Creating a rethink in the design and delivery of workplace health and wellbeing strategy

Abstract - This paper presents a provocation that challenges the status quo and asks how we could best reframe the picture of workplace health and wellbeing needs and change the narrative as it currently stands.

It is about learning from the past, understanding the present and thinking in the future.

Mark Howard

Emerging markets consultant at Krysalis Consultancy

Mark.howard@krysalisconsultacy.co.uk

07966 092224

Introduction

This paper considers why we should start to rethink the ‘beautiful mess’ we continue to create in the delivery of workplace health and wellbeing services.  A ‘confusion’ of disconnected and siloed services which are failing to efficiently serve organisations and employees alike.

In The Conversation, discussing recent discoveries in evolutionary science, Jenna Hubert, wrote the following:

“After the past few years, we’ve all gained a whole new appreciation of the dependable things in life. Before a global pandemic, the cost-of-living crisis and one political meltdown after another, you may have thought of stability as rather dull. Prepare for another shake-up.”

Our changing world is experiencing a substantial shift in the assessment of ‘Human and Organisational Risk’.  It is a shift which demands we rethink our approach to the design and implementation of workplace health and wellbeing initiatives.

I deliberately refer to ‘Human and Organisational Risk’ (a description taken from the world of Health and Safety) in order to create a new frame of reference.  Before we start conjuring up workplace health and wellbeing strategies, we must first develop a clearer understanding of the relationships and factors that impact on an individual employee, groups within an employee population, and an organisation’s ability to perform, together, at their best.  In short, we need to expand our thinking about the link between employee health and the success of the organisation.[1]

The Beautiful Mess

The ‘beautiful mess’ was well on its way to being created prior to the pandemic with insurers and health and wellbeing service providers offering partnership services in support of their core business.  The development to where it is now has been accelerated by responses to Covid-19 and the ongoing problems with the UK’s economy.

A plethora of value-added propositions have been introduced across many market sectors such as Health, Protection and Medical insurance (insurance companies, distributors and benefits companies); Occupational Health; Employee Assistance; specialist workplace health and wellbeing providers and Sickness Absence Management platforms.  If we add to these the rehabilitation support that is included in many Employers Liability insurance products; the growth in Mental Health First Aiders and the number of digital health apps employees are able to access directly we get ad-hoc, unaligned, silo, design; duplication; fragmentation; confusion; under-utilisation and poor/inadequate referral processes that are very often unmeasurable and fail to demonstrate sustainable return to/remain in work outcomes.

Challenges in developing the value proposition and employee experience

Employers, in an effort to meet the needs of their employees to improve their health and wellbeing, are now looking far more closely at the value and cost savings, as this article from the US reports.[2]  They are asking for proof of value; return on investment (ROI) but they really need a broader definition of ROI that includes choices based on driving quality, focusing on performance and productivity and lowering cost.

Employers will be looking towards their partners to work with them to build collaborative advantage;[3] to help them evaluate if solutions are working; adopt systems thinking; embrace innovation and understand how to optimise utilisation that impacts positively on both the employer and employee population.  This approach will deliver a better experience for all and go some way to helping to address the conundrum that providers are facing in seeking to solve the problem of employee awareness and understanding.

With employee turnover rates are on the rise, and expected to increase even more in 2023 it is interesting to note the top three benefits identified by employers as being their key focus in the CIPD 2022 Health and wellbeing at work survey

• A healthier and more inclusive culture.
• Better work-life balance.
• Better employee morale and engagement.

One of the primary motivators for employees in a post-pandemic workplace is finding a stronger life-work balance.  With the average cost of finding a new employee at £7,729 in the UK it is critically important for employers to adopt intentional, targeted, solutions to be able to attract and retain healthy, productive performers.[4]

“Health and wellbeing support must be based on a proper understanding of the issues but also of the workplace demographic and the specific needs of the employees. To obtain a return on the investment in wellbeing, employers must ensure it is targeted and tailored.”[5]

Physical, mental, financial, and social factors all have an impact and must be looked at multifacetedly as well as singularly.  Employers and their health and wellbeing service providers need to understand the risks inherent within any organisation and employee population.  Support is available for all aspects of health and wellbeing for employees, and when it is fully integrated and tailored, delivered by skilled and experienced health professionals, it will have the most impact.

Challenges are epitomised by employer responses when asked about OH and EAPs.  A new edition of Occupational Health: the value proposition, with a UK report authored by Dr Paul Nicholson, establishes that OH services enhance employee health, workforce productivity, business performance and the economy.  However, there is still a requirement for OH providers to keep in mind that which employers reported on, in 2019, about their relationship.

Employers when asked what could be improved about the relationship with OH providers highlighted three consistent tensions:[6]

• Slow turnaround or delayed responses.
• Vague or unactionable recommendations, and
• Poor communication and information sharing.

During the pandemic EAPs experienced significant growth but has their effectiveness grown proportionately?  There is a need for EAPs to focus more on education, provide indisputable evidence that will take them away from being described as a tick box exercise (right idea wrong solution) and that proves their effectiveness in bringing about sustainable return to/maintain in work.

Questions are being asked by employers as to whether EAPs are delivering for their workforces. This is demonstrated in a recent Rewards and Employee Benefits Association (REBA) – inside track article that stated “…During the pandemic, EAPs enjoyed a renaissance. But now the dust has settled, an increasing number of employers have told REBA that they are reviewing their EAP to ensure it is delivering what they need.”

A provocative question comes to mind here when evaluating duplication within the ‘beautiful mess’ and that is why would an organisation buy an EAP when it is “free of charge when you purchase a Group Income Protection Insurance or Group Life Insurance policy.”

Start of the rethink – What are workplace health and wellbeing services trying to achieve?

Even despite the significant inefficiencies in the ‘beautiful mess’, workplace health and wellbeing trends are being talked about as being at the heart of business transformation; with the World Health Organisation (WHO) recognising the workplace as one of the primary settings for health promotion in the 21st Century.

Expectations, both from an employee and employer perspective, have evolved and in many cases changed over the last couple of years. Employers’ perceptions of workplace health and wellbeing benefits have shifted, with an increased focus on their strategic value and what they deliver for organisations.  This is why it is incumbent upon service delivery providers in the workplace health and wellbeing sector to seize the opportunity to recalibrate and reframe their value propositions and find new ways to redress inefficiencies and prove value.

To understand how best to get there, it is necessary to have a clear notion of our purpose and desired destination. We must ask ourselves: What do we want reimagined health and wellbeing services to achieve?

I would suggest that the answer to this question is sustainable employment or “…the ability of the employee to provide added value for an organisation now and in the future, while also experiencing added value themselves.”[7]

Demands and pressures placed on employees and employers are increasing and emanate from a wider range of sources (macro and micro, from inside and outside organisations). Therefore, it is becoming ever more important that we look to developing a better understanding of the risks facing us.  Focus on forming win-win strategies that achieve success for employers and employees and strategies that are four pronged – primary, secondary, tertiary and quaternary.[8]  Given that the issues are often inter-connected, the solutions should be inter-connected and facilitated through a multidisciplinary approach[9].

What we do know is that the demands and pressures, when not addressed, when misunderstood or mismanaged, will lead to both poor organisational and employee performance. There is a clear need for both “individual” and “collective” productivity, and a much more nuanced and multi-dimensional understanding of “workplace health and well-being” – perhaps through the development of a WHS – Workplace Health Service.

Three ideas which might help kick-start the redesign.

1. The Case for a better understanding of the use and value of Vocational rehabilitation

Vocational rehabilitation “is whatever helps someone with a health problem to stay at, return to and remain in work. It is an idea and an approach as much as an intervention or a service.”[10]

We need to look toward the management of illness and injury through a vocational rehabilitation lens; early intervention only works when it is immediately supported by focused/appropriate therapeutic assessment that understand function (physical and cognitive) and interventions that set a return-to-work prognosis and appropriate, specific and consensual (sustainable) remain in/return to work pathways.

Currently, too little is really understood about just how effective a multidisciplinary[11] vocational rehabilitation[12] approach is, especially when integrated within a return to/remain in work philosophy that accelerates the introduction of therapeutic interventions, assessment and implementation of workplace adjustments and the use of assistive technology.

With all these factors combining, the approach will also enhance an organisations Equality, Diversity and Inclusion, and Corporate and Social Responsibility programmes.

2. Moving beyond ROI to VOC – the value of caring

“If employers are seeking to add benefits that employees value (or attract employees who value those benefits), the programmes may be worth it. But if the goal is to save money by reducing healthcare costs and absenteeism, or to improve chronic physical health conditions, the evidence so far is underwhelming.”

As the Washington Post article this excerpt comes from shows, there are serious questions being asked, globally, about the true value of workplace health promotions. Indeed, studies demonstrate negative ROIs in a number of cases.[13]

“Due to considerable heterogeneity, no specific type of intervention could be identified to be particularly effective, and the economic value of worksite health promotion remains uncertain.”[14]

So is financial ROI too narrow to be the sole measure of the value of workplace health and wellbeing provisions.  Perhaps a better measure of the value of health promotion expenditure would be cost-effectiveness.  We should also look to index new values. For example, the value of caring (VOC)[15].

By reframing value, we can employ not only a vocational rehabilitation lens but also a biopsychosocial approach, for which there is clear evidence.

For sickness absence and presenteeism management (illness and injury management) approaches to be fit for purpose, improvements need to come through:

• Systematically capturing psychosocial information on individuals, with proactive management of biopsychosocial risks.
• Ensuring that cultures, systems and processes do not create unnecessary barriers to recovery.
• Operations that are based on values and principles of fairness, including collaboration, timeliness, trust and reciprocity, personalised and respectful communication, and empowerment of stakeholders.

It pays to care.

3. The value of an integrated workplace health and wellbeing service

The trend of organisations reviewing their workplace health and wellbeing strategies has been evident in recent times.  It is now ever more important that we drive the conversation around how focused, targeted, integrated workplace health and wellbeing strategies might be structured.

Perhaps this might be a model led by professionally qualified vocational rehabilitation ‘case managers’; utilising a mix of illness and injury management, occupational health, mental health support, specialist therapeutic services (e.g. Physiotherapy, Occupational Therapy, Occupational Psychology and Speech and Language Therapy) assistive technology and workplace adjustments.  A far-reaching solution that would simplify access, enhance experience and improve outcomes.

It does beg the question that why with all the available technology there appears to be reticence about building a cross market sector, multidisciplinary, service platform. Is that because we prefer silos?  Is it because it is too hard, too complex?  Is it because service providers cannot afford the cost of developing such a platform and any solution has therefore got to come out of the digital health tech sector? Is it because we just do not think it is worthwhile?

Whatever the answers to these questions I personally am sure that such a model is the future and should be/will be at the heart of driving the most successful workplace health and wellbeing strategies – through the WHS.

[1] Shared values – shared results Positive Organisational Health as a win-win philosophy – Dee W. Edington PhD and Jennifer Pitts PhD. Microsoft PowerPoint – Dr. Dee Edington.pptx (uschamber.com)

[2] Most Employers Will Enhance Services to Improve Employee Wellbeing (healthpayerintelligence.com)

[3] the ability to form effective and rewarding partnerships with other organisations, for mutual benefit.

[4] Amanda Day, Director of People Enablement at Remote – Retention remains a driver for employee wellbeing – make a difference – workplace culture, mental health, wellbeing

[5] Debra Clark, head of specialist consulting at Towergate Health & Protection

[6] https://www.gov.uk/government/publications/occupational-health-services-and-employers/summary-employers-motivations-and-practices-a-study-of-the-use-of-occupational-health-services

Employers’ motivations and practices: A study of the use of occupational health services (publishing.service.gov.uk)

[7] A definition frequently used is that of the NEN (Dutch Standardisation Institute)

[8] Primary, Secondary, Tertiary, and Quaternary Care (verywellhealth.com)

[9] The multidisciplinary team – Rehabilitation Matters

[10] Vocational Rehabilitation: What Works, For Whom, and When? – Vocational Rehabilitation Association UK (vrassociationuk.com)

[11] Multidisciplinary team care in rehabilitation: an overview of reviews – PubMed (nih.gov)

[12] Vocational rehabilitation is the managed process that provides an appropriate level of assistance, based on assessed needs, necessary to achieve a meaningful and sustainable employment outcome.

[13] Baicker K, Song Z. Workplace wellness programs are big business. They might not work. The Washington Post, 17 June 2021.

[14] 25 Lutz N, Jan Taeymans et al. Cost-effectiveness and cost benefit of worksite health promotion programs in Europe: a systematic review. European Journal of Public Health 2019: 29(3): 540–546. ohaw.co/Lutz2019

[15] Dee Edington and Olga Reupert – Caring as a Shared Value: Caring for the Employees and for the Organization (corporatewellnessmagazine.com)