which raises, in our minds, the pointed question of why haven’t they done wellness?

We think it’s because Amazon’s philosophy about work is straightforward: if you work here, expectations are high and relentless. Amazon’s approach to employee well-being seems to be to not have one other than we invite you to grow with us. This is counter-cultural, and it has more to recommend it than first appears obvious.

When you are competing against Walmart and Target, remaining lean and low-cost is critical; wellness drives costs up, not down.

Expecting many staff to work 50, 60, or even 70 hours per week leaves little time for discretionary visits to the doctor that are pointless even before they happen because this superfluous care will save neither lives nor money. When you are not pouring money into coercing employees to join a wellness program, you preserve capital needed to optimize the technologies and product mix that help you grab market share and crush competitors like Best Buy.

Amazon’s corporate environment isn’t for everyone, and leadership appears to recognize that, too, with a new initiative that will actually pay people to leave. Letting people find their way out, or even to a new career on Amazon’s dime, treats people like adults by letting them choose their own path with modest support while they do it. Amazon doesn’t report its medical care spending data and, frankly, we hope they never do. They’re clearly concentrating on more mundane items, such as growing their nearly 25% gross profit margin.

In our view, there are a few things that Amazon could do to treat its people better without damaging growth. Amazon might take a few hints from wellness programs that do work and give people the opportunity to do some things that make them feel good.

They can ensure the food served in warehouses is healthy and inexpensive; give people frequent breaks during the day, and maybe even allow time for short naps; use the layout of the warehouses to build low-cost circuit training loops and actually encourage people to use them. Make sure all employees have access to a fitness facility either onsite or through a subsidized membership.

They could use drones to air-drop healthy snacks to employees in fulfillment periodically throughout the day.

The takeaway is simple: If Amazon’s approach to employee well-being isn’t your preferred operating system, don’t work there. Just because it’s a tough place to work doesn’t make it a toxic place to work, and we submit that the population of Amazon employees are largely a self-selected group who know what they’re getting into.

Treating people like adults and having transparent, adult-like expectations might be the best form of wellness after all.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is also the Wellness Editor-At-Large for THCB.

Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health CostsHow to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.

31 replies »

  1. My apologies, I should specify I don’t if Qliance provides a Diabetes Prevention Program service, but I beileve from their short descriptions their provide self managment education, and I willing to bet they provide smoking cessation resources, the latter being fairly standard in my understanding.

  2. Having no interest in reading this entire thread, I’d just like to point out that Jeff Bezos has made enormous investments in Qliance- a comprehensive health care service, which includes many preventive care services. This idea put forth that preventive care does not save money is at very least hyperbolic. I can’t speak to evidence or success of broadly implemented employee wellness programs, as I’m inclined to suspect those may target people who have no perceptible benefit from them, (so surprise! limited benefits) but numerous lifestyle intervention programs (when implemented in cost-effective group settings as documented in translational studies) have been shown to be cost savings in reduced direct medical expenditures, reduced early retirement, and reduced early mortality. At very least these are nominal cost savings/break even type results, which from the perspective of a no-cost, high effectiveness results, is quite promising when compared to standard care. The most obvious of which would be a smoking cessation program, but similarly instances exist of diabetes prevention programs (in translational studies, the within trial results are of course an order of magnitude higher), and chronic disease self-management education programs.

    Returning to my original point- Jeff Bezos has invested heavily in a provider- Qliance- who includes these very same preventive services. Deciding not to offer a health and wellness program may be correct that it does not show returns in cost avoidance to the employer, but this could easily be related to employee turnover (cost avoidance hardly matters if the employee leaves first) or a poorly implemented program (a prior- a result you would expect from attempting to save money by not hiring wellness coordinator) having little to do with the evidence based preventive services implicitly attacked in this post.

  3. “The difference is that other companies don’t pay you to leave if you don’t like your job.”

    Maybe the policy has more to say about the availability of alternate work than about Amazon’s “kindness”. This incentive to leave does not mean any employee is not performing their duties to expectations – otherwise they could be fired.

    It would help to understand the type of employee Amazon is hiring. If the work is so mind numbing and pressure cooked then it would only be attractive to the under educated in (more) economically depressed areas. That’s where the meat processing industry locates and hires.

  4. These are all very interesting threads. I would add one observation to the “volitional” argument, which can be used in a reductio ad absurdum about any job. The difference is that other companies don’t pay you to leave if you don’t like your job.

  5. Mr Khanna asks how many people at Amazon work against their will…….

    He might benefit by reading Michael Walzer on “trades of last resort” and “desperate exchanges.”

    When a woman resorts to prostitution to feed her children, often in wartime but in peacetime poverty also, she is technically not enslaved.

    But she is pushed into making a repulsive free trade that a compassionate society would try to make unnecessary.

    Where workers are organized, a job which is demanding and exhausting will pay higher wages. I have no problem with the free market working in that instance.

    Of course in agriculture and restaurants and retail and at Amazon, companies create exhausting jobs and then rely on desperate workers to take those jobs for low wages.

  6. Exercise, oh exercise, how do I love thee, let me count the ways. Well, there’s actually only one that matters: nothing does so much to improve nearly everything that is of value. The aramamentarium of medicine is so meager by comparison that the word pathetic is too grand.

    Thermodynamics being a pursuit beyond the ken of most people, the bottom line is that exercise makes people feel better. That’s what every employer should want. And, yes, I’m glad you noted that the longevity benefit ranges up to five years. But, it’s the quality of life impact and compression of morbidity that are most compelling, in my view.

  7. My impression is that Amazon is a non union nightmare.

    Anyone versed in German or Swedish labor law would find many aspects of Amazon to be utterly unbelievable.

    Especially the frequent firing of older and slower workers, if in fact that is what happens.

    The utter lack of job security and tenure might make the bosses happy, but most nations outside the Third World and China place far more restrictions on what management can do.

  8. The problem with exercise is a theoretical one: it’s bound to increase entropy and entropy must have some relation to aging. But empirically you are right, Vik. It does seem to improve survival by somewhere between 18 months and 5 years. Lots of studies. See MedLine.

    The reason it increases entropy is that you are adding heat to a closed system by a chemical reaction of ATP==ADP.

  9. “Either way, this conversation isn’t beneficial to me beyond this last post, so I won’t be responding further.”

    Just as well. Your comments seem rather confused. So, does Amazon treat their workers as “adults” (the core assertion of Vik and Al’s post) or do they treat them like the intractable deserving-of-the-panopticon juvenile delinquents your comments make them out to be?

    BTW, “social engineering” has a specific IT definition that escapes you. You really mean “I/O psychologists.”

  10. Not denying, just questioning deeper – like any good “journalist”.

    “tells me you (1) either work for Amazon, or (2) are an engineer or troll or all of the above.”

    Good journalists don’t assume or guess anything – as they would usually wrong, as you are.

    “so I won’t be responding further”

    Good “journalists” don’t have closed minds, or do they think they know everything they need to know.

  11. Unfortunately that’s the problem. Industrial engineers are not SOCIAL engineers. Engineers look at the physical and tech solutions. They don’t work with people. It’s been my experience as a service provider that engineers are the most difficult people to work with when it comes to social issues and people problems. They don’t, or can’t, factor in the human element. Engineers also like to believe that a simple employee doesn’t have the skill, knowledge or expertise to create anything better than they can envision, so they don’t listen to the input of anyone who isn’t an engineer or architect. They tend to be rigid, narcissistic, opinionated and critical. They are NOT people persons. During my time there I encountered what most factories encounter: people working minimum wage jobs who are treated as robots, not people. The people around me spent most of their time trying to get out work, complaining about work, and doing the bare minimum to get by. Your comment about things “being decided on willy-nilly by floor workers” is indicative of the arrogant attitude of Amazon in general. They simply believe that anyone they hire is too stupid to have creative input. Because engineers don’t work on the floor day in and day out over the long haul they couldn’t possibly understand what works or doesn’t as well as someone who does do it – temp or not. The fact that you’re denying my first hand experience as a temp worker, journalist and trained observer of my environment tells me you (1) either work for Amazon, or (2) are an engineer or troll or all of the above. Either way, this conversation isn’t beneficial to me beyond this last post, so I won’t be responding further.

  12. I just don’t take your description of your experience at face value and the judgement that they were all lazy and stupid.

    Amazon would probably have used industrial engineers to design a time/motion analysis of the steps necessary to complete tasks. It can be easy for a short termer to think how easy it is but is different for someone having to do it day in and day out. These are also the considerations of industrial engineers. The processes were not decided on willy nilly by floor workers.

    That’s my interest.

  13. “I actually worked at the Kentucky fulfillment center as a temp”

    What were your hours?

  14. I actually worked at the Kentucky fulfillment center as a temp while I was also a reporter for the local paper. I was in the warehouse, packing and picking and working the hard jobs. The work is NOT that hard, unless you’re lazy. Within a week I was actually exceeding the performance standards and being told to “slow down” because it made everyone else look bad and would result in Amazon upping their quotas. The goal of the workers seemed to be to slow things down, bitch and moan and complain. That wasn’t the worst. The worst part was showing initiative on the floor. By rearranging my work station I was able to double my output. Supervisors came by, not to learn or congratulate me on finding new ways to work, but to see how I was cheating. They didn’t believe I was truly interested in doing a great job or finding a better way. They were convinced I was scamming or cheating the system. Even when they stood there and WATCHED me for an hour, they didn’t believe that I was on to something. Morons. Since most of them were Black, they made it a race thing…white girl cheating….which was doubly annoying. They assumed everyone was lazy, especially if they were white. They were right…everyone I came into contact with was lazy. There were several people who were temps, like me, and we all worked our asses off, but the permanent employees….really didn’t like their job or want to be there. Good reason Amazon is paranoid, suspicious and can’t recognize quality employees even when they manage to get them. Very back stabbing organization. The employees steal all they can because they feel they are “owed” it for putting up with the culture there. The gates and pat downs are ridiculous because that’s not where goods exit the plant. They need to put cameras and guards at the loading docks and in shipping. It’s been years since I worked there, but if Amazon could learn to respect their workers, treat them like adults and recognize good employees instead of punishing them, they’d do a lot better.

  15. Thanks for the reality check Bobby. There’s always a cost, only good if someone else bears it. Wellness also includes workplace mental health I would think.

    Your point about “volitional” work smacks at the early 1800s textile worker having “volitional” work. Vik tends to exist in a Utopian myth much of the time it seems.

    I think from a customer’s point of view Amazon excels the way I wish more companies did – I do a lot of buying from them. Many other brick and mortor survive now due to size and market control – which amazon does not take for granted. I think I could wait a day or two longer for my order if Amazon made the warehouse floor more humane – tough for others in this instant gratification universe we’ve created.

  16. Bobby: I hate to say it, but I am probably more like Jeff Bezos than I would like to admit. If I ran a company, I would likely do it like the steamroller that I am. Keep up or go run with someone else.

    Now, the difference between me and Bezos is that I would empower people to build the strength to keep up, bind expectations with common sense, and I would be fiercely loyal to those who really tried and pushed themselves. There would be abundant fitness opportunities, lots of healthy food and a culture that would make junk food eating, smoking, non-exercisers feel feel REALLY out of place. I would also ensure that everyone got plenty of time away, even if I had to enforce it. Rest and recreation should be a corporate values. I’ve long admired workplaces that have sabbaticals for employees at all levels after a certain amount of time in service.

    But, on balance, I am not opposed to the love it or leave it mentality.

  17. “we don’t condone any of the practices described in the articles you quote”

    Understood. A book, actually. I have no doubt they’d sue Simon Head for libel were it not materially factual.

    “the decision of whether or not to work at Amazon is volitional”

    Understood as well. albeit just a tad theoretical in an economy where, in the aggregate, job-seekers still outnumber jobs by a ratio of 3:1 (and probably a lot higher in that particular labor pool cohort).

    In Brad Stone’s Amazon/Bezos bio “The Everything Store,” The boss makes no bones about his “love it or leave it” attitude toward his workforce.

    Just an unfortunate choice of title for this post, that’s all. Separate issue from the nominal “wellness policy” thing, I guess.

  18. Bobby: we don’t condone any of the practices described in the articles you quote, which we were aware of when writing the post. Nor do we condone violating OSHA standards, and Amazon and its contractors should be brought to task for violations.

    The fact remains, however, that the decision of whether or not to work at Amazon is volitional. As is the decision to shop Amazon. If the practices are so odious that they strike a negative chord with the consuming public, then maybe Amazon will feel additional pressure to change its practices. We suspect, however, that the consuming public is now well conditioned to the price advantages and service that Amazon offers and that consumers are not very likely to vote with their mice and migrate to other retailers.

  19. Actually, we are unaware of evidence that having “a little expert health advice around the workplace can save oodles.” It might be useful, help head off an occasional preventable issue, but the saving of oodles, which sounds like a technical term from the wellness literature, is pretty speculative.

    We agree that the culture and what it transmits to people is key. We would disagree about the health and economic benefits of exercise. In fact, nothing is more underrated, misunderstood, or underappreciated by employers, wellness advocates, and the medical community.

    Outside of serving healthier foods at subsidized prices, there is no health-related activity that is more powerful at a lower cost than exercise. At any rate, a longevity benefit for exercise is not going to Amazon’s concern because those workers will have long since left their employ. The relevant question about exercise for Amazon and other employers is whether it has a sufficient net present value to the enterprise that it is worth supporting. We say the answer is yes for the reasons enumerated above.

  20. We think you are correct, and it is likely one reason that large firms like Intel have dropped wellness, and we believe GE either has or will soon, but has not yet said so publicly.

  21. “Amazon Shows the Way on Wellness — Treat People like Adults”

    Unfortunate, Irony-Free Zone post title, in light of the apparent reality in the trenches at Amazon.

  22. As vp of human resources and quality at a high tech manufacturing company we closely tracked productivity….sales/employee and net income/employee….and we did employee satisfction surveys every year and
    used them to identify units where there were problems….and we made sure that the manager of the unit in question took corrective action.

    We could not find another manufacturing company in the US who came close to our workers’ productivity….and employee satisfaction was high.

    People like being on a winning team….people like working hard and being productive. People like being treated as adults. That is far more important than promoting wasteful “feel good” programs like wellness programs based on the current fads, groupthink and wishful thinking.

  23. Kim il Bezos

    Amazon’s system of employee monitoring is the most oppressive I have ever come across and combines state-of-the-art surveillance technology with the system of “functional foreman,” introduced by Taylor in the workshops of the Pennsylvania machine-tool industry in the 1890s. In a fine piece of investigative reporting for the London Financial Times, economics correspondent Sarah O’Connor describes how, at Amazon’s center at Rugeley, England, Amazon tags its employees with personal sat-nav (satellite navigation) computers that tell them the route they must travel to shelve consignments of goods, but also set target times for their warehouse journeys and then measure whether targets are met.

    All this information is available to management in real time, and if an employee is behind schedule she will receive a text message pointing this out and telling her to reach her targets or suffer the consequences. At Amazon’s depot in Allentown, Pennsylvania (of which more later), Kate Salasky worked shifts of up to eleven hours a day, mostly spent walking the length and breadth of the warehouse. In March 2011 she received a warning message from her manager, saying that she had been found unproductive during several minutes of her shift, and she was eventually fired. This employee tagging is now in operation at Amazon centers worldwide.

    Whereas some Amazon employees are in constant motion across the floors of its enormous centers— the biggest, in Arizona, is the size of twenty-eight football fields— others work on assembly lines packing goods for shipping. An anonymous German student who worked as a temporary packer at Amazon’s depot in Augsburg, southern Germany, has given a revealing account of work on the line at Amazon. Her account appeared in the daily Frankfurter Allgemeine Zeitung, the stern upholder of German financial orthodoxy and not a publication usually given to accounts of workplace abuse by large and powerful corporations. There were six packing lines at Amazon’s Augsburg center, each with two conveyor belts feeding tables where the packers stood and did the packing. The first conveyor belt fed the table with goods stored in boxes, and the second carried the goods away in sealed packages ready for distribution by UPS, FedEx, and their German counterparts.

    Machines measured whether the packers were meeting their targets for output per hour and whether the finished packages met their targets for weight and so had been packed “the one best way.” But alongside these digital controls there was a team of Taylor’s “functional foremen,” overseers in the full nineteenth-century sense of the term, watching the employees every second to ensure that there was no “time theft,” in the language of Walmart. On the packing lines there were six such foremen, one known in Amazonspeak as a “coworker” and above him five “leads,” whose collective task was to make sure that the line kept moving. Workers would be reprimanded for speaking to one another or for pausing to catch their breath (Verschnaufpause) after an especially tough packing job.

    The functional foreman would record how often the packers went to the bathroom and, if they had not gone to the bathroom nearest the line, why not. The student packer also noticed how, in the manner of Jeremy Bentham’s nineteenth-century panopticon, the architecture of the depot was geared to make surveillance easier, with a bridge positioned at the end of the workstation where an overseer could stand and look down on his wards. 23 However, the task of the depot managers and supervisors was not simply to fight time theft and keep the line moving but also to find ways of making it move still faster. Sometimes this was done using the classic methods of Scientific Management, but at other times higher targets for output were simply proclaimed by management, in the manner of the Soviet workplace during the Stalin era.

    Onetto in his lecture describes in detail how Amazon’s present-day scientific managers go about achieving speedup. They observe the line, create a detailed “process map” of its workings, and then return to the line to look for evidence of waste, or Muda, in the language of the Toyota system. They then draw up a new process map, along with a new and faster “time and motion” regime for the employees. Amazon even brings in veterans of lean production from Toyota itself, whom Onetto describes with some relish as “insultants,” not consultants: “They are really not nice. . . . [T] hey’re samurais, the real last samurais, the guys from the Toyota plants.” But as often as not, higher output targets are declared by Amazon management without explanation or warning, and employees who cannot make the cut are fired. At Amazon’s Allentown depot, Mark Zweifel, twenty-two, worked on the receiving line, “unloading inventory boxes, scanning bar codes and loading products into totes.” After working six months at Amazon, he was told, without warning or explanation, that his target rates for packages had doubled from 250 units per hour to 500.

    Zweifel was able to make the pace, but he saw older workers who could not and were “getting written up a lot” and most of whom were fired. A temporary employee at the same warehouse, in his fifties, worked ten hours a day as a picker, taking items from bins and delivering them to the shelves. He would walk thirteen to fifteen miles daily. He was told he had to pick 1,200 items in a ten-hour shift, or 1 item every thirty seconds. He had to get down on his hands and knees 250 to 300 times a day to do this. He got written up for not working fast enough, and when he was fired only three of the one hundred temporary workers hired with him had survived.

    At the Allentown warehouse, Stephen Dallal, also a “picker,” found that his output targets increased the longer he worked at the warehouse, doubling after six months. “It started with 75 pieces an hour, then 100 pieces an hour. Then 150 pieces an hour. They just got faster and faster.” He too was written up for not meeting his targets and was fired. At the Seattle warehouse where the writer Vanessa Veselka worked as an underground union organizer, an American Stakhnovism pervaded the depot. When she was on the line as a packer and her output slipped, the “lead” was on to her with “I need more from you today. We’re trying to hit 14,000 over these next few hours.”

    Beyond this poisonous mixture of Taylorism and Stakhnovism, laced with twenty-first-century IT, there is, in Amazon’s treatment of its employees, a pervasive culture of meanness and mistrust that sits ill with its moralizing about care and trust— for customers, but not for the employees. So, for example, the company forces its employees to go through scanning checkpoints when both entering and leaving the depots, to guard against theft, and sets up checkpoints within the depot, which employees must stand in line to clear before entering the cafeteria, leading to what Amazon’s German employees call Pausenklau (break theft), shrinking the employee’s lunch break from thirty to twenty minutes, when they barely have time to eat their meal…”

    Perhaps the biggest scandal in Amazon’s recent history took place at its Allentown, Pennsylvania, center during the summer of 2011. The scandal was the subject of a prizewinning series in the Allentown newspaper, the Morning Call, by its reporter Spencer Soper. The series revealed the lengths Amazon was prepared to go to keep costs down and output high and yielded a singular image of Amazon’s ruthlessness— ambulances stationed on hot days at the Amazon center to take employees suffering from heat stroke to the hospital. Despite the summer weather, there was no air-conditioning in the depot, and Amazon refused to let fresh air circulate by opening loading doors at either end of the depot— for fear of theft. Inside the plant there was no slackening of the pace, even as temperatures rose to more than 100 degrees.

    On June 2, 2011, a warehouse employee contacted the US Occupational Safety and Health Administration to report that the heat index had reached 102 degrees in the warehouse and that fifteen workers had collapsed. On June 10 OSHA received a message on its complaints hotline from an emergency room doctor at the Lehigh Valley Hospital: “I’d like to report an unsafe environment with an Amazon facility in Fogelsville. . . . Several patients have come in the last couple of days with heat related injuries.”

    On July 25, with temperatures in the depot reaching 110 degrees, a security guard reported to OSHA that Amazon was refusing to open garage doors to help air circulate and that he had seen two pregnant women taken to a nursing station. Calls to the local ambulance service became so frequent that for five hot days in June and July, ambulances and paramedics were stationed all day at the depot…

    Head, Simon (2014-02-11). Mindless: Why Smarter Machines are Making Dumber Humans (p. 42-44). Basic Books. Kindle Edition.

    It gets worse.

  24. Having a little expert health advice aroung the workplace can save oodles.
    I’m talking about experienced MDs or NPs or PAs who know to keep people with shingles at home. Impetigo. Early flu symptoms. You don’t need much else. After all, the culture sends information to people by osmosis…like don’t smoke and try to keep weight and blood pressure controlled. You don’t want to be dumb and allow people with fevers, e.g., to come to work. Exercise is a little overrated: exercise like crazy for years and you die about 18 months later.