2. Learning & Discomfort
“The truth is that our finest moments are most likely to
occur when we are feeling deeply uncomfortable…
For it is only in such moments, propelled by our
discomfort, that we are likely to step out of our ruts
and start searching for different ways or truer
answers.”
M. Scott Peck

3. EVIDENCE BELIEF
Worksite Wellness
At a Crossroads

4. Evidence vs. Belief

5. EVIDENCE BELIEF
Worksite Wellness
At a Crossroads
How successful do we want to be ?
How seriously do we want to be taken?

6. WHAT
IF?
Lots of:
• Questions
• Research
• Resources

7. What If…

8. 17th Century Science
• Mechanistic
• Reductionist
• Dualistic
• Patriarchal
whole = the sum of its parts
analysis = to break down
matter & spirit separate
aggression, competition and control

9. 17th Century Science
The Purpose of Science:
“to torture nature’s secrets from her so
she can be forced out of her natural
state and squeezed and molded.”
~ Sir Francis Bacon
Patriarchy

10. 17th Century Science
" Man is more courageous, pugnacious,
and energetic than woman,
and has more inventive genius."
Patriarchy
~ Charles Darwin

11. “Congressional Birth Control Hearing Involves Exactly Zero People
Who Have a Uterus”

12. 17th Century Science: Organizations
• “Scientific Management:” Control the
Machine
―Human nature to “goof off”
―Job tasks broken down to component parts
―Pay for production
―Micro-managing

13. Patriarchy Still Alive & Well in Organizations
• Gender Biases
• Success = Masculine Traits:
―Money
―Power

14. “Stuck”- The Old Paradigm
Worldview — Mechanistic
Science — Reductionist
(Whole = sum of its parts)
Culture — Control oriented
(hierarchy, patriarchal)
Health — Biomedical
(fix the machine)
Traditional Approaches to Change
Extrinsic (controlled) Motivation
Outdated Outdated

15. “Stuck”- Worksite Wellness
• Reduce and analyze
• Measure and quantify
• Scare, cajole, pressure, persuade
• Behavior modification
• “Get” people to change
 Fear
}Risk Factors
}Control

16. What If…

17. Roots of the Biomedical Model
“I consider the body as a machine ...my
thought...compares a sick man and an
ill-made clock with my idea of healthy
man and a well-made clock "
~Renes Descartes

18. " There is nothing included in the
concept of the body that belongs to
the mind; and nothing in that of the
mind that belongs to the body "
~ Renes Descartes
Roots of the Biomedical Model

19. Traditional Worksite Wellness
“I believe you have to address the things that matter most
– and those core programs will be pretty much the same
from worksite to worksite. These include physical
activity, proper nutrition and preventive screening…”
Aaron Hardy, The Power Of Incentive Campaigns, WELCOA Absolute Advantage, 2008

20. Traditional Worksite Wellness
• Health Risk Assessments
• Biometric Screens
• Weight Loss / Nutrition
• Exercise
• Smoking Cessation
• Stress Management

21. What If…

22. Why We Do What We Do
Autonomy & Authenticity:
• Actions come from true sense
of self
Control & Alienation:
• Actions come from being pressured
• Acting without sense of personal
endorsement
• Behavior isn’t expression of self
Source: Deci, E. (1995). Why We Do What We Do: Understanding Self-Motivation

23. Extrinsic Motivation
• Does not produce long-term behavior change
• Diminishes performance
• Diminishes creativity
• Fosters short-term thinking
• Encourages cheating, lying, shortcuts, etc.
• Becomes habit forming
• Reduces or extinguishes intrinsic motivation

24. Realities of Motivation
1995 2009 20101993

25. Incentives ??
Curry, Wagner., J.Consult Clin Psych. 1991;59(2):318-323)
Windsor, 1988, J.Behav.Medicine;11:407-21
Matson et al., AJHP 1993;7(4):270-80, 295
Koffman DM , et al., AJHP 1998;13:105-111
Redmond et al., Center on Budget and Priority Policies, June 2007
Cochrane Database of Reviews,Cahill & Perera, 2008, Issue 3
Kevin Volpp et al., Randomized Controlled Trial of Financial Incentives, JAMA 2009;360:699-709
Kramer et al., Behavior Therapy 1986:295-301
Obesity Reviews 2007;9, 355-367
Volpp, Financial Incentive-Based Approaches for Weight Loss, JAMA 2008;300, 2631
Geller, Rudd, et. al. Journal of Safety Research 1987;18:1-17.
Gingerich SB, et al. Impact of financial incentives on behavior change participation and risk
reduction in worksite health promotion, American Journal of Health Promotion 2012;27(2)
25 years of workplace
research:
Top 13 Reasons Not To
Use Incentives
Competitions & Incentives for Smoking Cessation, Kate Cahill and Rafael Perera - April, 2011

26. Trapped 17th-20th Century
“Words are the most
powerful drug used by mankind”
• How do we manage human resources?
• How can we “maximize” human capital?
• What’s best way to “drive” participation?
• How do we “get people” to change?
Rudyard Kipling

27. What If…

28. Participation & Engagement
• Participation - the act of taking part in something
• Engagement - how employees feel about their work
Engaged employees are committed to and excited about
their work and willing to go the extra mile to make a
difference

29. • Incentives increase participation
• Claim improved engagement
Bribing employees to participate may increase the numbers who do.
But it says nothing about how they feel about their work.
Participation, Engagement and Incentives

30. The Penn State Fiasco (2013)
Fiasco
“a thing that is a complete
failure,
especially in a ludicrous or
humiliating way.”

31. What If…

32. The “Safeway Amendment”
“Safeway figured out how to incentivize
people to take better care of themselves, and
they have flat-lined their health care costs for
200,000 employees in the last four years.”
The Rhetoric
Sen. Thomas R. Carper, Democrat, Delaware, Senate Finance Committee, September, 2009

33. “Safeway designed such a plan in 2005 and
has made continuous improvement each
year. The results have been remarkable, our
health care costs for four years have been
held constant.”
The Rhetoric
Steven A Burd, Safeway CEO, Wall Street Journal, June 12, 2009
The “Safeway Amendment”

34. The “Safeway Amendment”
“You know, there’s a guy who has
become pretty famous lately, and he’s
the CEO of Safeway… Safeway’s health-
care costs have gone down. Why can’t
we adopt that on a national scale.”
The Rhetoric
Sen. John McCain, Republican, Arizona, Town Hall Meeting, August, 2009

35. The “Safeway Amendment”
“It’s a program that has helped Safeway cut
health-care spending by 13 percent and workers
save over 20 percent on their premiums... And
we’re open to help employers adopt and expand
programs like these.”
The Rhetoric
President Barack Obama – June – American Medical Association speech

36. David S. Hilzenrath, Washington Post
“Misleading claims about Safeway wellness incentives
shape health-care bill”
Washington Post: Sunday, January 17, 2010

37. The “Safeway Fiasco”
The Reality
• Costs declined by 12.5 % in 2006
• Program was not implemented until 2009
—(only 28,000 out of 200,000 employees)
• 1st year of the program costs rose steeply
•
http://ilovebenefits.healthcarebenefitsnetwork.com/?p=3284

38. What If…

39. The “Safeway Amendment”
The Reality
“Although it may seem obvious that charging higher premiums for smoking
(body mass index, cholesterol, or blood pressure) would encourage people
to modify their habits to lower their premiums, evidence that differential
premiums change health-related behavior is scant. Indeed, we’re unaware
of any insurance data that convincingly demonstrate such effects.”
Volpp, et. Al, Redesigning Employee Health Incentives, NEJM 2011;365:388-390

40. The “Safeway Amendment”
The Reality
“We also have a pretty good idea of what doesn’t work, and
heading the list are strategies that tie individual employees’ share
of health insurance premiums to health-related behaviors and/or
meeting benchmarks.”
Workplace wellness regulations: First do no harm. The Prevention Institute, The Greenlining Institute, 2013

41. WELLNESS OR ELSE !
By 2016 the % of employers who will punish
employees for not participating in their workplace
wellness program is expected to triple.
• Now - 22%
• End of 2013 - 36%
• By 2016 – 61%
2013 Staying @Work Report from Towers Watson & Company
??

42. WELLNESS OR ELSE !
Health professionals of all persuasions
Punishing employees who don’t comply:
• Something you believe in?
• What you went into your field to do?
• Something that will improve their “wellness”?
Or have we really lost our way?

43. WELLNESS OR ELSE !
CEO’s, managers, HR, benefits professionals
Punishing employees who don’t comply:
• Likely to improve engagement?
• Help employees want to bring their best selves to work each day?
• Enhance employee “wellness”?
Or have we really lost our way?

44. The “New” Sciences
• Quantum Physics
• Chaos and Complexity
• Psychoneuroimmunology
• Neuroscience
Getting “Unstuck”

45. Quantum Physics
• Key Learning:
- Universe bears little resemblance to a machine
- Vast interconnected living web
- Parts exist as both matter and energy at the same time
- Universe made up of relationship not things
- Parts are difficult to quantify without knowing their
relationship to each other and the whole
- Whole can be misunderstood by focusing on the parts

46. Complex Systems: Nonlinear Causality
• Small changes in a variable can produce huge outcomes
• Everything effects everything
• “The Butterfly Effect”
Chaos & Complexity
0.506
0.506127

47. Complex Systems: Nonlinear Causality
• Cannot know all initial conditions exactly
• Small errors grow exponentially over time
• Limits ability to predict the future
• Most living systems are complex
• Includes human behavior
Chaos & Complexity
0.506127
0.506

48. Chaos & Complexity

49. Chaos & Complexity

50. Psychoneuroimmunology (PNI)
• Matter & spirit are not separate
• Thoughts feelings, and emotions
powerfully influence our health
• Psycho
• Neuro
• Immuno
Mind, Body, Spirit Science

51. Neuroscience
Prefrontal
Cortex Basal
Ganglia
Limbic
System
Nucleus
Accumbens

52. “Unstuck”- The New Paradigm
Worldview — Organic-Living
Science — Holistic
(Whole > sum of its parts)
Culture — Relationship-oriented
(equalitarian)
Health — Bio-psycho-social-spiritual
(holistic, ecological)
Re-Thinking Approaches to Change
Intrinsic (autonomous) Motivation

53. Organizational Wellbeing
• Organizational Health Defined:
”An organization is healthy when it is whole, consistent, and
complete, that is, when its management, operations, strategy and
culture fit together and make sense.”
―Minimal Politics
―Minimal Confusion
―High Morale
―High Productivity
―Low Turnover
Source: Patrick Lencioni, The Advantage (2012)

54. Employee Wellbeing
5 Universal, Interconnected Elements:
• Career Wellbeing
• Social Wellbeing
• Financial Wellbeing
• Physical Wellbeing
―Emotional Wellbeing
• Community Wellbeing

55. The 7 Points of Transformation

56. TP #1: Survey the Land
• Reality Check of Current State:
―Organizational Wellbeing Data
―Employee Wellbeing Data
• Dynamic Complexity / Holistic View

57. TP #2: Create the Blueprint
• Beginning the Journey…
―Strategic Thinking > Strategic Planning
―Include EVERYONE!
―Telling Your Wellbeing Story

58. TP #3: Pour the Foundation
Framework for Developing Quality Leaders:
1. Enhancing Self-Awareness
2. Building Effective Thinking Skills
3. Developing & Fostering Quality Relationships so
Others Can Grow
4. Growing the Organization

59. TP #4: Frame the House
• Create a Supportive Climate:
―Leaders Intentionally Living Values & Desired
Culture
―Clear Purpose & Direction for Culture Change
―Communication
―Wellbeing = Platform for Employee Experience

60. TP #5: Wire the House
• Rethinking Change - 2 Types of Challenges:
Technical
Adaptive
Ronald A. Heifetz & Donald L. Laurie (December 2001). The Work of Leadership. Harvard Business Review, p. 131-141

61. TP #6: Decorate the House
• Are Your Programs…
―Addressing the issues that have the greatest
impact on employee well-being?
―Addressing the issues that have the greatest
impact on organizational health?
―Promoting engagement? …or Inhibiting it?
―Evidence and experience based?

62. TP #7: Maintain the House
• Continuous Quality Improvement
―Meaningful Evaluation
―Engagement > Participation
―Course Corrections

63. Final Thoughts…
It’s a JOURNEY, not a destination!

64. Our Recommendations
1) Read outside of your profession:
• Not just trade journals and vendor research
• PNI, quantum physics, chaos and complexity, neuroscience,
motivation
• Leadership and “culture” – not “wellness” culture but real
organizational culture.
• Research design and statistics

65. Our Recommendations
2) Make sure what you are doing is evidence based:
• Can’t do that effectively without spending considerable time doing
#1.
• Lack of evidence of efficacy = proceed with great caution.
• Evidence of lack of efficacy = don’t proceed at all.

66. Our Recommendations
3) Please keep this in mind:
The only way to achieve the goal of having employees act
like creative, thinking, responsible, autonomous adults is to
treat them as if that is exactly what they are.

69. How To Build A Thriving Culture at Work
• Rosie and Jon
• One-Day Workshop
• Tampa, Florida
• February 10th or 11th – 2015
• More information to follow – SOON !
Featuring:
The 7 Points of Transformation