From Worksite Wellness Programs to a Framework for Flourishing
As workplace wellness has exploded into a $6 billion industry, the value of worksite wellness programs has become the topic of a much-needed and vigorous debate. As part of the dialogue, an article by Al Lewis and Vik Khanna in the journal Health Affairs questions whether worksite wellness programs improve health and wellness and save money OR if they cost money, coerce people and create adverse effects.
Many medical interventions (including drugs and surgery) often look good in observational studies only to be shown to be ineffective (or effective in a subgroup only) in rigorously done randomized controlled trials.
My work with the military and at Samueli Institute has shown that the issue is bigger than we thought and it requires a new approach.
An Inside Look at Large Scale Military Wellness Efforts
While working at the Office of the Army Surgeon General in the 1990s, I had the opportunity to work closely on one of the early, large scale, wellness efforts that the military implemented. One of the biggest challenges we found to changing wellness behaviors was getting all the stakeholders (commanders, medical clinics, families and family services) working together toward the same goals and with coordinated strategies.
Health emerges from daily life (not just at work or in the doctor’s office) and even in the military the entire culture may not be in sync when it comes to healthy behavior. The military found that implementing wellness programs from a medical or worksite framework was not optimally effective. A whole systems community approach was needed. Thus, the concept of Total Force Fitness and the Healthy Base Initiative was born.
The Army is currently taking a similar approach with “resilience” programs (e.g., Comprehensive Soldier and Family Fitness) aimed at improving psychological health in which Master Resilience Trainers are embedded in work units.
Instead of using a framework of illness prevention or focusing on health care cost-savings alone, they seek to drive behavior change through culture change.
Time will tell how effective this is.
What has been consistently found throughout these efforts, however, is that commitment to the mission and the job was the biggest driver of performance. Those motivations may also be the major drivers of health and risk factor change in the civilian sector.
Countering a Misguided Approach
Although evidence indicates that some lifestyle and behavior change “wellness” programs are ineffective, throwing them ALL out does not make sense.
It may very well be that these programs and their evaluation metrics are misguided in that they focus almost exclusively on behavior change for physical and certain behavioral outcomes, while the more subtle and difficult to measure (but perhaps more important) components such as life purpose and work engagement have greater impact.
A New “Flourishing” Approach Emerges
At Samueli Institute we have developed a “Framework for Flourishing” model (image below) based on our work for the military on Total Force Fitness and contributions to the National Prevention Council dialogue.
This human flourishing model starts with the central importance of meaning and purpose in life, and then layers the social and behavioral factors around that central factor. It then identifies the social, physical, leadership and health care environments that enable or inhibit optimization of these factors for individuals and groups.
We have used this model effectively to help organizations create their own whole person, whole systems approaches to optimal health, function and well-being.
In testing this model randomizing people or groups to all these factors is perhaps impossible, but the answer might found by using a complex systems modeling approach.
This type of approach would to create a multi-dimensional instrument useful for tracking the impact of ANY program and then allow the communities at worksite units to customize and adjust what they need locally for optimal flourishing.
We are working on just such a model for the military now called the Central Evaluation of Resilience Programs or CERP. Perhaps this approach would be of value for the worksite wellness field also? Learn more about the special issue on resilience.
Measuring the Culture of Workplace Health
To measure an Optimal Healthy Workplace, Samueli Institute developed an assessment toolthat is derived from the Institute’s work on Optimal Healing Environments. The instrument measures the culture of health at a workplace, not just its wellness programs.
This approach allows any worksite to determine where its strengths and weaknesses are in creating human flourishing for its workers and so allows it to track the impact of any “program” or initiative it may implement.