Organizations are struggling with the transition from a commute-to-the-cubicle, 20th century Industrial Age environment where work is performed during set times in centralized locations to one that affords more control over when and where work is performed. As a result, many are also struggling with wellness programs, finding that staff lack the time in their daily schedules for sustained physical activity, as shown by the recently released 2013 Global Workplace Health and Wellness Report. The findings of the survey 378 organizations in various industries and a link to the report can be found in this Forbes article, Employees Don’t Have Time for Wellness Initiatives.
The survey’s finding that lack of time for exercise is a major obstacle for wellness programs is hardly surprising. The Industrial Age work style consumes most of people’s waking hours and energies in minimum 8-hour-long “shifts” and time sucking, stressful commutes. All involving prolonged sitting that studies show adversely affect health status. Then when they get home mentally exhausted, it’s more inactivity and collapsing onto the couch, often with take-out food. And we wonder why as a society we’re getting fatter and sicker.
Achieving wellness requires exercise. And sustained exercise done at least daily takes time. The implication to be drawn from the Global Workplace Health and Wellness Report is wellness isn’t so much as a “workplace” issue as a personal time management and lifestyle issue.
The good news is organizations have 21st century Information and Communications Technology (ICT) at their disposal to help alleviate the time crunch. ICT allows staff to work most any place and time, affording them more control over their personal schedules to engage in exercise programs in their own communities chosen by them and their health care professionals. While organizations clearly have a stake in the health of their members, health is ultimately an individual lifestyle choice. Making the right choice for health requires organizations provide their members sufficient control over their work schedules to exercise that choice.
BenefitsPro.com has posted an item forecasting four employer wellness trends for 2013 featuring Stephanie Pronk of Aon Hewitt. Pronk emphasizes a point for every employer interested a healthier workforce and lower healthcare costs: that employee wellness cannot be seen simply in the context of the work site, but must create a lifestyle change. “When you think about why safety programs are so successful in organizations, it’s because they’re engrained in the culture,” Pronk is quoted as saying. “It’s part of the way they do their work every day, so we need to work at health and wellness in the same way. We need culture changes to support healthy behaviors in the long term.”
A major health safety hazard of the information and Internet economy of the 21st Century is holding onto outdated 20th Century practices that assume knowledge work can only be performed in a central office location between 8:30 and 5, Monday through Friday. That forces knowledge workers into a sedentary existence that can lead to and aggravate chronic conditions associated with lack of exercise. Riding the commute-to-cubicle treadmill (in a seated position) also sucks valuable time out of their lives, leading many to justifiably claim they lack the time for meaningful, regular exercise and even sufficient sleep. And that’s not even counting the adverse impact on employee engagement and retention. The commute-to-cubicle treadmill isn’t merely a job – it’s a default lifestyle – and an unhealthy one.
Employers that are truly committed to helping their staff members adopt healthier lifestyles must give them the freedom and responsibility to do so by giving them control over their daily schedules. As this blog has noted previously, recently released research has shown the potential of schedule control to support health promoting behaviors – and by extension, healthier lifestyles. Schedule control enables knowledge workers to function whenever and wherever they are productive with the proviso that they stay in communication with their team and management and fulfill their job functions and tasks. It’s an elegant, low cost wellness program that leverages the power of today’s Information and Telecommunications Technology (ICT) and truly represents the kind of organizational cultural change for the 21st Century that Pronk correctly observes is necessary to achieve a healthier workforce.
Knowledge workers earn their livings analyzing, abstracting and communicating. In today’s Information/Internet economy, all too many knowledge workers needlessly do so working under legacy Industrial Age 8-5 office schedules, spending even more time each day relatively immobile than sleeping. Add to that another 1-3 hours spent sitting in a daily commute to a central office location. Month after month, year after year of this occupational lifestyle sets the stage for the development of preventable chronic conditions such as diabetes, hypertension and obesity that drive the health cost curve and the health insurance crisis.
But that’s not all. Lack of physical movement can also dull the knowledge worker’s most important tool: their brain. This Sacramento Bee article cites research linking physical activity to the brain’s ability to perform learning and memory tasks.
The clear conclusion to be drawn is sustained exercise could produce dividends for organizations by not only lowering their healthcare and insurance costs, but also the added bonus of better and more creative thinking. For knowledge organizations, affording workers control over their schedules and time for sustained exercise probably is likely the most cost effective “workplace wellness” program going. A key program component is ditching outmoded Industrial Age commuting and office hours and becoming a more virtual organization and maximizing the use of Information and Communications Technology (ICT). Knowledge work can be done anywhere, and some of the most creative thinking happens during and after sustained exercise. That requires freeing up time for it every work day by getting people out of their cars and cubicles.
In November, the U.S. Department of Health and Human Services (HHS) issued a proposed rule governing wellness programs offered as part of employer-sponsored health plans for plan years beginning January 1, 2014. The proposed rule is aimed at boosting incentive for large employers to increase the health status of their employees since large employers will be continue to be regarded as discrete risk pools under the Patient Protection and Affordable Care Act, whereas small employers will be collectively treated as a single risk pool.
In addition to the traditional participatory wellness programs such as discounts on fitness club memberships, health assessments and seminars, the proposed rules create an enhanced incentive for employers to offer health contingent wellness programs. The contingency? Employees must adopt a lifestyle changes and health improvement plans designed to help them reach target biometric goals such reducing weight, body mass index (BMI), blood pressure, or cholesterol levels. If they hit the prescribed targets, the proposed rule would allow employers to reward the employee with a payout of up to 30 percent of the cost of the employee’s health coverage for the plan year, an increase over the current 20 percent permitted under rules adopted in 2006.
The rulemaking’s preamble suggests HHS believes the increase in the maximum reward is necessary to boost participation in contingent wellness programs. It cites a 2010 survey by NBGH and TowersWatson in which just four percent of responding employers reported offering financial incentives for maintaining a BMI within target levels. Only three percent did so for maintaining targets for blood pressure and cholesterol levels. Based on these numbers, increasing the maximum award level alone isn’t likely to produce a significant increase in the number of employers and employees participating in contingent wellness programs.
However, if such programs were joined with affording employees greater control over when and where they work, participation could increase substantially and employers would see a potentially large payoff in improved employee health status and reduced medical utilization. Schedule control eliminates the “I don’t have time” excuse for not engaging in health promoting behaviors such as regular exercise and getting sufficient amounts of sleep. If employers want employees to take responsibility for their health, they must give them the means to adopt healthy lifestyles and avoid the daily sedentary (and hardly health promoting) routine of commuting to and from and sitting in a centralized office. Plus they would likely enjoy the added bonus of crisper and more creative thinking and better ideas from employees getting plenty of sleep and exercise thanks to having more control over their work schedules.
As organizations increasingly seek ways to improve the health status of their workforces and reduce burgeoning waistlines and health care utilization costs, they must look to new approaches that hold potential for achieving meaningful results. A strategy previously discussed on this blog is affording workers more control over when and where they work – known as schedule control – in which work is seen as an activity and not a destination.
In a 2011 study, schedule control showed promise among knowledge workers who thanks to today’s information and communications technology (ICT) are able to be productive independent of time and place. The study of 659 knowledge workers found that affording them schedule control can promote employee wellness, particularly in terms of prevention behaviors. Another study published in 2007 found a positive association among workers who perceived greater control over their work schedules with hours of sleep and the frequency of physical activity. It concluded schedule control may play an important role in effective worksite health promotion programs.
Health professionals would agree that health promoting behaviors take dedication and time – sufficient time for meaningful exercise and adequate sleep. In recent decades, however, time has become a restricted commodity for full time workers, taking a toll on their health status. Indeed, a 1996 study correlated too insufficient time for both work and family obligations to poor health outcomes. Another study sponsored by Health Canada in 2004 found workers with high levels of work time conflict were in poorer physical and mental health and made greater use of Canada’s health care system.
Schedule control provides a means to take back wasted time and thus offers a potential win-win wellness solution for organizations. Providing it costs organizations virtually nothing and even offers the possible bonus of saving on office space costs. For knowledge workers, it frees up time devoted to a no longer necessary daily commute to the office. (Commuting has been shown in a European study to interfere with patterns of everyday life by restricting free time and reducing sleeping time.) While more study is needed, existing research suggests that perhaps the most promising “worksite wellness” intervention may be to drop the “site” and instead focus on the work and the worker.
California, which once basked in the suntanned imagery of youthful vigor and health and fitness recognizes the shine has faded as its population grows older and more sedentary and obese, spawning an unprecedented increase in chronic, preventable disease. Earlier this year, the administration of Gov. Jerry Brown formed a task force with the vision of restoring the Golden State to the healthiest in the nation by 2022. This week, the Let’s Get Healthy California Task Force released a draft report outlining how the state will achieve that vision based on six goals and associated priorities and health indicators.
Brown and his Health and Human Services Agency Secretary Diana Dooley – who also chairs Covered California, the state’s health benefit exchange — are to be commended for initiating and championing this monumental project. When it comes to something as big as improving the health status of the nation’s most populous state, one of the task force’s members, Dave Regan, president of Service Employees International Union – United Healthcare Workers West, clearly understands what’s needed to generate the enormous momentum to counter the sickly, sedentary status quo. Here’s what he said with the release of the draft report as reported by the California HealthCare Foundation’s California Healthline:
There’s lots and lots of good stuff in here. What I’m thinking about is what’s not in here,” said Dave Regan, president of Service Employees International Union. “I keep going back to two things — 80% of what drives health care costs is behavioral, and only 20% of the cost of health care can be affected by what we do today.”
Regan said there needs to be a bigger change, a cultural change, to affect some of the root causes of rising health care costs and poor health of Californians.
“When you look at the goals and indicators in here, we may have a forest-and-trees effect. The behavioral culture is far more influential than all of us nibbling at the margins. … Unless we change the behaviors of millions of people, then we’re just tilting at windmills.”
Regan’s exactly right. And he need look no further than the state workforce – a large portion represented by his union – to see a glaring example of a subsection of the bigger California health problem. These thousands of state employees need to get out of their offices and cubicles and exercise more. Especially as they drive up the cost of providing them health care with one third driven by chronic conditions and raise serious questions as to whether the state will be able to afford to provide them health coverage in retirement.
But they are held prisoner by a rigid, outmoded Industrial Age work culture that requires them to be at the desks from 8 to 5, Monday through Friday. Most could shift their work outside this fixed time frame and location, thanks to today’s information and communications technology — much of it innovated in California — that makes it easily possible for them to do their jobs in a home office or other locations where they can be productive.
This “work shifting” is an essential cultural change that Regan correctly says is needed because it affords people control over their daily schedules and frees up hours each week of wasted commuting time. A 2011 University of Minnesota study found when people are afforded control over when and where they perform their jobs, they got more sleep and exercise. Schedule control is thus a potentially powerful cultural shift because it enables healthy living – a goal identified in the task force report – and makes it easier for people to adopt healthier lifestyle choices.
NCHC recommendations for reducing health care spending overlook schedule control as key to adoption of healthier lifestyles
The National Coalition on Health Care has issued its recommendations for bending the relentless rise in health care costs, Curbing Costs Improving Care the Path to an Affordable Health Care Future. The bulk of the report focuses on treatment and payment reforms with one section devoted to “Prevention and Population Health.” A key recommendation is sin taxes to deter the consumption of tobacco, alcohol and sweetened beverages. That’s hardly a prevention and wellness strategy.
Conspicuously absent are meaningful recommendations to give people more control over their lives and schedules so they can spend more time engaging in healthy behaviors like getting adequate exercise and sleep and eating a nutritious diet. Achieving it will involve nothing short of a transformation of how we conceptualize knowledge and information-based work and when and where it gets done. We no longer need to commute daily to an office to do it, thanks to the widespread availability of information and communications technology. Here’s how one blogger described this arguably obsolete work routine:
1 – Wake up earlier than you want to.
2 – Get stuck in traffic on the way to work.
3 – Feel stressed all day at work.
4 – Go home, throw a frozen dinner in the microwave because you’re too tired to cook.
5 – Plop down in front of the TV because you’re too exhausted to do anything else.
6 – Go to bed later than you meant to.
7 – Repeat.
This is a toxic societal lifestyle that over time sets the stage for the development of chronic, preventable conditions that drive much of the health care spend. A 2011 University of Minnesota study found when people are afforded control over when and where they perform their jobs, they got more sleep and exercise. Bravo. That’s true, low (negligible) cost prevention that can go a long way toward maintaining health and reducing medical utilization and spending.