How Wellness Become the Wrong Word

What do employers want more than anything? Healthy, engaged, productive, energized, and thriving employees who provide great customer service and high quality products. What they have is all too often the antithesis of that.

This article is about why and how to move away from “wellness” to “wellbeing.” Wellness is one dimensional—the absence of illness. But for employees to thrive, they need so much more. The essence? They need to be happy with what they are doing and where they are doing it. Without that, good physical health, engagement, and productivity are almost impossible. It’s as simple as that, and with happiness comes success on multiple levels for the employee and the employer. And yet the all too many of today’s American employees are dreadfully unhappy with their jobs and bosses. It’s time for that to change.

The companies that successfully address the deteriorating health (both physical and mental/emotional) of their employees have a huge competitive advantage, and not just from reduced healthcare coverage, but in cultivating more enthusiastic, productive, and engaged employees which drive competitive and financial success through better products and better service.

Dee Edington confirmed this in his book Zero Trends when he wrote: “Our mission is to create shareholder value. We create shareholder value because we have innovative, creative, and quality products and services. We have innovative, creative, and quality products and services because we have healthy and productive people.”

This is, as we say in Massachusetts, “wicked important.” Yet most American CEOs do not yet see it as even rising to their level of attention. That is nothing short of astonishing given how much they pay for healthcare coverage and the truly poor value they receive in return. Starbucks pays more for employee coverage than for coffee. GM pays more for coverage than for steel. Businesses don’t realize it, but they are truly in the healthcare coverage business whether they like it or not. And that doesn’t even begin to total up the costs of disengagement, absenteeism, and turnover.

So, what about today’s garden variety workplace “wellness” programs? In fact, they haven’t worked on virtually any level. The “wellness” industry has deservedly opened itself to criticism that “wellness” investments are a waste of resources. Critics have eviscerated the industry all too often.

Typically, workplace “wellness” initiatives have been developed by HR and floated to senior management for approval with the usual justifications of reducing coverage costs and a healthier workforce. Someone in C-Suite, often NOT the CEO, might approve such proposal and its budget. In rare cases, there might even be some business plan. But little else. There are so many other things to focus on like quarterly dividends, customer relations, and the current crisis, whatever that might be.

And then the matter goes back to HR and becomes largely indistinguishable from any other employee benefit plan. Nice to have, but not strategic in any sense. HR might retain a vendor or hire wellness coaches, and may acquire programs that focus on exercise, smoking cessation, and nutrition. All good things, but not nearly enough. Employers also may do the dance of incentives and penalties, but neither result in long term lifestyle change or improved morale.

After a few years of lukewarm enthusiasm and modest employee participation, someone in C-Suite might ask about the return on the program’s investment. Unfortunately, few companies even try to measure returns, and if they did, the numbers would be indeed disappointing. Even so, shouldn’t something be done about healthcare costs? And wellness programs, whatever their returns, just seem like the right thing to do. That is indeed sloppy thinking.

The reasons why today’s workplace wellness programs have not worked are many, but the most important are: lack of strategic focus with a comprehensive approach; focus almost exclusively on the physical health side ignoring mental and emotional health; lack of CEO leadership; absence of a culture of wellbeing; and a one size fits all approach that appeals primarily to the already healthy and fit.

The stark truth is that the wellness industry has accomplished remarkably little in the areas of return on investment (ROI, which I define as reducing employee claims expense by more than the cost of the wellness programs) and long term lifestyle behavior change. To have any chance at positive ROI, the focus must be on chronic illness with a supportive culture of “wellbeing” and caring to maximize employee and family enthusiastic participation. Yet so often, it is not. Swim, gym, and weights alone won’t do the trick. Programs for smoking cessation, weight loss, exercise, and nutrition (traditional “wellness” programs), while helpful on almost any level, do not truly move the needle on coverage costs or employee engagement. They are one size fits all and quite randomly implemented.

Accordingly, it is submitted that we must move away from “wellness” to “wellbeing.” There is a world of difference between those two similar nouns. When our society and our medical profession refer to “wellness” (as in being well), what they really mean is the absence of illness, almost always the physical kind. “Wellbeing” is far broader, meaning a positive physical, mental, and emotional state. The difference is profound.

Shawn Achor in his book The Happiness Advantage underscores the importance of this point when he writes:

“You can eliminate depression without making someone happy.  You can cure anxiety without teaching someone optimism.  You can return someone to work without improving their job performance.  If all you strive for is diminishing the bad, you’ll only attain the average and you’ll miss out entirely on the opportunity to exceed the average.”

Despite abundant data from Gallup and others showing the central role of employee wellbeing (as opposed to mere wellness) in driving workplace engagement, American employers haven’t taken the cue. And Gallup has been doing this for decades!!

Gallup’s 2016 Q12 Meta-Analysis of The Relationship Between Engagement at Work and Organizational Outcomes makes it abundantly clear how engagement drives measurable and substantial improvement for “customer loyalty metrics, productivity, employee turnover, safety, absenteeism, patient safety and quality.”  According to Gallup, higher engagement means higher profitability.

And when you combine high levels of wellbeing and engagement, magical things happen. Consider that Gallup’s Well-Being Enhances Benefits of Employee Engagement tells us that the benefits of adding high wellbeing to high engagement are enormous with employees reporting:

  • 42% more likely to evaluate their overall lives highly
  • 27% more likely to report “excellent” performance in their own job at work
  • 27% more likely to report “excellent” performance by their organization
  • 45% more likely to report high levels of adaptability in the presence of change
  • 37% more likely to report always recovering “fully” after illness, injury or hardship
  • 59% less likely to look for a job with a different organization in the next 12 months
  • 18% less likely to change employers in a 12-month period
  • 19% more likely to volunteer their time in the past month

So why is a move away from workplace “wellness” to workplace “wellbeing” so wicked haahd (how we say “very difficult” in Massachusetts) to do well? There is a forest for the trees aspect here. It is so obviously the right thing to do on any business level that it is simply missed. It doesn’t sound critically important or strategic. CEOs and boards are distracted by other things and do not connect the dots between employee wellbeing/engagement and operational success. And if they do consider it, many believe that it is like curing world hunger and sitting around the campfire singing songs. After all, they can’t be responsible for what happens away from work. Yet…they can be responsible for what happens at the workplace, which is where many Americans spend more time than anywhere else and is a primary cause of stress.

Once organizational leaders and boards really, really focus on the importance of the difference between employee wellness and wellbeing, they should have an “aha” moment. Workplace wellbeing should be the​ top strategic objective of any company. Done right, workplace wellbeing must be strategically planned, staffed, and financed like any other mission-critical strategic objective. The outcomes that matter must be measured. Leadership, from top, to mid-level, to front line, must be engaged, enthusiastic, and held accountable. When is the last time a CEO was held accountable by his/her board for employee wellbeing? When is the last time organizations based a significant part of executive incentive compensation on employee wellbeing?

Whole person “wellbeing” must become a defining characteristic of the company’s culture and environment. It must become part of how organizations “do business.” And it most definitely is not too much to take on, particularly considering the potential upside benefits as outlined by Gallup.

Employees and their families must come to understand that the company invests in their wellbeing because it truly does value employees. It also happens to be both the right thing to do and very good business that will reap untold dividends.

More to come on this subject. But please, tell me if I’m wrong. And of course, why. And if you disagree with the move to the word “wellbeing,” what word would you use to be the label for what has been described above?

Jim Purcell is the former CEO of Blue Cross & Blue Shield of RI, and prior to that, was a healthcare and trial lawyer in Providence RI. Today, he mediates and arbitrates healthcare disputes, and is writing a book to start a national movement for employee wellbeing. See ReturnsOnWellbeing.com.

5 replies »

  1. i wonder if just focusing on hypertension and obesity would give the most C/B results. After all, we are all chemistry and moving muscles around hardly attacks much relevancy.

  2. I am not a fan of the word wellbeing ..

    It sounds suspiciously like a rebrand of wellness

    Which has unfortunate fru fru connotations that probably doomed it

    Me? I like a straightforward, real word like say happiness

    or maybe

    healthy workplace

  3. Maybe we could take a look at current average costs per licensed or occupied inpatient bed in academic medical centers and community hospitals. Then subtract the amount currently spent on billing and collections. There are huge differences among hospitals in payer mix. For example, NYC’s Health and Hospitals Corporation has 11 hospitals in its system. Roughly 65% of patients are either uninsured or on Medicaid. A large chunk of the rest are on Medicare. Hospitals in wealthier areas, by contrast, have very little uncompensated care and a large base of privately insured patients with very few on Medicaid.

    I’ve never heard of any government run program, department or agency that admits to being overfunded or even adequately funded. They always whine that they’re underfunded. Constituents, for their part, always seem to want more from government than they’re willing to pay for. Maybe they think we can just soak wealthy people ad infinitum so everyone else can have a free ride. So it goes.

  4. The London School of Economics says to think of capital as a tool. More specifically, it is something you do not consume but set aside to generate future cash flow. Your idea is apropos and good.

    This is why I think we have to try, someplace, somewhere, as an experiment, running non-ambulatory acute med and surgical care as a PUBLIC good. It would be a community’s baby, drawing on all the social capital for its birthing, inertia and momentum. It would take all the innovation and effort a community could muster to pull this off.

    But, what we would learn is minimum costs. Skeleton costs. What we could do ‘it’ for. No billing. No insurance. People all on salaries. No consultants telling us about cash management. You get the point. And, of course, we would learn how much financial resource the community is willing to expend to have its own hospital and professionals. We would finally learn what the theoretical minimum costs are needed to run an inpatient all purpose mechine to take care of the sickest among us. We would learn about how much altruism pharma would extend to us and labor unions and federal sharing. We would learn how large and rich a population has to be to support its own hospital. We would learn how much we have to pay physicians to match the quality and productivity demanded by acceptable norms.

    We have to somehow remove non-essential stakeholders for awhile and see what real root cists are.

  5. Oddly, a study of state by state maternal mortality data for 2005 through 2014 might be of value here. The data set appeared recently in OBSTETRICS & GYNECOLOGY, a medical journal published monthly. The October 2016 edition reported the first such data set since the one published for 2001-2006. And the first data set covered 1987-1996.
    Among the 10 lowest or highest nation’s in all three data sets:
    —Among the 10 States with the lowest (best) maternal mortality, 3 States were listed on all three (Alaska, Massachusetts and Rhode Island), 2 States were listed on two of the lists (Maine and Oregon) and 14 States were list on one of the lists.
    —Among the 10 States with the highest (worst) maternal mortality, 4 States were listed on all three (Georgia, Louisiana, Michigan and Mississippi), 6 States were listed on two (Michigan, New Jersey, New Mexico, New York, Oklahoma and South Carolina), and 6 States were listed once.
    —Among the three data sets, the top grouping averaged 4.5 deaths per 100,000 live births annually and the worst grouping averaged 27.5 deaths per 100,000 live births annually.
    The best 10 states would have averaged among the 10 developed Nations (of 51) of the world with the lowest maternal mortality ratios. Among the 10 State that averaged the highest (worst), the average for each data set worsened in each successive data set. The national evaluation of this problem repeated indicates that the absence of equitably available Primary Healthcare, community by community, is a substantial cause of maternal death. It is also likey that a community’s equitable, accessible and efficient level of healthcare generally play a part.
    A case could be made that . Stable HEALTH . is related to the level of Social Capital occurring within the community networks of the citizens (ie, employees or women during a pregnancy) involved. So, here is my definition of Social Capital. It may be defined as:
    —the enduring Caring Relationships
    —within the networks of a community’s citizens,
    —especially the neighborhood network of each citizen’s Family,
    —that enhances the community-wide expression
    —of Collaboration, Reciprocity, and Trust by these citizens
    —to spontaneously resolve the Social Dilemmas
    —they encounter daily within their community’s civil life.
    Though a variety of statistical correlations, it is likely that the cause of causes for State by State maternal mortality is its level of Social Capital. For instance, there is a very high level of poverty in the States with the highest maternal mortality. One could say the opposite for employee HEALTH. The higher an employer builds their institutional Social Capital the better the HEALTH and productivity of their employees.
    Regarding healthcare reform, it is likely that all of our current “levers” for change will be for naught without a nationally promoted, community by community commitment to assure that Primary Healthcare is equitably available to each of its citizens. This effort should be linked to a multi-sector effort to promote an investment process to augment is level of Social Capital. Given the resent hurricane disasters, the study of local and regional disasters has reliably shown that communities with a high levels of Social Capital survive and recover more quickly and thoroughly based on their pre-disaster level of Social Capital.