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.

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?

Sending Your Employees to Fat Camp

Every kid can probably remember a schoolmate who was sent away to fat camp and forced to endure not only the mockery of fellow children, but also bland, paltry portions of undressed salad and other "diet" foods. Losing weight was never cool, but with the mercurial rise of reality shows, even fat camp has been buffed to a high gloss. Shows like The Biggest Loser and other reality diet shows feature die hard trainers who effectively supplant the participants' "lack of will" with their own shrill and uberfit war cries. They harass participants through bootcamp-like workouts (4-6 hours worth at a pop) and analyze their every bite. The results are - well - dramatic enough to capture the attention of a rapt television audience.

Corporate wellness programs seem to be picking up on the trend. Home grown Biggest Loser competitions are popping up all over in America's offices. Sure, this approach can work. Particularly when on someone else's dime and exercising 4-6 hours a day, but for the average working Joe or Josephine, dramatic weight loss can be a setup for disappointment.

And for the ambitious wellness program director? For starters your program might not actually be reaching the least healthy among your workers. A skinny pack a day smoker who does not exercise (unless you count lifting beer to mouth) and has a family history of illness may not have a lot to lose when it comes to shedding pounds.

While it may be tempting to assume that we can look at someone who is obese or overweight and judge their level of health, studies show that a moderately active obese or overweight worker is at less risk of disease than a thin co-worker with high stress, sedentary lifestyle, poor sleep habits, and a lousy diet. Some of the more serious risk factors for cardiac conditions and stroke (think cholesterol and high blood pressure) are not necessarily something you can determine by looking at a scale.

On top of that, if there are big prizes on the line there are actually plenty of unhealthy ways to show dramatic weight loss (think: dehydration, binging, diuretics, stimulants). About 65% of the human body is made of water. Do the math on that. Ask any amateur wrestler (you know the guys who basically wear garbage bags as they run around the block prior to being weighed in) and they can give you a few easy hints for ways to manipulate scale weight. Such tactics can dramatically alter scale weight; however, they put unnecessary stress on the body (dehydration and muscle loss) and the results are typically temporary at best.

Additionally, men have an advantage in the weight loss game. Men's hormonal makeup allows their bodies to rev up the fat burning engines. Women, and particularly those undergoing hormonal changes such as menopause, can still see tremendous benefits from exercise, but thanks to their hormones and body composition will see more gradual weight loss than most men.

So to recap:

• 'Skinny smokers' have little incentive to get healthy - there's not much to lose and have you ever tried running a mile after a cig? It's not fun.
  
• Weight Loss competitions unnecessarily shame larger people. Health and its relationship to weight is complex. You could be singling out otherwise healthy people based mainly on their appearance, which is not exactly a textbook team building approach.
  
• The fix is in. Offering prizes can emphasize unhealthy weight loss methods and put men at an advantage over women.
• The graph below shows average excess medical cost per employee of various health risks. Do you think the Biggest Loser is going to do much to reduce the first two?

If your wellness goal is to improve the health of your workforce, emphasize friendly competition and team spirit, and improve productivity then is fat camp really for you?

Campaign for a Healthier America

Tanya Barham spoke at IHRSA this year and took a moment to ask legislators to consider how better health for Americans could go a long way toward improving our economy.

IHRSA Health Promotion for Club Owners

Thanks to everyone who attended the IHRSA workshop on Health Promotion Leads to Healthy Business. Here are notes from the presentation:

http://recesswellness.com/download/RecessIHRSA2009.pdf

Here is a link tofmyi - which we discussed can be a handy tool for managing wellness communities using social networking style tools:

www.fmyi.com

Now go forth and promote health!

Stop the Pop! Headache Pills Make Matters Worse.

Research shows pain relievers make matters worse

Do you suffer from chronic headaches? Research indicates that as many as 50 percent chronic migraines sufferers and 25 percent of all headaches, are actually triggered by the overuse of common both prescription and over-the-counter drugs used to treat them.

So when your head is pounding is there anything you can do to stop the pain?



90% of headaches are primary headaches (i.e. not caused by another medical condition) and can be attributed to tension (tight muscles and spasms of the neck and back), vascular (migraine), and cluster (non medical causes such as stress).

Sitting for long periods without stretching or moving, jaw clenching, and the kind of physical habits we adopt at work can contribute to muscular tension. Short bouts of stretching (20 seconds of stretching every twenty minutes) and exercise (a 5 minute walk around the block) can ease muscular tension, will produce hormones that counter stress and help you relax. While you may not see immediate results, continued adherence to a self-care routine will lead to more overall relaxation and fewer headaches.

It's the little things - Part 2: When you don't measure, you fail.

A lot of people think that being healthy is all about the stressful hour at the gym and an ascetic lifestyle/diet rivaling that of a cloistered monk (and not in one of those monasteries that brews yummy beer). The truth is actually a lot less likely to make it the stuff of a good television mini-series.

Small, intelligently thought out changes made consistently over long periods of time are much more likely to produce sustainable results than are heroic efforts that can only be sustained for a couple of months at a time. In wellness, it seems, pacing is key. This is true for both the individual wellness program and the corporate wellness program.

We covered an individual wellness example last time and will cover a corporate wellness example today.

Part 2: When you don't measure, you fail.

True story. I talk to a lot of people about corporate wellness. Many people tell me they have a corporate wellness program in place. When I ask what program they have in place they typically rattle off one or all of the following answers: a wellness fair, an online portal offered for free or low cost by their health plan or Employee Assistance Program, a yoga class, on-site massage, a corporate gym membership.

My next question?
"What is participation like in your {fill in random program here} program?"

If you actually know then take this poll:
http://polls.linkedin.com/p/24137/smrgy

The answer is normally a variation of one of the following two responses:

The truth:

"I don't know," or, "It is pretty lousy - just a handful of people."

The euphemistic version of the truth cooked up to make the respondent feel better about spending money on this program:

Respondent: Well there are a couple of people here who seem to really like the program and {more totally anecdotal blah blah blah} there's been quite a positive response.
Me: So have you participated?
Respondent: ......
Me: So about how many people, would you say, have given you this positive feedback?
Respondent: A lot
Me: 5? 10?
Respondent: Well the Director's assistant...
Me: 2? 20?
Respondent: Maybe 3 Me: Out of how many employees?
Respondent: 2,000
Ok so the rosey assessment of their wellness offering is based on a sample size of less than 1% of their employee population??!?!?! I'm sorry, but in this economy please hope that I never am your manager. Because if I find out that you are justifying an expenditure with anecdotal feedback and a quantitative evaluation with a sample size of 0.0015% I will fire you.


Measurement helps you manage programs so that you get more for each $

When companies, consumers, the government, banks, and - hey - just about anyone who turns on the radio or TV these days is blowing a freaking gasket about the economy you need to be able to show that you are making effective use of your company's money.

Even if your company's cash position is solid, perception is reality and investors, managers and employers are taking this very grave moment in history as an opportunity for a little financial introspection. When the top brass turns its eye on your pet programs, you'd better show that they have value and that you are creatively exploring ways to get more for your money.

Today I will let sleeping dogs lie and side step the issue of how effective any of the specific programs mentioned above are likely to be outside the confines of a strategic, planned, well-measured and effective wellness program design. Let's just assume all of the programs are fantastic and each is amazingly effective at transforming the health of its participants {cough}.

But I do have to complain about the very minimum employers could do to ensure the effectiveness of wellness programs but often don't do: measure them. Data is one of those little things - those small, pesky continuous things that is not fun to collect, clean or analyze for most of us.

On the flip side, those who have meticulously gathered data around wellness have shown that well-rounded, multi-year, multicomponent wellness programs produce significant, positive return on investment (ROI). This is especially vital to businesses who shoulder the health care costs of employees - a cost that now makes up the lion's share of employer sponsored benefits.

The catch?

1. The average study length of effective, multi-component wellness programs is 3.6 years.
2. The average cost of effective, multi-component wellness programs is $150 (or more!) per employee per year.
3. The average participation in effective, multi-component wellness programs must be more than 40% in order to make a dent in health care costs.

If you are going to be allowed to manage a program that is responsible for that much in spending, for those many years, and touches half or more of your workforce, do you think anecdotal evidence is going to help this program survive the revolving door of HR Directors, C-Suite execs or directors at your company?

Take a minute to answer that.

No?

Oh really.

Measure measure measure.


Look at the data in excruciating detail. Get deep into it. Ask questions. Are you not a numbers person? Find someone who is. Hire someone who is. Make excel your Valentine. Ask all the questions that the CFO and shareholders will be asking you. Dissect the data 20 different ways until you feel satisfied that you understand.

At a freaking minimum - measure program cost and participation and ask how and whether you can get more people to particpate for the same or less money. When someone asks you how many people use your program and how much it costs per person, produce a cogent answer. If the number looks unimpressive present a convincing plan on how you will improve matters.

The easiest way to ensure you do this is to pick 6 key things to measure early on in your program. Define what you are measuring, how that measure relates to some of your company's strategic goals, where the data comes from and how often it needs to be collected, and some of the considerations and assumptions you are making when analyzing the data. Once you've pulled that together in a one page overview, simply filling in new data points should not be too difficult.

It's the little things - Part 1: You are what you eat

A lot of people think that being healthy is all about the stressful hour at the gym and an ascetic lifestyle/diet rivaling that of a cloistered monk (and not in one of those monasteries that brews yummy beer). The truth is actually a lot less likely to make it the stuff of a good television mini-series.

Small, intelligently thought out changes made consistently over long periods of time are much more likely to produce sustainable results than are heroic efforts that can only be sustained for a couple of months at a time. In wellness, it seems, pacing is key. This is true for both the individual wellness program and the corporate wellness program.

We'll cover an individual wellness example today and a corporate wellness example in next week's blog.

Part 1: You are what you eat


You might have trouble reading this but the table on the left shows a client's food log. Nothing too crazy on there...this person never felt as though she was binging or eating excessively. In general she averaged about 3000 calories a day, which given her unique body composition and level of physical activity was just right to maintain her post baby weight. Trouble is, she wanted to be pre baby weight - a mere 10 pounds lighter. Losing any more weight was not necessary or healthy.

The stuff highlighted on the left shows things she worked with a consultant to substitute or go without. Little things: cheese - OR - BBQ sauce on her burger, but not both. A bagel with low fat cream cheese instead of a soft pretzel. Little things. But the little substitutions added up. The table on the right - with the substitutions amounts to only about 2,300 calories per day. Big difference, huh?

Is cutting out more better?

While it might be tempting to think that if she made heroic changes she would lose EVEN more EVEN more quickly, the truth is that few people can sustain, for very long, dramatic shifts in their eating patterns without breaking down to binge or their body down-regulating their metabolism. If the goal is weight loss, then neither of those outcomes is going to help our friend achieve her goal.

After following a consistent, healthy pattern of eating our female friend should expect to lose about .5 pounds per week following about two-six months of consistent and moderate exercise and diet choices. The longer she maintains her consistent and moderate plan the closer she will eek to a weight where he body will happily stay - a healthy weight appropriate for her body type.

Plan well. Be informed. Pace yourself. Slow and steady wins the race.

Recess vs. Paying Not To Go To The Gym

If you like paying for stuff you don't use - Join a gym!

Ok. Here we go. Picking a fight again.

A 2005 study by two California researchers, titled "Paying Not to Go to the Gym," examined nearly 8,000 gym members' attendance over three years. You might be surprised to learn that 85% of users who bought a monthly contract were spending more money than if they paid on a per-use basis. That's because most members paid more than $70 per month but only visited the gym 4.8 times each month. They paid about $17 for each visit.

How effective were those 4+ visit per month at actually transforming members' health? It's anyone's guess, but chances are a 30 minute workout on the treadmill and a couple of half-hearted bicep curls are hardly enough to make a dent in the number of calories found in daily latte, scone or other weekday indulgence.

Last month we kept it clean, but this month's fight could get ugly:



The 300 Pound Gorilla:
Gym Membership

Weighing in at an average of $50-70 per month, this hometown favorite is sure to pummel you with early cancellation fees when you realize that your 4 trips per month just aren't cutting the mustard.

The Contender:
Recess Personal Transformation Package

For the same price as a weekday latte and scone the Recess Personal Transformation Package will have you in fighting form. You'll meet more than one time every other week for a year with an expert at your home or office gym. By the time this fight is through you'll have tackled not just strengthening exercise, but also nutrition, cooking, lean body composition and calorie burn.

What is your vote? Would you rather contract foot fungus in a gym locker room or shower in your own bathroom? Weigh in with your answer in the comments below.

Corporate Gym Memberships - A Perk for the Healthy

Ask companies what they are doing to improve the health of their workforce and many respond that they offer a corporate gym membership.

In an era where growth of the cost of health care is surpassing nearly every other business expense, I can't help but feel like banging my head against the wall every time I hear this response. Here's why:

Poor Participation:
Chances are, people aren't using your corporate gym membership program. An article by Bradley Cardinal Ph.D. estimates that only 9-20% of employees take advantage of corporate gym memberships. Those who take advantage of the programs are often the ones who would have participated regardless of whether or not their employer subsidized membership.

Nationwide only 16% of Americans belong to a gym; however, more than 60% of Americans don't get enough regular physical activity. You do the math but the outcome is the same - for whatever reason most people don't like or are not able to go to a gym.

Ignoring Employee/Buyer Motivation (and reality!):
Hoping that offering a corporate gym membership will entice those same people to see the error in their ways and pick up the exercise habit is a bet with lousy odds.

A report in The Houston Christian Post cites an IHRSA official as saying "Despite the national obsession with fitness, about 85 percent of Americans do not belong to a gym, according to the International Health, Racquet and Sportsclub Association. The most frequently cited reason for not joining a gym? A lack of time and intimidation, said Brooke Correia, the industry group's spokeswoman."

Raise your hand if you think offering a corporate gym membership is going to give people more time or help them feel less intimated by a gym. If you raised your hand you are a fool.

Not Rewarding Or Encouraging the Right Behaviors (i.e. increased fitness):
Even among the few who do go to the gym, statistics show they do not go enough to make a difference in their health. The Surgeon General recommends that Americans engage in a minimum of 30 minutes of moderate physical activity most days of the week. Most health club members only make it to the gym 92 times per year and that does not speak to the quality or the duration of their visit - simply that they walked in the door of their health club.

As we all know many of those same clubs offer massage, tanning and other non-exercise activities - like standing around and talking to the tan, muscled up guy at the weight station to the right.


Return on Investment?
Those going to the gym are too few to impact your company's general health. And if those going are otherwise healthy (i.e. have fewer risks to reduce to begin with) then offering Corporate Gym Memberships is leaving a very substantial subset of your workforce progressing toward inevitably higher levels of disease risk as time passes.

What's next?
Keeping people's real motivations in mind, how can you make physical activity accessible and attractive to a larger portion of the working population?

1. Offer classes on-site as part of a larger multi-component wellness program that is convenient and appealing to employees.
   
2. Monitor attendance and market the program in a way that is attractive to high and medium risk populations.
   
3. Remove barriers to entry by emphasizing moderate intensity programming and comfortable, qualified instructors with experience teaching mixed level classes.
   
4. Award incentives to those with improved risk status, regular program participation, or, a combination of both.

Don't get me wrong, as part of a broader, multi-component corporate wellness program, offering credits for joining a gym can be a good way to reward folks who are already motivated to practice healthy behaviors. On the flip side, corporate gym memberships alone are not an adequate or even substantial substitute for an effective wellness program.