On January 16, 2014, the Interdisciplinary Center for Healthy Workplaces (ICHW), a UC Berkeley research center, convened a group of 48 researchers, corporate representatives, public policymakers, and service providers for a one day “Mixer” at the University Club on the Berkeley campus. The purpose of the Mixer was to gather together a diverse group of stakeholders to discuss how we can make significant progress towards creating healthy workplaces. It was called a “Mixer” for the simple reason that people were brought together who didn’t know each other and weren’t acquainted with what other attendees know and do. By learning new things about each other, we hoped that we would be better equipped to see how real progress could be obtained. Specifically, the meeting goals were:
- For participants to learn something entirely new and important from the day’s discussion.
- For participants to share information that is critically important for advancing our understanding of how to create healthy workplaces.
Because this was the first of a series of Mixers planned for the Center, we planned the agenda to maximize the amount of information that could be shared among stakeholders during the five-hour event. Structured conversations were planned throughout the day to stimulate enlightening and meaningful exchanges so that by the end of the day we might have a good start on designing concrete next steps to significantly move this effort forward. We assigned participants to different tables throughout the day in order to facilitate diverse conversations. The event was divided into four parts:
1. Discovering what we know and don’t know, and what is working and not working.
Ten participants representing different stakeholder groups gave briefings on programs or initiatives in place in their respective domains and their assessment of how their work could be aided by more knowledge or assistance from others (each presentation is described in more detail below). The presenters were Kathy Gerwig from Kaiser Permanente, Stephanie Verabian and Dawn Mugavero from Toyota, Mary Davidge and Aaron Stoertz from Google, Bill Zachry from Safeway, Steve Hargis from Jones Lang LaSalle, Stephanie Douglass from Teknion, Christine Baker from the California Department of Industrial Relations, and Casey Chosewood from the CDC/National Institute of Occupational Safety and Health (NIOSH).
Following each set of two or three presentations, participants at each table were encouraged to discuss what they heard and what it means to them. If desired, ideas and insights generated from the table discussions were captured on post-its and posted on easels placed around the meeting room. For this part of the Mixer, participants were organized by stakeholder group, enabling discussion to be focused on the meaning of each presentation for their own stakeholder group.
2. Determining what needs to change and/or what to change.
For the second conversation, we mixed participants at each table to facilitate conversation across stakeholder groups with the hope that exchanges across perspectives may stimulate new ways of looking at the problem or new ideas for collaboration. Participants at each table were encouraged to focus on the following questions: What appear to be the barriers to the creation of healthy workplaces? What needs to change and why?
George Breslauer, Executive Vice Chancellor and Provost for UC Berkeley, also gave a short talk to the group during lunch relaying his thoughts about the importance of the work being accomplished at the meeting and by the ICHW in general, and about the need to put strong effort toward solving the health crisis by making workplaces healthier for employees.
3. Determining what knowledge/expertise is needed to significantly move this effort forward.
At this point in the day, participants were invited to gather with other attendees who interested them the most. Researchers were grouped by subject matter and located in different areas of the meeting room, enabling other stakeholders to join in a discussion on topics within each subject. Participants were encouraged to move around to different groups or initiate conversations with others as desired. The subject matter groups were:
- Organizational policies, procedures and rules;
- The physical environment;
- Health promotion, prevention and disease management; and
- Organizational culture and climate.
4. Determining partnerships to advance this effort.
Participants assembled again at the tables to wrap up discussion from the day’s activities and to indicate what they had learned and how they want to proceed in the future.
The following are short descriptions of the presentations made by the 10 participants.
Kaiser Permanente (KP) is in the unique position of being the health care provider to 100% of its employees, and based on the knowledge it accumulates regarding the health of individual employees through its own healthcare system, KP can test the impact of a variety of health incentives on its employees and evaluate directly the impact of incentives on health care costs/premiums. On January 1, 2014, KP implemented a major strategic initiative to build a healthy workplace culture. Created by multiple stakeholders including the senior leadership and 20 unions, KP’s Total Health Incentive Plan consists of two parts: doctors’ advice and provision of resources to encourage the adoption of healthy habits by employees, and an incentive payout system which rewards employees financially if they participate in a total health assessment, update their biometric status, and show health improvement at the end of the year. Program participation and health outcomes are measured on a regional – not individual – basis. This program will affect KP’s 33,000 employees. KP invited ICHW researchers to measure the effectiveness of collective/group approaches to incentives and to help design an appropriate program evaluation and health measurement process.
Toyota is facing dramatic change in its organizational culture as it moves from a very traditional Japanese culture to an American one inside a Japanese company. Because of very low turnover rates, Toyota has been slow to adopt change such that old ways of working and conformity to established rules and authority are deeply engrained in the company culture. However, the need for change has become apparent, and this has created the opportunity to change the organization strategically and holistically, focusing on the infrastructure to create change. Two components of this change effort were discussed: (1) the well-being program (previously known as the wellness program), and (2) the work-out program. The well-being program examines issues such as flexible schedules, creating more choice in employees’ work, relaxing the dress code, and building incentives to reward healthy behaviors. The work-out program focuses on the work environment: creating more activity-based work spaces, designing work environments that create more movement, introducing more color into the workplace, and changing desk equipment (sitting vs. standing desks). Toyota was interested in learning how ICHW could assist them with culture change efforts and measurement of program outcomes.
Google is already a leader in the healthy workplace space. Its vision is to create an extraordinary human experience at work, ranging from improving indoor environmental quality (acoustic, thermo, lighting, air quality, daylight, and use of biofuels and removing toxins) and providing a rich, variable and multi-sensory work environment, to encouraging employees to feel engaged, alive and comfortable in their workspaces. Several wellness teams have been created at Google as part of this effort. These include (1) the healthy (healthcare) plan design that examines health policy; (2) the wellness center team that addresses healthcare management; (3) the health and wellness team that is focused on public health interventions; (4) the people development team that examines health education; (5) the food team that is focused on Google food and the food industry; and (6) the fitness team that examines the fitness industry.
A few things appear to be effective in their efforts to create an extraordinary work experience: first, creating high quality programs that employees are interested in being a part of; second, creating a low threshold for trying something, but creating a high threshold for scaling the program company-wide; third, personalizing the program and targeting the program to certain people; and fourth, following the academic research rather than listening to industry insights when designing programs. Note also that Google does not use incentives at all to drive behavior change.
Google still faces many challenges. There is a great deal of redundancy in their efforts: many teams work on the same health issues, each with a separate mission. Measuring program effectiveness also proves difficult. They are looking for help in creating a consolidated set of metrics for health to use as the evaluation criteria by which all efforts could be judged.
Safeway has had a high-profile wellness strategy since 2005 with a focus on creating a culture of health. Approximately 150,000 employees and family members are part of Safeway’s wellness program. This organization is self-insured, so it experiences a direct relationship between health care cost and the company bottom-line; every dollar saved in costs goes directly to profit. With such a direct relationship between health care spending and company profit, Safeway is motivated to do what it can to lower illness, injury and disease rates so that premiums go down. The program includes on-site fitness programs and on-site clinics, among other programs that serve to prevent illness and injury. It has a strong metrics program which tracks such aspects as BMI, cholesterol, and tobacco cessation. Employees can receive up to $2,000 toward their premiums based on health improvements.
Safeway is exploring ways to increase individual employee’s ability to cope with a disability (as a function of a work-related injury). A pilot program initiated in Walnut Creek, California tests the hypothesis that if injured workers receive counseling and other psychological services in addition to physical treatment, their recoveries are faster and more permanent. So far, they have achieved positive results. They have preliminary evidence that increasing coping skills leads to faster recovery and less use of group health services.
Safeway is also exploring ways to identify high risk employees so that they can intervene early on to prevent these employees from becoming highly disabled and thus major expenditures for Safeway later down the line. Safeway expressed interest in learning how ICHW could assist with evaluating their program and how to make it more effective.
Jones Lang LaSalle is a service provider to companies needing real estate and real estate management services. This organization’s offerings are designed to provide physiological comfort, productive work habits and effective process staging. It investigates the context of the work and work performance expectations when designing solutions. Recently, they began exploring ways in which psychological temperament (such as introversion vs. extroversion) may influence their design solutions; different temperaments may be most comfortable in differently designed spaces.
Choice and control are the most important principles they try to achieve in their solutions, but in their experience, these are very difficult to achieve. They contend that if you can solve this, people will be happier at their workplace. They believe that the world around us should be healthy and sustainable, and that we should have things in our work environment that help us to be more productive. A stimulating and game-changing approach to a healthy world comes from a new area of design called “biomimicry” where elements in the natural world come together and stay in balance. This organization is interested in potentially pursuing this line of thinking with ICHW.
Teknion is interested in being part of the holistic change happening in workplaces, and its focus is on ergonomics, user engagement and healthy product decorations (what is going into the products during the production process). The company provides education in workplace planning, conducts in-house investigations and partners with academics to obtain the right science behind the development of their products and services. Teknion is interested in gaining help with independent research and in ways to help companies understand how a wellness culture impacts their employees—and shouldn’t be thought of as just a “perk” of employment.
The California Department of Industrial Relations deals at the policy level on issues between labor and management such as health benefits and medical delivery for employees, among other things. It attempts to strike a balance between overutilization and underutilization of health care. One of the issues being worked on relates to the independent medical review process which comes into play when an injured employee wants more care than initially provided through workers compensation insurance. The department has achieved some efficiency gains in this area by moving the independent review process to early in the treatment stage in order to avoid costly litigation when treatment plans are challenged under the old rules governing independent reviews. Also of interest to the department is updating empirically-based medical treatment guidelines and preventing bad (non-empirically-based) treatments from being practiced. Educational outreach is an important element of this initiative. Lastly, the department is interested in figuring out how to join the group health programs with workers’ compensation programs. Currently, they are run and paid for separately yet they are closely linked–better management of health and health status through group health programs may directly impact the likelihood of work-related injuries and disabilities, and when employees are injured or disabled, may more effectively manage those injuries and disabilities under group health programs.
The department has observed that workers do better when they return to the workplace, so they are interested in understanding how organizations can make returning to work more available and feasible. They are exploring innovations in ergonomics in the workplace to accommodate work limitations more readily as well as preventing injuries and disabilities in the first place.
CDC/NIOSH is focused on the intersection of work and health. NIOSH has embarked on a strategic initiative called Total Worker Health™ which combines both prevention of illness/injury with health promotion. Previously, NIOSH was primarily concerned with preventing illness and injury in the workplace through structural, educational and programmatic interventions. Because this wasn’t enough to stem the rising tide of employee illness and injury, the organization broadened its mission to include health promotion—studying and then recommending changes in companies that could improve employee health and thus lower the risk of illness and injury down the road.
This organization contends that work provides employee health benefits if designed and managed correctly. It encourages organizations to prioritize programs that are accessible to all employees rather than to focus on employees at particular levels (higher rather than lower) by extending health promotion programs like smoking cessation and weigh control to employees most at risk and those least able to access health benefits such as part-time workers not covered by health benefits. They are also conducting research that helps to set up exposure limits to improve employee health.
CDC/NIOSH contends that it is most economical and efficient to focus on organizational health interventions rather than on individual behavior change efforts. The question is, which organization-wide interventions would be the best candidates according to the scientific evidence? NIOSH is looking for partners in their efforts to promote their strategic initiative and is interested in providing funds for supporting research in the workplace.
Questions and Insights
Participant reactions to the presentations stimulated a great deal of discussion, some of which was captured through questions and ideas jotted down on post-it notes during the meeting and in participants’ post-Mixer evaluations:
- “Organizations have not been initially designed to incorporate health in any deep or meaningful ways. As a result, they are trying to play catch-up, i.e., “grafting” health on after the fact. RETROFIT is an even better term of what they are trying to do non-systematically.”
- “THE measure of an organization’s health is its “mental well-being.” Yes, ergonomics, etc. are important, but mental health is key.”
- “Family engagement is critical in changing healthy behaviors although currently most employers focus just on the employee.”
- “Engagement is a new buzz word—but do we really know what it means, or is meant to mean? How can it be assessed or enhanced?”
- “Accessibility is a huge, important issue. How can ICHW help move viable benefits to the other 95% of workers?”
- “One ‘pilot’ program is not enough. Can ICHW play a major role in replication and extension of the programs of the emerging best practices companies or successful start-ups?”
- “How do you tie aesthetics and comfort features to ROI? This is important for buying into the program.”
- “Can technology be leveraged to capture metrics—such as GPS, etc.?”
- “The shift from ‘individual’ to ‘collective’ interventions is huge in many ways. What are some of the things that would need to be done to make sure this shift will be effective? How can all stakeholders become a supportive part of this change?”
- “Can behavior change without financial incentives? Will pairing behavior change with financial incentives erode employees’ desire to become healthier over time and as the financial incentives are removed?”
Participants were asked to evaluate the event and provide information on personal outcomes achieved via an on-line evaluation form. Answers to that form and from emails received following the event are summarized below.
New relationships formed. Numerous new relationships were established through conversations during the meeting. For example, Christine Carter from Greater Good Science Center stated that she will be connecting with Shelly Zedeck regarding w¬ork/family balance research, and with Aaron Stoertz from Google regarding happiness at Google. Laura Guido Clark from Herman Miller indicated that she formed new relationships with several attendees consisting of researchers (Gail Brager), other service providers (Steve Hargis, Janice Cavaliere), public policy makers (Casey Chosewood), and corporate representatives (Mary Davidge, Dawn Mugavero and Stephanie Verabian). Rudy Mendoza-Denton established new relationships with Casey Chosewood, Stephanie Douglass, Aaron Stoertz and Janice Cavaliere. David Rempel (UCB, UCSF) had an opportunity to clarify with Casey Chosewood (NIOSH) what they are looking for in their next round of research solicitations on worker health. Barbara Burgel (UCSF) connected with Mary Kay Gilhooly (Safeway) and with David Lindeman (CITRIS). Throughout the day, we observed many conversations between people with entirely different perspectives and for some, this was their first time working across stakeholder groups: policymakers with researchers, company representatives with government agency leaders, and service providers with policymakers and researchers.
New opportunities for research. All corporate representatives expressed an interest in working with ICHW to explore new research project ideas and to serve as potential study sites. A few of the research ideas that came forth from the discussions are:
- To develop a set of metrics to systematically evaluate the effectiveness of the Kaiser Permanente Workforce Wellness for the People of Kaiser Permanente Program. Several ICHW researchers discussed ideas for this research with Kathy Gerwig at the Mixer and will follow up to explore this opportunity further.
- To evaluate the effectiveness of mini experiments at Google more systematically. David Rempel (UCB/UCSF) proposed a conference to exchange these mini experiment findings with ICHW researchers and other employers.
- To work with Jones Lang LaSalle to flesh out some of the theoretical ideas presented at the Mixer on the relationship between temperament and environmental design.
To collaborate with the CA Dept. of Industrial Relations on new research studies that would be mutually beneficial in the area of workers compensation and employee wellness and return to work.
Most important take-aways. Participants who completed the Mixer evaluation elaborated on what they found to be the most important things they took away from the Mixer. Selected responses are listed below:
- “Compassion and more focus on letting others have more ability to control their environment.” (Christine Baker, Director of CA Dept. of Industrial Relations)
- “Everyone needs metrics and ROI backup to sell these health and well-being programs. That’s the biggest missing piece across all of the different corporations.” (Rebecca Ruggles, Gensler)
- “That it is important to try to pilot as many small programs as possible to find the right ones before it is rolled out to the entire organization.” (Marco Lindsey, Haas School of Business)
- “That it will take further conversation with industry folks to develop common projects. There is a need to refine the possibilities for research and joint activity and to share perspectives on what is feasible and useful.” (Julia Faucett, UCSF Nursing)
- “That there is commonality in the work we are doing with regard to choice and control and we are all dealing with constructive ways to communicate complex ideas.” (Laura Guido-Clark, Herman Miller)
- “The importance of ‘talk’ across disciplines and practitioner groups.” (Karlene Roberts, Haas School of Business)
- “…the opportunity to hear from industry, especially Kaiser’s collective group reward pilot…and meeting other members of the Center and discussing for example, bringing nature into work environments.” (Barbara Burgel, UCSF)
- “With respect to any of the interventions described today, one could read that RESEARCH has shown that they were successful. I am not convinced that there is a cause-and-effect between the company’s efforts and outcomes. Research is needed to evaluate the effectiveness of any and all programs.”
Universally, participants indicated that they wanted to continue meeting in this type of format—across disciplines and with diverse stakeholders. Participants requested that we hold Mixers twice per year, with follow-up meetings in smaller groups (perhaps by stakeholder group) to discuss learnings from the Mixers and to plan separate activities tailored to the needs of each stakeholder group. Several suggested that we have more presentations by corporate representatives and more detailed presentations to allow for more in-depth analyses of the effectiveness of various interventions and of the science underlying positive findings that may emerge.
Given this input, we will hold another Mixer in June 2014 to continue our conversations on what we know about creating healthy workplaces and how best to make significant strides forward. We will expand the number of company presentations and have more focused discussion which will lead to clearer outcomes and actions to take. We will also follow-up with stakeholder-specific meetings in the months leading up to the second Mixer to facilitate each group’s ideas for how to advance their own agendas in the service of greater employee health and well-being.