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6th Key Observation – 2001 to 2011: Same 10 Common Concerns

Wellness in the Workplace 2.0

What Got Us Where We Are Today…Won’t Get us Where We Need to be Tomorrow

10 Key Observations from Thirty-Five Years in the Field


6th Key Observation…

“2001 to 2011:  Same 10 Common Concerns”

presented for your intellectually driven consideration, emotionally driven engagement and—most important—your viscerally driven action


This is not meant to be a genie-in-a-bottle, but more to provoke thought and creative team solutions.


“We’ve got great programs, dedicated health professionals, and supportive management — so why is participation so low?”

Unfortunately, the “other guy” syndrome is part of human nature.  The norm reminds us that until a measurable event occurs — a teachable moment — people deny the need for prevention services.  This phenomenon is independent of knowledge and understanding; the cause is emotional.  “Yes, I smoke,” goes the story, “but I’m going to quit, soon; honest.”  “Of course I’ve put on a few more pounds, but this is the way life is.  You gain weight as you get older.  One of these days… .”  “I don’t drink any more than most people; besides, I can hold my booze, pretty well.”  “I know I should get more exercise, but right now, I’m too busy.”

The above excuses are all grounded, not in fact, but in desire.  The consequences of poor lifestyle choices are all real, however, they are not the person’s reality; not, at least, until there is an event.  This, the event; the heart attack, stroke, mental breakdown, divorce papers, child in crisis, bankruptcy, onset of type II diabetes, knee replacement, etc., triggers a marked increase in both motivation and activity.  The activity is emotionally driven by fear, pain, and the stark reality that, indeed, it can happen to me.  I am, now, “the other guy.”  Unfortunately, as the symptoms subside often the newly discovered good health practices seem less urgent and the individual begins to slip back into the world of “should,” and “someday” and the cycle repeats.

The bad news is that illness, age, and corresponding disability will increase disease management (DM) activity.  However, incidence of disease and the need to manage that disease is not where we want to see growth.  We need to foster growth on the prevention side of HP.  To increase prevention participation, we need to broaden our target market and focus on all the components of optimal health, and, we need to understand the role of staging and readiness to change.


“Our organization is increasingly diverse.  So, with a limited budget, how do we provide programs that are gender specific and accommodate differences in age and culture?”

The “Great Melting Pot,” as the United States was called at the dawn of the 20th century, consisted, primarily, of Western Europeans, however, today’s melting pot is truly international.  Asia, Latin America, Eastern Europe, and India are the jumping off points for millions of today’s immigrants.  In addition to diverse cultures, the workplace often houses up to four different generations of workers; kind of a Pearl Harbor to Pearl Jam mixture of memories, attitudes, and expectations.

To be effective, DM/HP programs must respect and understand the history and sociology of health and lifestyle practices relative to age and culture.  The days of cookie-cutter programs are over — or, certainly should be.  Before throwing programs and activities at your employees you need to identify an individual’s needs, interests, beliefs, and position in the stage model.

In addition to understanding the dynamics of organizational culture and individual change, research shows a direct correlation between desired outcomes and degree of individual tailoring.  The more the individual feels that the program is speaking to him or her, the more vested they become in the process.  It the old story of which news bulletin grabs and holds your attention, more:

  • Typhoon Strikes the Coast of Japan
  • Hurricane Bearing Down on the Caribbean
  • Miami Prepares for “The Storm of the Century”
  • Funnel Cloud Spotted North of Town:  Take Cover, Now!


“What expectations should we set for our DM/HP programs and how should we measure success?”

It is important to remember that change is a process, not an event (more about this, later).  Certainly, when it comes to the DM aspect of HP, we can look to specific biometrics as one indicator of success.  However, in management as well as prevention, the initial key indicator is participation.  Regardless of anything else, programs must promote and reinforce entry and progression through the continuum of change.  Any movement along this continuum should be measured and viewed as success.

By limiting success criteria to bio-metric indicators you not only set your programs up for perceived ROI failure (more about that later) but, also by definition, you limit the breath of your program offering to that small segment of the population who is ready for a specific intervention strategy.  In tobacco use, as an example, you miss the 85% of smokers who are not ready to begin a formal intervention program but are primed for more education or need assistance in maintaining their non-smoking status.  Which tobacco control program is more successful: one that has 30 out 100 attendees tobacco-free at the end of one year, or a program that moves 600 out 1000 tobacco users from the point of NEVER wanting to quit their habit to thinking seriously about changing in the next 30 days?  As with so many options, they both have merit.  But keep mind that without the “pipeline” component, you will never have more than a handful of tobacco users ready, willing, and able to walk away from their addiction.  A successful (efficacious) process includes a strong feeder component.  Recruit, measure, and tout participation at all levels of change — awareness, education, intervention, and maintenance!

Reaching Dependents

“We know that a considerable percentage of our healthcare costs are incurred by dependents.  What can we do in the areas of DM/HP?”

Dependents range in age from birth through retirement years.  And, at each age, they can cost your organization, time, money, and energy.  Any DM/HP process that does not include dependants is fraudulent — not just inadequate — fraudulent.  To presume that your DM/HP efforts will have a significant impact on organizational health and dollars without including dependents is misleading and grossly insufficient.  Not convinced?  Take a look at your prescription drug utilization and your healthcare claims.

Because of expanded limited access, I suggest you take advantage of the 24/7 feature of electronic healthcare.  By using qualified public domain information and carefully selected e-vendors you can greatly enhance the health and lifestyle of dependent populations.  In particular, take a close look at programs specifically designed for teens.  Teens are huge medical claims waiting to happen.  Short-circuit these costs by targeting their unique needs.

Vendor Selection Criteria

“We are bombarded with individuals and organizations selling health-related products.  How do you sort out the good, bad, and truly ugly?”

Twenty years ago, there were a handful of quality programs available through national vendors.  Choice was not that difficult.  Today, with the advent of the Internet and the flood of scientific data, there are hundreds of vendors anxious to for you to engage their services.  An upcoming article will deal specifically with this topic.  However, for now, keep the following in mind that a vendor should be much more than a provider of drop-off products and services.  They need to be comprehensive, accessible, flexible, and experienced.  Sound simple?  It’s not.  Due to limited dollars, you need as much quality one-stop-shopping as possible.  You do not have the time, dollars, or energy to have multiple contacts for each of your offerings.  Find an experienced multi-component provider and stick with them.  They will not only help you with paperwork and sanity, they will also help with triage, cross-over, data collection, analysis, and strategic planning.  Like a good pharmacist, they will also help you avoid unhealthy DP/HP interactions.  An excellent provider will have a pattern, philosophy, and support network that is consistent throughout their offerings; this will help you, immensely.  A good vendor is, at a minimum, equal to one FTE (full time equivalent).

Follow-On Programming

“Most of our employees have multiple risk factors; what should they do first and how do we help them maintain momentum once they get started?”

After some basic data collection, you probably have an idea as what is most important — and therefore, should-be-first — on someone’s list of disease prevention and management needs.  So, what?

Need is only a part of the decision process.  Interest, access, learning style, and belief in success are critical factors to consider when beginning a change program.  Hypertension, diabetes, and high blood pressure may signal weight loss for someone who is morbidly obese.  However, if distress is blocking visions of success, maybe a good stress reduction/management program is the way to go, first.  On the other hand, maybe someone has recently loss a close friend or relative to lung cancer and their teachable moment has arrived. If finances are in runaway mode, maybe financial responsibility is the first step (yes, this is part of comprehensive DM/HP — check your VISA charges if you doubt this…).  There are a number of factors that influence the whens, whats, hows, and whys of DM/HP.  The more barriers you can remove and the more control you give to your employee the more likely the individual is to begin a program, stay with it, and springboard their success into other areas of change.


“Funds are limited.  How do I provide comprehensive services without adequate resources?”

Look around.  Borrow from other departments.  Use the graphics person to help you with a promotion campaign, tap the IT folks to help develop and maintain a database, and pick the brain of your VP of sales to help you develop the right pitch.  A lament often is heard is, “I can’t do it all!”  Of course you can’t and if you try you will fail.  The common mistake is to place too much emphasis on acquiring operating dollars and not enough on controlling expenses.

Budgeting & Funding

“I seem to be on the short-end when it comes time for budget approval.  Any ideas?”

In brief, it is important that you keep your budget request reasonable, measurable, and tied to the corporate mission.  Also, find a champion; someone in senior management who inherently recognizes the full value of a solid DM/HP program.  And, most important, the tone, structure, and presentation of your budget request must look and read like any other business unit’s budget.


“My boss is a numbers person and wants to know how much everything costs and what kind of return we can expect from our investment.”

I’m tempted to refer back to my company carpet comment but I will resist.  Of course, management must believe there is value in what you’re doing and you need to show numbers.  The best way to do this is with the data collected from a business similar to yours and refer to it.  As shown earlier in this paper, national leaders like Johnson & Johnson and the companies studied in the HERO study (Chevron, Health Trust, Inc., Hoffmann-LaRoche Inc., Marriott Corporation, State of Michigan, and State of Tennessee) have already demonstrated both the costs of high risk employees and the ROI associated with comprehensive DM/HP programs.  Refer to authoritative resources such as the American Journal of Health Promotion for detailed studies.  Quite honestly, if someone wishes to shoot down any project based upon the inability to pin ROI to the penny, it can easily be done.  It usually boils down to the fact that management either believes in an extrapolated data position and in the intuitive logic of DM/HP or they don’t.


“Cost is always an issue.  How can we deliver quality services and watch our dollars, at the same time?

Cost is always an issue and it should be.  The good news is that it is a buyers’ market and you do have room to negotiate.  Unit price is one way, however, I recommend you use your leverage to expand service more than lower price.  As mentioned earlier, you should find a vendor who is willing to provide more than drop-off products and services.  All vendors should provide an open-line support person who will, in effect, become your staff person, someone who will guide you step by step with the introduction, marketing, delivery, and evaluation of whatever product or service you may purchase.  Price is usually fairly fixed, however, service is another matter.  Most top-notch vendors appreciate a client who is sincerely focused on using their products to the best of their ability.  It makes you both look good.  To sweeten the deal, offer to be a reference and an advocate to the vendor’s prospects.



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