Stress and the Elephant in the Middle of the Room

Far be it from me to want to turn away work that could put food on the table for my staff, but as wellness consultants we are often asked by clients to address issues stemming from workplace stress. Probably no one is surprised to hear that many Americans find work stressful:

An NIOSH report from the early 1990s cites the following:

• 40% of workers reported their job was very or extremely stressful;
• 25% view their jobs as the number one stressor in their lives;
• 75% of employees believe that workers have more on-the-job stress than a generation ago;
• 29% of workers felt quite a bit or extremely stressed at work;
• 26% of workers said they were "often or very often burned out or stressed by their work."

The report goes on to quote an insurance company study that concluded "Problems at work are more strongly associated with health complaints than are any other life stressor-more so than even financial problems or family problems." Yikes.

Here's the freaky part, though. It gets worse. According to the American Institute of Stress an average of 20 workers are murdered each week in the U. S. making homicide the second highest cause of workplace deaths and the leading one for females. Many employees cite their or their co-workers increased job stress and lack of ability to cope with such stress with an increase in physical or verbal hostility in the workplace. 2 reports in 2000 compiled by Gallup and Integra revealed that:

• 14% of respondents had felt like striking a coworker in the past year, but didn't;
• 25% have felt like screaming or shouting because of job stress;
• 29% had yelled at co-workers because of workplace stress;
  
• 14% said they work where machinery or equipment has been damaged because of workplace rage
  
• 19% or almost one in five respondents had quit a previous position because of job stress and nearly one in four have been driven to tears because of workplace stress;
• 62% routinely find that they end the day with work-related neck pain;
• 34% reported difficulty in sleeping because they were too stressed-out;
• 12% had called in sick because of job stress;

Over half said they often spend 12-hour days on work related duties and an equal number frequently skip lunch because of the stress of job demands.

If you can pick even three of these items and you feel they adequately describe your working environment, there is no amount of on-site yoga or wellness campaigns that can help. Your problem is systemic. That is not to say that yoga or corporate wellness can't help those employees who participate better cope with a stressful situation, but if you look around and see the signs of deteriorating health and humanity in your workplace chances are good you have bigger issues to address.

Where is this all coming from?
I reached out to professionals on facebook, Twitter, LinkedIN and the blogosphere to ask what they saw as the biggest sources of workplace stress. Their answers seemed to echo two main themes:

Lack of clarity and discipline in work processes.

Typified by responses like this:

"This is related to employees who refuse to answer or even acknowledge emails. And, as a project manager, I'm held responsible for not having an answer. That's stressful for me."

"Process. Inefficient coordination that wastes time kills spirit. "


This includes: passive, unfocused or unclear communication or hierarchy among team members, lack of consensus or goals, poor accountability to project deadlines or deliverables, leading people to feel as though they were constantly firefighting rather than working effectively and productively.

- or -

Lack of empathy and understanding.

Typified by responses like this:

"Unreasonable expectations. Often of the, "I want an answer today!" type, when the standard timeline is several days."

"When everyone needs everything RIGHT NOW. Clients don't care that you have other projects or other clients."

"Treating everything as an emergency, as a top priority, while less urgent items are ignored to become tomorrows' emergencies. "

When coworkers or clients not taking time to define their own goals and understand project and time constraints, the ensuing lack of clarity in communication seems to drive people nuts. We can probably all recall a project fraught with: interrupting, introduction of scope creep, lack of respect for other organizational priorities, dropped balls which result in blaming and deviceiveness among team members, leading to micromanagement and disrespect for co-workers' expertise.

How do we stop this train wreck from happening?
So here is the interesting part for me. Nope, wellness alone won't fix the underlying problems. This is something that even we have to grapple with as a wellness company. Perhaps the best advice we've had to offer in this arena is our own example. There is a quote by Thich Nhat Hanh that is displayed prominently in our office and included in every employee orientation at Recess.

"Our own life has to be our message."

Easier said than done. Especially if everyone at your company is communicating a different message. Getting everyone on the same page, unifying around a vision, mission, set of values and ways of doing business is hard work. It means that at every level of the organization people need to be given time to work on the business as well as in the business and that all new hires, client acquisitions and business decisions must be constantly evaluated through this lens.

Cameron Herold was COO at 1-800-GOT-JUNK? His leadership helped build a presence in 46 states, 9 provinces, and 4 countries while being ranked the “2nd Best Company to Work for in Canada” by Canadian Business Magazine and “the #1 Company in BC to Work for” twice by BC Business Magazine. During his tenure the company was studied by numerous MBA programs including Queen’s University in Canada & Harvard. Here's Cameron (please note, no subtitles provided for his Canadian accent):



He articulates in his talks the need for a broad and all encompassing vision that is then executed through a series of well orchestrated and disciplined internal processes and plans. Take a look at how that vision trickles down on a daily basis:



Even before starting Recess, I worked as a management consultant. When I showed up on client site I'd see everyone running around frantically, firing off emails after email, powering through lunch, working long days on projects that still never seemed to be done "right" or on time. The company that I worked for advocated a long painful process whereby clients aligned their work habits with long range planning and resource allocation and right sized their organizations rather than simply grabbing anyone breathing (only to leave a firing bloodbath once sales dried up).

I saw over and over that trying to implement suggestions like Cameron's can be difficult once organizational problems are endemic; however, doing so is probably the best way for an organization to achieve rapid business growth without churning and burning the exceptional employees and clients it worked so hard to find.

If you really want to eliminate workplace stress then:

1. Define long term, mid term and short term goals based on vision.
2. Create systems that balance the skills, talents and availability of your workforce with a realistic plan for achieving your goals. This provides a basis for communicating your vision in a meaningful way to every person in your organization.
3. Manage the process. Track. Measure. Create structured and regular opportunities for employees to report on milestones, then get out of their way.
4. Of course the last bullet requires that you hire capable people who value your mission. Weed out employees, managers and clients who don't get it. Bad apples are like entropy inducing kryptonite for even the best run companies.

So while I don't want to discount the benefit that yoga and good health have on well being (after all I would be out of a job if that were the case), companies that wish to lessen the impact of stress should start by doing the difficult systemic work necessary to create a humane work culture. Culture isn't something you can get through a workplace personalysis or a ropes course. Best management practices improve your company's bottom line and make work a more predictable, reliable and sane place for the people that keep your organization afloat.

Biking. In heels. 8 months pregnant.

Every summer I usually take part in Recess' Health Immersion Program, which is a total blast and the highlight of my summer. I always make new friends and really enjoy the companionship and commitment the group inspires. Oh, and did I mention my arms always look totally cut by the time camp is done?

I also learned how to surf one year when all of the campers did a surf camp at the end of the program. As proof see one of my buddies to the left there. Well this year camp starts on July 1 and I could be giving birth at any time, so I am missing camp this year. WAAHHHHHHHHHH!

So, how have I managed to at least keep my heart rate up and my body feeling healthy under the strange pressures of pregnancy? My bike. That's right. My number one form of transportation is still a reliable standby and allows me to get out, get fresh air and move my body in a low impact way. So far so good. I have continued to enjoy the summer in Portland and in the meantime my primary mode of transportation is also keeping me fit.

True, it's more cardio vascular than muscular (no cut arms for me this summer) and I might not look like a runway model but my pregnancy has been really healthy and I feel I have regular exercise to thank for it!

Recess 2009 Portland Health Immersion (Formerly Boot Camp)

Enroll in the Next Two Weeks for a Chance to Win!

Free classes galore, and a yoga mat to boot A big hello and a giant thank you to those of you who have gotten in touch with us about this year's Health Immersion. If you've been thinking about signing up, the time to act is now! Thanks to our wonderful sponsors, we've got a killer package of free classes and goodies to give to one fun lovin', wellness-embracin', future Recess Health Immersion participant. If you sign up in the next two weeks, that's by Tuesday, June 9th, you'll be automatically entered in a drawing to win... One month of free membership at Alameda Fitness Center Two weeks of free classes at Studio Nia One free class at NW Pilates One free class at Yoga Pearl A yoga mat A lucy activewear water bottle A Bob's Red Mill cookie Scroll down to sign up, and have a chance to check out some of Portland's coolest wellness studios!

The Essential Info

Dates, Times, Location, Workouts, and Goodie Bags! For this year's health immersion (formerly boot camp), we'll have two groups--one that meets Mon/Wed and one that meets Tues/Thurs. The groups will meet together on Saturdays. Dates: 2009 Health Immersion runs from 7/1-8/29. Mon & Wed, 6:15-7:30 p.m. Sat 10-11 a.m. or Tues & Thurs, 6:15-7:30 p.m. Sat 10-11 a.m. *Must enroll by June 24th* Location: Duniway Park - SW Portland - easily accessible by bike and close to every major roadway (26, 405, 5). Certain activities may meet at other easy-to-reach locations. The camp includes: * Pre and post body composition/fitness assessment * All of our personalized reports * Seminars on nutrition, cooking, exercise and integrative arts like yoga, Pilates, Tai Chi, Budokon, etc. * A cool group of "campers" and Recess instructors * Participant-only web portal access * Goodie bags and prizes worth over $200 Cost: $250 a month More questions? Email Kaitlin at kaitlin@recesswellness.com SIGN UP ONLINE TODAY>>

Jack of All Trades & Master of None

Poor focus hampers wellness implementation

Are you updating your facebook status via Twitter from your iPhone as you apply your make-up or eat your burger on the drive to your next open enrollment meeting? Many Americans feel as though they are good at multitasking and engaging in multiple activities simultaneously leads them to believe they are accomplishing more. In her book, Distracted: The Erosion of Attention And The Coming Dark Age, author Maggie Jackson points to a growing body of research studies that seem to suggest the opposite. A flood of stimulation, interruption and fleeting human contact have created a culture of "diffusion, fragmentation." She points out the consequences of what most of us consider par for the course in our lives and working environments: Interruption and the knowledge worker: Knowledge workers switch tasks every three minutes. And once interrupted, a worker takes an average 25 minutes to return to their original task, according to informatics scientist Gloria Mark. How often are we interrupted? The average worker gets 156 emails a day, according to the Radicati research group. And that's just the beginning; instant-messages, phone calls, faxes and snail mail add to the influx. Making a national habit of multitasking: Sixty-five percent of people eat while they drive. Sixty percent of kids age eight to 18 multitask some or most of the time they're doing homework. Twenty-five percent of restaurant meals are ordered from the car, up from 15 percent from 1988. American kids are exposed on average to nearly six hours a day of non-print media. Two-thirds of children under six live in homes that keep the tv on half or more of the time, an environment linked to attention-deficiencies. Time and time again in the world of wellness we see this habitual tendency toward mindless overcommitment, interruption, and multitasking lead to programs that are too diffuse to do much good if the desired outcome is a healthier workforce and reduced health care costs. Why wellness fragmentation does not equal results How does ROI for wellness work? It is more of a cost avoidance than an actual savings in most cases. Here is a simple (and maybe a little too simplistic) example to help walk you through the "savings." Half of your workforce participates in a risk based population health strategy (wellness program) and the other half does not. For the participating half of the population, whose risk is known, you are able to offer outbound (active) and passive programs that directly impact and address the risks you've identified as prevalent to this group. Let's say the programs you've implemented are effective, engagement in them is high, and you retain these employees. Over a series of years you should see something happen that is counter to what will have happened with no intervention. That is to say, this group will not get sick as often as non-participants because your interventions were effective and employees stuck around long enough for you to see results. The non-participants at your company, as an aggregate, are an unknown entity to you. You have very little data on their risks and, as a group, they will most likely continue to use health care at the same rate as before. Yet, if your company-wide wellness communications are effective and appealing, your participant group is vocal and influential, and your non-participants stay at your company without developing any major illness then some studies indicate that your wellness program might actually have a halo effect. That is to say, even non-participants will learn a little more about self care whether they participate or not. Sure, that could slow the rate of health care cost growth in that group, though probably not by a lot. Both groups' cost trends together is your overall trend. Both may continue to rise, but your participant group's trend over several years will rise more slowly - making your overall costs appear to grow more slowly. UNLESS. Yes, there is an unless. Unless, your participant group is so small and the growth in the cost of health care is so large that your non-participants' health care usage effectively nullifies any impact you had on participants. Wellness is not Wii Fit. You need to focus. As much as we know that on an individual level good health is as simple as: sleep well, eat right, and move more, achieving a successful organizational wellness strategy is as much an art as it is a science. It takes focus, discipline and rigorous measurement to impact behavior, motivate and sustain participation, and to quantify results. If your program is to be successful then you will need to engage a large chunk of your workforce, stratify their risks, and follow a disciplined series of steps over several years in order to see return on investment. Oh, and do all of this while simultaneously carrying out the core work of your company. Fight the urge to multi-task While multi-tasking may be transitioning out of vogue when it comes to work effectiveness, its cousin - work sequencing - can help break large and complex tasks into more manageable pieces. Plan to succeed by drafting a multi-year strategy with a realistic timeline. Schedule monthly (core team), quarterly (key shareholders and decision makers) and annual reviews (company wide) of a the wellness program before you even begin work. This will hold you accountable for reporting progress toward implementing your strategy and plan. Build up to maximum efficiency by starting with only a few key program components that will get you the most bang for your buck. Gradually add complexity as your initial program begins to show results. More often than not, companies initially underestimate how much time it takes to implement a strategic wellness program. They allocate too few resources and take on too many program components to ever really get much traction. As a result, their programs suffer from poor participation due to fragmented management and the overall program shows high attrition. Plan intelligently and sidestep this common trap. Have the will but lacking the way? Recess can help. »

Will restricting HSAs and FSAs and tax credits help cut health costs?

So what do you think?

Workforce.com reported today that:

"The Senate Finance Committee will discuss controversial options that include curbing the tax-favored status of employer-provided health care coverage, wiping out health care flexible spending accounts and placing new restrictions on health spending accounts when it meets Wednesday, May 20."

1. How will this effect your company and its employees?
2. Will this change the kind of benefits you currently offer?
3. How will this impact your company's willingness to offer wellness and health benefits to your covered employees and dependents?

The Bun In The Oven & The State of Preventative Health

Here are some snippets from an email I received from the US Department of Health and Human Services today:

"We know that the health care crisis impacts every American, but our mothers, daughters and sisters are paying a particularly heavy price. Today, 21 million women and girls are uninsured. Women who try to purchase insurance find that the private market is often stacked against them. Premiums in the private market for young women are often higher than they are for men. In some states, insurance companies can legally discriminate against women, and leave them with higher health care bills or inadequate coverage.

We know America's women can't afford to wait for comprehensive health reform. Roadblocks to Health Care reports:

• In the individual insurance market, women are often charged higher premiums than men during their reproductive years. Holding other factors constant, a 22 year old woman can be charged one and a half times the premium of a 22 year old man.
• In a recent national survey, more than half of women (52%) reported delaying or avoiding needed care because of cost, compared with 39% of men. "

Why are women charged more?
Among other things, because we can get pregnant and pregnancy in the US is very expensive. We therefore use more health care and are charged more or denied insurance coverage. But here is the crazy part, folks: women cannot self-impregnate!

Not long ago, I received a very personal lesson on the wacky state of preventative health care for maternity. As an otherwise extremely healthy person with a good track record for taking care of myself and little in the way of worrisome health risks, I'd gone the way of financial prudence. I purchased a health plan with a high deductible, but with inexpensive co-pays on doctor's visits and alternative medicine as well as discounts on pharmaceuticals should I need them.

This was all working out very well. I continued to do my part for the team by taking good care of myself, paying my insurance company dutifully and not using any medical care! I was mentally prepared should a catastrophe befall me. I figured, should that happen, my piddly $5k deductible would seem like chump change in comparison to what I would otherwise have had to spend out of pocket for catastrophic care. All those years of paying unused premiums to my carrier would have been put to good use!

Then, about 6 months ago I developed a small "medical" problem. That's right. I got pregnant. Ok so this is no catastrophic illness or disease condition, right? I mean, there are more than 6 billion people on earth and unless I am mistaken pregnancy is the way we all got here. As a scientist I will grudgingly agree that pregnancy looks suspiciously like a highly evolved parasitic infection. Yet, unlike malaria - for instance - my health plan wasn't ponying up any cash for pregnancy vaccines or other preventative measures against this "disease."

So it was one $20 co pay with my primary care doc, the cost of a pregnancy confirmation test and then I was on my own. At that point my options were to start clocking maternity care against my catastrophic deductible. After meeting that limit I'd pay 30-70%. After doing the math I realized that if I ended up in a hospital for a routine, healthy birth with no serious complications that I would most likely end up paying $7,500+ out of pocket for my "disease."

Compare this to a $2000-2500 bill if I pay cash for a home birth with a certified nurse midwife including all prenatal scans and labs and two months of well baby care and it left me scratching my head. Now if there were complications (need for surgery, premature birth, gestational diabetes, preclampsia, etc.) that led to a need for emergency medical intervention then, as I said, there is not much room to gripe over the deductible when so many dollars and someone's life is on the line. Yet when all signs in my case (and in the case of nearly 75% of pregnancies that come full term) point to a completely normal, healthy pregnancy and birth I am perplexed about how this situation serves any sort of greater good.

In my case I simply opted to pay the midwife out of pocket and should an emergency arise, well, it's an emergency - deductible be damned. Yet I think about all of the women whose partners may have left them; women whose partners lost their jobs; women who have lost their own job and are not sure how to afford COBRA, but would be denied individual coverage due to their "pre-existing condition"; women who are short on the cash to be able to afford the relatively less expensive but still cost prohibitive bill for good prenatal care and who end up with very costly bills later on down the line due to having delayed or avoided care.

And these mothers who were impregnated by partners who - in most cases - will not be denied coverage or see rate increases due to their partners' "disease," are left unable to pay and to pass on the costs to the remaining payers in the current insurance system - thus becoming contributors to the astronomical rise is insurance rates. These are not some handful of bad people "out there." If you are reading this blog, breathing and have a pulse right now then you have a pregnant woman to thank.



People are not going to stop making more people, people. It just isn't going to happen. So what are our options when it comes to taking pregnant women off of the bad apple list with regards to health care costs?

1. Provide safe, effective and affordable contraception and family planning services to women of reproductive age (yes, this means after menarche) .
2. Ensure that pre-natal care is covered as preventative care under health plans.
3. Stratify pregnancies by risk and ensure that health plans cover lower cost but safe and effective birth options such as licensed birthing centers and midwife assisted home births for low risk pregnancies.
4. Ensure that health plans rapidly identify and direct high risk pregnancies to maternity care and coaching programs that help manage behavioral risk factors and more closely monitor pregnancy through birth.
5. If you are en employer providing maternity benefits and health insurance for your employees and spouses, make sure you emphasize prental care and maternity benefits offered by your health plan. Consider setting aside lactation rooms to encourage breastfeeding mothers to pump so that they can continue to feed their babies breastmilk (which has health benefits for the mother and child).
6. Support legislation that accomplishes all of the above and funds community health education centers that provide outreach, education and services to uninsured populations - eliminating a cost barrier which might keep pregnant women from seeking care until it is too late.
   

If altruism isn't your bag, then consider that early prenatal care helps all payers in the health insurance game by lowering costs shared by the pool. And if you are still feeling the glow from that gift that had your mom in tears last weekend, then - hey - do it for the lady who loved you enough to endure nausea, swollen feet, ill-fitting clothes and a whole lot more to bring you into this world.

An Apple A Day or A Bad Apple?

I was recently listening to an episode of This American Life titled, "Ruining It For The Rest of Us" where they featured stories about how easily one person's behavior can have a contaminating effect on others. One particularly haunting story covered the research of Will Felps, a professor at Rotterdam School of Management in the Netherlands, who placed a confederate in a group and observed the impact that this "bad apple" had on the rest of the group. In nearly every case the influence of even one spoiler tarnished the productivity and the morale of the group.
One thing that the researchers in Phelp's study didn't look at, however, is that poor health can impact mood. Could an apple a day and a brief jaunt outdoors help the bad apple get his mood back on track? Or could workplace health and wellness be a protective means of coping for those who might otherwise be affected by a bad apple?

How do health and mood interact in your workplace? Have you seen an instance where a bad apple lowered the productivity of a work group and subsequently led to more sick days or a reluctance of team members to show up for work?