Guest opinion: Workplace wellness must move from trinkets to cultural transformation


John C. Peters
Workplace wellness is not a new concept.  It has been around for years and looks very similar from workplace to workplace. The usual elements include “opt in” participation in a health risk appraisal, disease management programs, behavior management programs like smoking cessation and weight management, possible discounts on health club memberships or other activities, and finally, the obligatory office “challenges” to get people engaged in a health-promoting activity for at least a brief period of time.

Given that these programs have been around for a while and are intended to reduce health care costs among employees, you might expect health care costs to be going down or at least leveling off. Sadly, that is not the case. Costs continue to rise. In response, some employers are shifting more of the cost burden to employees in an attempt to manage organizational expenses.

Most of the upwardly spiraling costs are driven by preventable lifestyle behaviors including smoking, physical inactivity and excess calorie consumption leading to obesity. Obesity fuels a growing list of health issues including hypertension, diabetes and heart disease, which are responsible for a large fraction of health care costs in the workforce today.

In a typical workplace, health care risks and associated costs can be grouped into three categories: low, medium and high. Low-risk employees typically have fewer than two risk factors, medium-risk workers have three to five factors and high-risk workers have more than five risks. While health care costs for any worker go up with age, the costs are greater at any age if an individual has more than two risk factors. A study to look specifically at CU Trust beneficiaries and their risk factor profile is currently under way and will be completed this fall.

It is striking that over time the “flux” of employee movement between risk groups is disproportionately from lower-risk to higher-risk categories. Hence, the overall change in costs over time within a business is essentially an unbalanced movement with more people moving from lower-cost to higher-and-higher-cost categories than the other way around.  This is important because most of the money that is spent on wellness programs is spent on the highest-risk individuals, e.g., those under treatment for one or more diagnosed chronic diseases. Relatively little is spent on the low-risk individuals, because they are healthy. Given that many fewer of the high-risk individuals ever become low-risk individuals and low-risk individuals frequently become medium- and then high-risk individuals, it becomes obvious that we are never going to stem the tide of rising risks and costs without paying more attention to keeping the low-risk people at low risk.

In total quality terms, the system we have today amounts to “waiting for defects to occur and then trying to fix them.” A corporate CEO would never do this when running a successful business. That would be like running an airline and waiting for the airplane’s engines to fail in flight before fixing them.  Would you want to be a passenger on such an airline? Airlines rely on routine preventive maintenance so that key systems don’t fail. In health terms it should be the same: If you do routine preventive maintenance, the key body systems won’t fail. In quality terms, this translates to “fix the systems that lead to defects to prevent them from occurring.”

We need to think differently about the problem of rising health care costs.  We need transformation.  We need a new approach to promoting health in the workplace, one that is focused on keeping the healthy people healthy, and keeping the people with existing risk factors from getting any worse.

The missing ingredient in today’s wellness programs is providing a compelling enough reason for people to change anything. The most common approaches today provide nominal incentives (“trinkets”) for good behavior, like reduced health care premiums or monetary payments for completing health risk appraisals or enrolling in disease management plans. While these are sound approaches to encourage participation, they have proven insufficient to drive lasting behavior change.

This is perhaps not surprising considering that employees are expected to practice these health behaviors largely “on their own time.” Historically they have not been rewarded in the workplace for healthful living.  People typically practice the behaviors they are rewarded for, and the rewards for sitting at your desk and staying on task far outweigh the “trinkets” that can be earned for participating in wellness activities. In the workplace, advancements, salary increases and related recognition typically come from achieving results relevant to the organization’s goals, not from keeping a healthy body weight, blood pressure or serum cholesterol.

To achieve the organization’s health goals then, we need to align them with its overall goals and to manage health as an integral part of the entity/organization. The closest tie between health and most organizational goals is productivity however you define it. Healthy people are productive people, have more energy, miss less work due to illness, get more done when working and help create an environment that is good for recruitment and retention.

Making a business case for employee health is really no different than what happened in the 1980s around total quality and in the 1990s around workplace safety. At first, these initiatives were just “programs.” Over time, they were recognized as good for business. I see the same thing happening with employee health over the coming years.

We need a cultural transformation in the workplace such that being healthy is part of how the culture defines itself.

So, what would characterize a workplace of the future that aligns employee health goals with its business goals? Taking care of one’s self is an expectation of employment. Senior and midlevel leadership embrace this principle because it ties directly to the purpose, values and principles of the organization. Employees are given permission and access to practice healthy behaviors. All levels of management are held accountable for creating and sustaining an environment that supports employees being able to achieve and maintain healthy behaviors in the workplace. Individual employees at all levels of the organization are held accountable for creating and sustaining a work environment that promotes employee health.

Now, some would say that creating expectations at work about health behaviors is crossing the line into individual privacy. However, there are already many expectations in the workplace for how employees should behave, from interpersonal propriety to information security. All of these behavior expectations are enforced because they help the organization achieve its goals – just like good health. It is even more critical in the case of health because the employer is paying for a large share of the cost for unhealthy behavior. Until this situation changes, it is incumbent on employees to hold up their end of the bargain by devoting effort to staying healthy, as long as the employer creates a supportive environment.

Of course, any culture change takes time. How do we progress from where we are today to this future state? I recently had the opportunity to speak to a collection of leaders from all four CU campuses as part of the Excellence in Leadership Program. I engaged them to think about what some of the first steps might be in creating a culture of wellness here at the university. They broke into groups and each group addressed one of six questions; to view the questions and responses, click here.

Workshop participants were full of ideas about what a healthy workplace environment might look like.  It is striking that most of the suggestions don’t require large financial investments: It is more about changing people’s attitudes, giving permission to be healthy and valuing healthy behaviors as important for the work of the organization.

Changing the culture in the workplace to embrace employee health as part of business as usual will take support from all levels of the organization top to bottom. People at all levels will have to see “what’s in it for them” that relates to how they are recognized and rewarded in the workplace. We must look for better ways to measure how employee health improves individual and organizational performance. This will be critical to build the necessary evidence base to drive more investment and engagement in creating the desired cultural transformation.

I think this is the right time for the university to embrace such a transformation. Our health plans are self-insured, so every penny we save on health costs is a penny to invest in keeping the healthy people healthy and preventing those with some existing condition from getting any worse.

And doing this is in perfect harmony with the university mission statement: “The University of Colorado is a public research university with multiple campuses serving Colorado, the nation, and the world through leadership in high-quality education and professional training, public service, advancing research and knowledge, and state-of-the-art health care.” We just have to think of health care as keeping people well as much as treating the sick, and we must be sure to include university employees in the focus on state-of-the-art health care.

John Peters, Ph.D., is chief strategy officer of the Anschutz Health and Wellness Center as well as associate professor at the Center for Human Nutrition.


First Steps In Creating A Culture of Wellness
at the University of Colorado

Ideas generated by participants in the CU Excellence in Leadership Program

Describe at least three things you could do to align employee health explicitly with your organizational purpose.

  • Extend Anschutz Health and Wellness Center services to entire CU system
  • Provide incentives to participate in health promotion programs
  • Reward healthy behaviors
  • Reduce health premiums for good health results
  • Tailor programs to be inclusive…everyone can play…healthy, unhealthy, etc.

Describe at least three things you could do to make healthy behaviors easy choices at work.

  • Provide healthier food options
  • Encourage brief walking breaks
  • Encourage walking meetings
  • Stage fun healthy events
  • Provide incentives for exercise
  • Provide personal lifestyle trainer/coach

Describe three things you could do to set an example and inspire others to do the same.

  • Turn meetings into walks
  • Take time for yourself—set an example
  • Engage in less off-hours emailing

Describe at least three things you could do to align workplace incentives with employee health goals.

  • Conduct in-person communication vs. email/text
  • Replace stairwells with open staircases or interactive stairs
  • Offer flex time for life balance
  • Leverage technology, e.g., Nike fuel band

Describe three things you could do to empower employees to be their best at work.

  • Provide educational sessions about what behaviors work
  • Shift beliefs about when exercise is acceptable (e.g., work breaks)
  • Encourage stand up during meetings

Describe ways to measure results for each element above.

  • Expectations—see CU Denver mission statement, it includes health care…and should apply to employees, too
  • Environment—look for evidence of change, e.g., healthy food at official functions, standing work stations
  • Leadership—monitor communication from leadership, monitoring campus communications for mentions of wellness
  • Rewards—enumerate incentives, frequency, amount, use data from monitoring devices like Nike Fuel Band
  • Self-leadership-survey practices and policies to look for change—e.g., change the dress code to allow for “active wear”

Note: The Excellence in Leadership Program (ELP) began in 2000 as an initiative sponsored by CU President Elizabeth Hoffman to support leaders and leadership at the University of Colorado. The nine-month professional development experience provides opportunities for faculty and staff to become more effective leaders who can successfully address key challenges of a dynamic university. Throughout the program, university leaders gain the knowledge and skills needed to fulfill the promise of academic and administrative excellence that CU requires today and in the future. To strengthen the understanding and relationship within and across CU, the program includes participation from all campuses and the Office of the President.