by Rex Miller — This article originally appeared in the November/December 2018 issue of FMJ
Back in the 1970s, the sudden rise in corporate health costs launched wellness programs as a prevention strategy. The reach for better health quickly exploded into a massive “wellness industrial complex” that now consumes US$3.7 trillion globally each year.
The prevention promise simply has not worked. According to available data, wellness programs neither improve health nor reduce costs.1 So, predictably, the industry has lowered the bar despite facing a clear, present and growing health crisis. Many wellness programs now equate simple participation (usually above 15 percent) as “success,” not improved employee health or happiness.
However, that downward spiral was disrupted in 2013 by a dramatic reset that launched three revolutions. A single project drew more than 130 experts and corporate leaders to uncover the root issues driving the health crisis, rethink assumptions about human nature and ask, “How can we work and live healthier and happier?”
The Great Wellness Reset
The 2013 opening of the new Southern California CBRE headquarters presented a showcase of new workplace design and technology. It also provided a textbook case study in successful change leadership by shifting its traditional private office arrangement to a fully open, free address workspace. Many observers assumed that such a dramatic shift might trigger an exodus of key brokers, a potentially disastrous outcome. However, not one broker jumped ship, and that story was shared in the book, Change Your Space, Change Your Culture (Wiley, 2014).
In the first six months after the book’s release, the CBRE office ordered several hundred copies, and more than 14,000 visitors had toured their office in the first eighteen months. What made their space so uniquely magnetic?
CBRE had partnered with Delos to become the first WELL Certified corporate space. It was the first time that building science and medical science converged to build a measurably healthier workplace. That process led to a transformation of not only the office, but also of their culture. CBRE employees openly shared they were happier and healthier. After two years of unflagging enthusiasm, CBRE continued to explore new ways of thinking about work and the workplace. Facility managers, corporate real estate departments and human resources joined that ground-breaking new conversation.
Twelve national leaders representing diverse interests met at the CBRE offices in June 2015 to explore the implications of the project. Was it just an unusually successful project or was it a tectonic shift in the wellness narrative? That question led to the formation of a larger group — more than 130 organizations, specialists, and corporate leaders — in a two-year research project called the Well MindShift Initiative.
The story of that project was told in The Healthy Workplace Nudge (Wiley, 2018), and the group confronted three realities that challenged everything we knew about workplace wellness:
- The alarming rise in chronic disease
- A fundamental misunderstanding of human nature
- The deadly but hidden enemy: chronic stress
We learned that chronic disease makes up 80 percent of a company’s health costs and those costs originate from only 10 percent of its workforce. The bottom line: Wellness programs are primarily designed to prevent the other 90 percent of employees from becoming high risk.
By every measure and analysis, however, only 15 percent of employees make even a token effort to participate in all the wellness programs. A 2018 report by the National Institute of Health on the State of Illinois’ wellness efforts found that of that 15 percent, 10 percent were “inframarginal.” In other words, they would have participated regardless of incentives.
The Great Wellness Reset, however, launched three revolutions that more effectively shift behavior and improves the health of 100 percent of employees without the hassles or costs of programs, and it addresses the number one driver behind the four deadly lifestyle choices.
Revolution 1: Human Nature and the Power of a Gentle Nudge
Wellness programs are divided into two components: disease and lifestyle management. Disease management addresses the unique challenges of employees with complex health issues. Even though they represent 80 percent of a company’s cost this element falls outside what most have come to know as corporate wellness initiatives.
Lifestyle management provides education, incentives and lots of enthusiastic programs to help employees make healthier choices. These programs use traditional assumptions about how humans make risk and reward decisions. In other words, a rational person, given the right information and incentives, will surely choose well. But we all know that’s not how people behave. Yet, corporate wellness programs are built on that flawed premise.2
However, new research, called behavioral economics, begins with the supposition that humans are basically irrational beings. But, predictably irrational. Here’s how Daniel Kahneman, one of the two founders of behavioral economics, describes it:
“…instead of asking, “How can I get him or her to do it?” it starts with a question of, “Why isn’t she doing it already?” Very different question. “Why not?” Then you go one by one systematically, and you ask, “What can I do to make it easier for that person to move?” 3
That thinking led Richard Thaler to the simple idea of a gentle nudge. That is why he won the 2017 Nobel Prize for Economics. Thaler first became known for changing the approach to 401k programs. A simple nudge shifted the choice from an opt-in to an opt-out structure – making the “better” choice easier for millions of Americans. That one little nudge increased 401k participation from 30 percent to 90 percent.
Until recently using nudges was applied primarily to policy. But nudges have also proven effective in design as companies like Google, GoDaddy, Haworth, DPR and many others have demonstrated. They can profoundly influence the behaviors, habits, norms, and even emotions in the workplace.
Revolution 2: A Measurably Healthy Building
After decades of research, we understand how various building elements — lighting, air quality, ergonomics, etc. — impact health and productivity. It was not until the 2013 CBRE project that building and medical science collaborated to provide a systematic framework and standards for creating measurably healthier environments. In addition to the WELL Building Standard, several more benchmarks have emerged. We see this new shift as a tipping point for new facility conversations and investments.
Some early adopters of WELL Certification have completed successful projects for less than a one percent premium over traditional construction. These organizations approached their projects with health and wellbeing as integral design objectives instead of just following a checklist of possible features. That deeper understanding allowed more engaging design and contractor conversations to find trade-offs to accomplish the intended health outcomes with a minimal cost increase.
Furthermore, consider the direct ROI argument compared to traditional wellness programs. A healthy workspace provides positive health benefits to 100 percent of the employees in that space. Wellness programs typically reach only 15 percent. The cost of improving or building a healthy workspace is less than one year’s direct cost for running a wellness program. When you add the indirect and soft costs, it can be as much as 70 to 80 percent less.4 Enhancing the building is primarily a one-time investment, while the cost of wellness programs is perpetual.
Direct savings is merely the tip of the iceberg. Up to 80 percent of a company’s cost is its employees. If those employees feel healthier and happier, the workplace becomes a “force multiplier” for performance. Companies like GoDaddy, Google, Next Jump, Johnson & Johnson and Barry Wehmiller represent just a few of the companies that reflect force multiplier thinking versus a cost containment mindset.
Revolution 3: Tackling Stress, Reducing the Friction of Work
Work has become the fifth leading cause of death. Why? One simple reason: chronic stress.5 It drives the four lifestyle behaviors that lead to chronic disease: overeating, alcohol or drug abuse, smoking and sedentary living.
Those behaviors are the body’s coping solutions to numb the pain of chronic anxiety. That is why foods high in starch and sugar are called comfort foods. Biology is much stronger than any wellness program. Programs designed to coax behavior change must first address root causes and consider human nature. Otherwise, companies will continue down the futile path with a flaring black hole of costs.
Workplace stress is a combination and interaction between six primary sources: interruptions, the friction of getting work done, poor job fit, weak management, high cognitive load and an unhealthy culture. Our role as facility managers can’t address all of these sources, but we can effectively reduce many of them.
How can we use our roles to increase and improve focused work? Can we make it easier to find the right resources or individuals for the task? Is our work environment easy to navigate? Are the messages of the environment supportive of our work and interactions?
Surely, we can and must provide more autonomy through the pure ability and freedom to choose where, when, how and with whom to accomplish our work. How can nudges create and improve cultures of greater connection, acceptance, respect and meaning? Could nudges encourage more meaningful breaks, increase physical movement throughout the day and tilt employees toward better food and drink choices?
These revolutions are just beginning. Healthy design, behavioral nudges and reducing the friction of work are proving to have significant impact both in the quality of our work, and more importantly, the excellence of our lives.
During our research, we discovered several companies that stood out as positive examples. They all shared one common attribute: a belief in the inherent worth of their employees as humans. Sure, most have wellness programs. Their real emphasis, however, was around building healthy cultures and great places where people enjoyed working.
What do human resource and wellness managers think about this message? I found out when I presented these ideas in a general session of the 2018 WELCOA Summit. I had the good fortune of sitting with several HR managers for breakfast and listening to their conversations before I presented. I heard all the frustrations — trying to get better participation, the lack of CEO support, the two-steps-forward-one-step-back struggles and the funding battles for better food options.
I took what I heard and wove it into my closing:
“What would it be like to improve the health of 100 percent of your employees without poking, prodding or prying into their lives? What would it feel like to improve the health and happiness of your employees regardless of the leadership commitment behind your efforts? Imagine for a moment showing management you can do all of this for less than they are currently spending for a single year of programs? Please let me know what how that sounds to you?”
After the presentation, a rush of people eagerly let me know how that sounded. I heard the typical notes of gratitude and a few variations of, “I’ve never heard anything like this.” But, I can summarize a prevalent attitude that day, “This liberated me. You explained how I can do my job and make a real difference in the lives of our employees.”
1 Mattke, Soeren, et al. “A Review of the U.S. Workplace Wellness Market.” Rand Health Quarterly, RAND Corporation, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC5052082/. Accessed 23 Sept. 2017.
2 Beaton, Thomas. “86% Of Employers Use Financial Incentives in Wellness Programs.” HealthPayerIntelligence, 7 May 2018, healthpayerintelligence.com/news/86-of-employers-use-financial-incentives-in-wellness-programs.
3 Dubner, Stephen J. “How to Launch a Behavior-Change Revolution.” Freakonomics.com, October 25, 2017 http://freakonomics.com/podcast/launch-behavior-change-revolution
4 Miller, M. Rex, et al. The Healthy Workplace Nudge: How Healthy People, Cultures, and Buildings Lead to High Performance. John Wiley & Sons, Inc., 2018.
5 Pfeffer, Jeffrey. Dying for a Paycheck: How Modern Management Harms Employee Health and Company Performance–and What We Can Do about It. Harper Business, an Imprint of Harper Collins Publishers, 2018.
Rex Miller is an international award-winning author, advisor and futurist. He started as a project manager in facility management in 1978 joining IFMA in the early 1980s. He holds a master’s in strategic foresight and is a highly accomplished executive coach. Rex has authored several widely read books and received the CoreNet Global Innovator Award and the CoreNet Global Industry Excellence Award. He is also a long-time USPTA Certified Tennis Pro and uses Strenghsfinder in his coaching of a Hall of Fame golfer, a Hall of Tennis player, and the U.S. Olympic Pole Vault Team. Rex has built an extensive career around the ability to see things differently and lead others to think collectively in a way that generates harmonious collaboration, innovative ideas and a plan for progress. This process, MindShift, is also the name of his company. His firm specializes in creating healthy high performing leaders, teams and cultures. They have worked with over 12,000 employees, on some of the largest capital projects and with many leading-edge organizations. His team are experts in turning around wicked issues like shadow culture and toxic teams.