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At SAS, a software company headquartered in Cary, N.C., an employee might start her workday by dropping off her child at one of two onsite daycare centers. If she’s feeling under the weather, she can go to the campus healthcare center to see her doctor before heading to her desk. At lunchtime, she might head to the gym for an aerobics class, to the pool for a swim or perhaps to a workshop on finding assisted living for an aging parent. If the employee is a nursing mom, she can use a comfortable lactation station during the day to nurse or pump in private. And if she works later than she expected, she can stop by one of several cafeterias to buy a takeout dinner — maybe a half tray of lasagna and some fresh veggies from the salad bar — to bring home.

SAS, a private company with nearly 10,000 employees worldwide and more than 4,000 in Cary, is almost unrivaled in its proactive use of wellness programs to create a culture that values employees and helps them to achieve work-life balance. For example, when the company set out to launch its fitness program, “We put all the reasons why people don’t exercise up on a wall and, one by one, tried to eliminate all of them,” says Jack Poll, the recreation and employee services manager who looks after a complete fitness center and several outdoor athletic fields.

More companies are beginning to follow SAS’s lead. They want to make their people healthier. But they’re also looking for ways to acknowledge that employees are more than what they do from 9 to 5. They want to encourage their employees’ outside interests and show them that their personal life and values are respected on the job. They also want to provide support and solutions for those who struggle with personal issues that could be stressing them out and distracting them from doing their best work.

There are several explanations for the interest in corporate wellness programs and for this new corporate point of view. But the primary motivation, it appears, has its roots somewhere near the intersection of health, fitness and the cost of insurance.

Sick and Tired

America has perhaps never been less healthy. According to the Centers for Disease Control, approximately 65 percent of U.S. adults are overweight, and 30 percent of those people are obese. One in 10 (about 25 million people) suffers from chronic illnesses severe enough to limit his or her activity. Correctable conditions like obesity, poor nutrition and smoking (and failure to be screened regularly for things like diabetes or high blood pressure) are leading causes of chronic illness.

The CDC categorizes such lifestyle-related diseases as highly preventable. Left unchecked, however, they’re costly, accounting for more than 75 percent of what this country spends on healthcare each year.

It should come as no surprise, then, that as Americans have gotten heavier, healthcare costs have soared. According to the Centers for Medicare and Medicaid Services ( www.cms.hhs.gov/statistics/nhe/default.asp?), total health expenditures rose from $246 billion in 1980 to $1.7 trillion in 2003. Expenditures per capita rose to $5,670 in 2003, more than doubling from $2,738 in 1990. The Institute on the Costs and Health Effects of Obesity, in Washington, D.C., reports that obesity alone costs corporate America more than $13 billion a year in healthcare claims, absenteeism and lost productivity.

To make matters worse, Americans are also working longer hours, often in sedentary jobs. All that time spent in front of the computer and away from family and activities is hurting our bodies and minds. Inactivity contributes to a variety of major diseases, including colon cancer, diabetes and hypertension. Musculoskeletal ailments, which may arise from repetitive stress or excessive time spent in sedentary, static postures, have become common.

Our mental health is suffering, too. David Hunnicutt, PhD, president of the Wellness Councils of America, a nonprofit organization in Omaha, Neb., estimates that 20 percent of managers in corporate America are depressed.

Rewriting the Work Contract

It’s easy to see these broad trends trickling down into individual companies. Blue Cross and Blue Shield of Texas, for example, estimates that five out of eight of its employees are overweight or obese. David Dahlke, a corporate wellness manager at the company, reports that two of the top reasons employees go to the doctor are for repetitive stress ailments, such as carpal tunnel syndrome, and “those ill-defined conditions that usually have to do with stress, like stomachaches and headaches.”

“The new issue in the workplace isn’t absenteeism, it’s ‘presenteeism,’” observes Renee Moorefield, CEO of Wisdom Works Group, a wellness consulting firm in Boulder, Colo. “People show up to the office,” she explains, “but they work at a reduced capacity because they’re burnt out or depressed or have personal issues distracting them.”

One more motive in the drive toward wellness is less easily measured than health insurance and disease, but no less important. “There’s a new contract emerging between companies and employees,” asserts Moorefield. The prospect of lifetime employment used to drive employee loyalty and give people a sense of shared values and mission with their companies, she explains. (Remember when there was such a thing as the company song?) But after several cycles of layoffs that began in the 1980s, and the frequent job-hopping that so many people did during the Internet boom, it’s become clear, says Moorefield, “that companies can’t be loyal for a lifetime, and employees won’t be either.”

Currently, only 53 percent of Americans feel that their company’s values are consistent with their own, according to a recent study by the American Business Collaboration, in Watertown, Mass. But competitive companies still want to be seen as good places to work, and they are looking for ways to communicate that. Meanwhile, Moorefield observes, “People want to bring more of their spiritual and ethical selves to work. They want an outlet for their creativity. They’re willing to take a lower salary to focus on family and physical and emotional health. And they’ll choose an employer that shares these values over one that doesn’t.”

Putting a Value on Wholeness

The corporate wellness programs coming into favor these days acknowledge that an employee might also be an active community volunteer who’d like a flexible schedule, or a baby boomer concerned about an aging parent who lives alone, or a young mother worried about finding quality childcare. These programs also recognize that people who are always scrambling to meet deadlines are less likely to pay attention to what they eat for lunch, how little they exercise or when they’re overdue for a physical.

Moorefield and others say that a good wellness program can bring a company’s values closer in line with employees’ personal values, which fosters morale and boosts loyalty. And she might be right. In a survey of large companies, conducted by the National Business Group on Health, in Washington, D.C., 56 percent said they saw employee morale improve after they launched fitness programs. In a separate survey commissioned by the American Association of Occupational Nurses Inc., more than 50 percent of employees said a health and wellness program would provide a strong incentive for them to stay at their current jobs.

The best wellness programs look at employees holistically, and they tend to their career goals as well as their values and their mental and physical well-being. A comprehensive wellness program might offer weight-loss and smoking-cessation groups; health and fitness assessments; workshops on life issues such as paying for college or caring for an older parent; various coaching and counseling services; plus, access to a fitness center, walking and running clubs — even healthier vending machine and cafeteria options.

Among the largest companies in the United States, 95 percent offer some sort of wellness initiative, according to Hewitt Associates. But Hunnicutt warns that many of these programs are fairly basic: They might be nothing more than a monthly newsletter with wellness tips, or a perk like weekly chair massages.

“These types of programs are a good way to get started,” Hunnicutt says, “but they don’t generate concrete outcomes.” He says it’s harder to count the number of companies offering the broader, more well-rounded approach to wellness that he prefers, but he observes, “In the past 15 months, I’ve seen more changes in health promotion than I’d seen in the previous 15 years.”

Planning a Program

Hunnicutt, who advises companies on how to set up a wellness program, prefers what he calls a results-oriented approach to wellness. He likes to see companies set measurable goals, like trimming absenteeism and turnover, or keeping health-insurance costs at a certain level, and then build a broad wellness program to meet them.

SAS, for example, has kept its employee turnover below 5 percent a year, about a quarter of what it is at other tech companies. And Gale Adcock, manager of corporate health services at the company, says the health center alone, with four doctors and 10 nurse practitioners, saves the company about $1 million a year in insurance costs and lost productivity. “Any time employees use our doctors instead of going outside, they don’t file an insurance claim, which keeps our premiums down,” she explains. “And we estimate that a trip to an outside doctor can take two hours out of the day. But if nothing is seriously wrong, we can have employees back at their desk in 30 minutes.”

While the breadth and depth of SAS’s program is something to shoot for, it’s important to remember that the company started modestly and built up gradually over 28 years. Adcock, for example, started with one nurse practitioner (no doctors) in a small office.

The Container Store, a Dallas-based retail chain that has won recognition for being a good employer, launched its first serious wellness effort in 2004. The company has tried to make the program broad in its philosophy and has given it measurable goals (reducing insurance claims enough to keep insurance costs flat). But with only one person dedicated to wellness full-time, the company decided to get its program started with a single, high-profile effort that it could build on as the human resources staff learned more about wellness and about what employees were likely to respond to. The idea was that focusing on one activity would also give the wellness director a chance to build interest and excitement among employees scattered across 34 stores nationwide.

That first project was a yearlong challenge, where employees earned points toward prizes that included $500 health reimbursement accounts — sums they could use toward their share of their health-insurance premiums or for health-related items like gym memberships or eyeglasses.

Employees earned points by taking part in companywide contests meant to turn them on to healthy habits. One had them drink more water for eight weeks; another had them walk, run or bike more. They could earn additional points by doing active volunteer work, going to the gym, joining a weight-management group, getting a physical or doing an online health assessment, which asked questions about smoking, weight and even whether a person wore a seat belt regularly.

About 800 out of 3,000 employees took part, according to Rene Morris, who oversees the wellness program. And she expected 400 to do well enough to qualify for prizes. The cost of getting it up and running: about $30,000. This year, Morris plans to offer more exerting physical challenges — her experience last year suggests that her relatively young employees are up to it — and add elements that focus on overall well-being, such as a smoking-cessation program.

Measuring Impact

Most of the studies done on wellness programs measure both investment and results. And for well-done programs the impact is real: Hunnicutt estimates that these companies will see at least three dollars in savings for every dollar they spend on wellness. But if the employees don’t see clear health and monetary benefits for themselves, even a well-planned program is likely to falter for lack of popular support.

“If an employer saves 10 percent on insurance costs, that savings can go back to the employee,” says LuAnne Heinen, director of the Institute on the Costs and Effects of Obesity. The company can cut the employees’ share of the costs, too, or spend more on care for nonpreventable illnesses.

Some employers try to directly tie employees’ insurance savings to healthy behavior. Highsmith, a library-supplies distributor in Fort Atkinson, Wis., launched an incentive-based wellness program after it saw its health-insurance costs spike 53 percent in one year. One of the company’s ongoing initiatives is to give employees who keep on top of their health a discount on their insurance. To qualify for the discount, employees can’t smoke, must get tests from their doctor that are appropriate to their age and gender, and take the annual company-offered physical.

Eighty-three percent of employees go for the discount. And with the aggregate information collected during the physicals (they can’t see an individual employee’s results) Highsmith can create programs that zoom in on its workforce’s most widespread health problems.

For a program to succeed, employees have to see more than bottom-line results, though. Particularly if they are putting in a personal effort by exercising, eating healthier or instituting other healthy habits, they expect to see a change in themselves. And in a best-case scenario, they do.

At Highsmith, after the company discovered that high cholesterol and high blood pressure were common problems, they focused on educating employees about how to improve these conditions. Between 2000 and 2004, the number of employees at risk for each condition fell by more than 50 percent, allowing both employer and employees to breathe a sigh of relief.

To combat companywide obesity, Blue Cross and Blue Shield of Texas began offering low-cal entrées like grilled salmon in the company cafeteria, at a lower price than the usual meat-and-potatoes options. And it launched an eight-week challenge program similar to The Container Store’s that focused specifically on weight loss. By the end of that program, its 3,000 employees shed a combined two-and-a-half tons. “Some lost 10 to 12 pounds and some lost in the 20-to-25-pound range,” says Dahlke.

And, coming full circle, what’s good for the employees is usually good for the employer, too. At The Container Store, Morris knows of a handful of employees who lost more than 25 pounds as a result of that challenge program. She says, “I’ve had a lot of feedback from employees who say they feel better and have more energy [and as result] I have to assume that we’ll find that absenteeism is down and they’re at work more.”

The tangible benefits such as savings on health insurance are what compel most companies to look into wellness programs. But this dynamic of mutual appreciation — companies valuing and supporting their employees as loyal high performers and employees crediting their employers with making them healthier and less stressed — often proves to be an even more meaningful payoff in the long run.

Once again, SAS is a case in point: “One of the most important things at a technology company is to have a culture where people are innovative. But people don’t create when they’re worried about something that’s going on in their personal life or at home. You have to be feeling pretty good in order to have good ideas flowing,” notes Laura Wallace, manager of work-life programs at SAS. “We understand that, and inherent in our wellness program is the message that it’s not just about an employee’s role or position. What matters to us is the whole person.”

Resources

Books
Health Promotion in the Workplace by Michael P. O’Donnell (Thomson Delmar Learning, 2001)

Dangerous Waters: Strategies for Improving Wellbeing at Work by Stephen Williams, Lesley Cooper (John Wiley & Sons, 1999)

Getting Active: 50 Great Ideas for Working Well by David Hunnicutt (Wellness Councils of America, 2001)

Driven by Wellth: The 7 Essentials for Healthy, Sustainable Results in 21st Century Business & Leadership by Julie Maloney, Renee Moorefield (Wellth Productions, 2004)

Planning, Implementing, and Evaluating Health Promotion Programs: A Primer by James F. McKenzie, et al. (Benjamin Cummings, 2004)

Web
www.ibiweb.org — The Integrated Benefits Institute (IBI) is a national, nonprofit membership organization that provides objective research, education and analysis.

www.mayoclinic.com — Click on Healthy Living, then on Working Life to locate the Mayo Clinic’s Healthy Working Life Center, which offers articles on everything from finding life balance to stretches you can do at work.

www.nqi.ca/articles — The National Quality Institute (NQI) is an independent, not-for-profit organization and is the leading authority in Canada on workplace excellence based on healthy workplace criteria. Their Web site provides an array of articles on making work healthier.|

Healthy Boundaries

While more companies are offering wellness programs to help their employees reach that elusive goal of balancing work and life, many are still leaving people to manage the juggling on their own. Bonnie Michaels, president of Managing Work & Family, a work-life consulting firm with offices in Evanston, Ill., and Naples, Fla., offers some advice on how to do a better job of it.

Be alone with your thoughts: “People need time to be alone and reflect,” Michaels asserts. Giving your brain relaxation breaks will help you focus better throughout the day. Turn the cell phone off during your morning jog or daily commute. Sit quietly at your desk for a few minutes before jumping to a new task. Get outside for a few minutes at lunchtime.

Break distracting habits: If “just checking” your email as soon as you get home usually leads to an hour of work that you hadn’t planned on, or if you’re prone to listening to voicemails before bed, find new habits to replace the workaholic ones. Water the lawn, chop some vegetables for dinner or walk the dog when you get home. Take up reading chapter books or set aside special time to connect with your spouse before turning in. You’ll come to see that most work-related things really can wait until tomorrow.

Come home with care: Most people need a little decompression time between clocking out of work and coming home to their real life. Let the kids know that you’re off limits to them for the first 15 minutes you’re home each night and use that time to unwind: Take a shower, get changed, read your mail. “It’s not easy to draw that line, but I know people who have done it and it’s made all the difference in how their evenings go,” says Michaels. For more on making the work-to-home transition, see “Making the Transition” in this issue.

Wean yourself from work: If your overscheduled, disorganized boss likes to call you at home on the weekends, come to an agreement with him or her about your availability. “It’s OK to negotiate limits,” Michaels advises. “Tell him you’re willing to work weekends when a project calls for it, but that you value your personal time and expect it to be respected.”

Fit in Exercise: Walk around the office building or park your car at the end of the lot. Stretch a little throughout the day, or do a few yoga poses before bed. “These things can be done in five-minute increments,” says Michaels, who notes that even a little time devoted to fitness is better than none. “Exercise doesn’t have to be perfect,” she says. “It just has to work for you.”

Want a Wellness Program Where You Work?

The Wellness Councils of America (WELCOA) offers these seven steps to companies that would like to encourage employee wellness but don’t know where to begin.

Get the support of your top executives: Show them how it will make a real difference to the company in terms of lower health-insurance costs, less absenteeism or more productivity. Then, start with a program just for them before you expand to the whole company. “If the CEO isn’t healthy himself, he won’t want to start a program he won’t be successful at,” says David Hunnicutt, president of WELCOA.

Put someone in charge: Wellness efforts that rely on volunteer leaders get lost in the shuffle of deadlines and busy seasons. Name a point person to organize the program, market it to employees, work with outside service providers and oversee progress. And make this a recognized part of their job description.

Find out what employees want and need: Analyzing your insurance claims data or sponsoring a companywide physical that screens for common diseases and health risks will help you zero in on which problems your employees need to tackle, such as smoking, high blood pressure, stress or obesity. A simple survey can help you figure out the kind of programs they’ll respond to. For example, some working parents love the idea of squeezing an onsite gym class into their workday, while others “don’t want to wear gym clothes in front of their coworkers,” Hunnicutt says.

Set goals: Work with management to decide how much you want to invest and what objectives you want to meet short term and long term. For example, a two-year campaign to promote weight loss and exercise might lower health insurance for the next five years. According to data from the WELCOA Web site, employers with comprehensive programs spend about $100 to $150 per employee annually. Though that amount might create sticker shock, employers can get back around $3 for every $1 they spend.

Choose appropriate programs: While coming up with programming that meets company goals and employee needs, also make sure it fits your work environment. For example, if employees are tied to their desks (think stock traders or telephone customer-service providers), make sure organized events will fit within break times.

Create a supportive environment: “The CEO has to get behind the program and use it,” Hunnicutt says. “If he’s using the gym in the afternoon, that says it’s OK for others to do it. And that creates a culture that’s supportive.” Hunnicutt points to a company he knows that opened a beautiful fitness center but kept it closed from 8 to 5 so employees wouldn’t use it during work. “All it did was create resentment,” he says.

Evaluate how you’re doing: Whether you count the people who show up to a workshop or hand out surveys at the end of a class series, keep in touch with employees to make sure the program remains aligned with their needs over time. And be sure to bean count, too, to remind those at the top that their investment is paying off.

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