© Copyright 1999 Maclean Hunter Publishing Ltd. The following article first appeared in the March 1999 edition of BENEFITS CANADA magazine.

The state of wellness

Canada was once a leading light in the development of healthy workplaces. Now our employers are engaged in a desperate game of Follow the Leader. What's next?

The BENEFITS CANADA 11th annual roundtable is dedicated to this important trend. Our guests are well-placed: Ed Buffett is chairman and chief executive officer of Buffett Taylor & Associates Ltd. in Whitby, Ont.; Judy Hackett is a manager, group healthcare at Eli Lilly Canada Inc. in Toronto and a spokesperson for the Pharmaceutical Manufacturers Association of Canada; Barry Noble is national director, managed care with Manulife Financial in Toronto; Sue Pridham is a partner, client services at Tri Fit Consultants Inc. in Mississauga, Ont.; Terry Sullivan is president of the Institute for Work & Health in Toronto; and Dr. Scott Wallace is a clinical/organizational psychologist at BCT.Telus in Vancouver.

Kevin Press: Let me play the role of decision maker. I think wellness in the workplace looks great on paper--I'm onside ideologically. But these are still relatively early days, in development terms. And I'm not sure now is the time for my organization to be on the cutting edge. How do you respond?

Ed Buffett: I would endeavour to find out whether or not you, as an employer, want to be a leader in your industry. In order for you to realize that goal, you have to recognize the value of the intellectual capital that's represented by the people that work for you. I find it somewhat ironic that senior executives will express reluctance when it comes to committing dollars to wellness initiatives and disability management programs. At the same time, they will invest millions of dollars in computer and building maintenance.

The reality is folks, some of our business leaders just don't get it. Why is stress such an issue? Why is depression such an issue? What has changed about life? Obviously, the speed with which we are doing things--the amount that we expect to accomplish in such a short time-frame. It's becoming overwhelming. If there isn't some sensitivity to that, then the willingness of the people who hew the wood and draw the water is going to become less and less evident. We're going to have some very real labour problems.

Wellness is really a partnership between the employer, the employee and a range of stakeholders. When we did our survey back in 1997 (The First Comprehensive Canadian Wellness Survey), CFOs identified employee health as the primary reason for implementing wellness programs--not cost savings, not a reduction in LTD claims or worker compensation claims. They were saying "we value employee health."

Scott Wallace: If you had come to me with that question, I would have talked to you about dinosaurs. It didn't take much of a change in the global climate--maybe a degree or two--to kill dinosaurs. What we tend to do sometimes, in the face of change, is build stronger walls. We become that much more rigid and inflexible. It's not too soon for wellness. I might ask you if it's too late.

Judy Hackett: Whether it's driven by a need to have an improvement in health, because it's a warm fuzzy thing, or whether management sees it as a line on the balance sheet, buy-in has to come from the CEO. Everybody says they want to have a healthy company. But minimal effort doesn't cut it in the long run. You're just painting a new layer of paint on the house--it's still rotting underneath. You need to have a CEO willing to commit, and to delegate the resources that are necessary to make it happen.

Barry Noble: With some of those CEOs, that's not something that can happen easily. I use a line that sometimes offends individuals--there's not a lot of value in watering the stones. There are organizations that, no matter how much time and energy you put into the pitch, it's just not going to happen. Providers will focus on organizations that ultimately turn wellness into a commodity. We've seen this with standard employee benefits and employee assistance programs. That's how you get other types of organizations to move forward. The leaders in their industry do it first.

Wallace: I don't want to send the message that you have to have that support initially.

Sometimes we just need to step out of the box, and go ahead and get a groundswell--whether it's voluntary enrollment or whatever. Let's not close ourselves off to CEOs whose doors are closed to us.

Noble: But in some of those cultures, if you attempt to innovate without the endorsement of the leadership, you could put yourself in job jeopardy.

Wallace: Ultimately, if you're working for some place like that, you have to make a decision about whether or not you want to stay there.

Noble: It's more of a challenge for Canadian business leaders, because a lot of organizations are validating these programs on the basis of dollars saved in their medical plans. In Canada, that's not an area of payback for us. It's a much more difficult proposition.

Buffett: That is one of the things that has made the sale difficult here. In fact, it is why it's taken us 18 years to really get into the workplace wellness business here in Canada. But a couple of things are happening that are changing that dynamic.

Whether we're talking about the U.S. healthcare system or our healthcare system, absenteeism is a huge expense. I don't agree with the employer who says: "We're not going to do it here in Canada--the cost-benefit isn't there because of the different healthcare system." The potential dollar savings associated with increased productivity, less absenteeism and better employee morale will far outstrip anything that you're going to pay in the area of worksite wellness or health promotion.

Another dynamic that has to be considered here is the fact that we're getting governments increasingly off-loading services. Private plan sponsors are going to be asked to pick up more of the healthcare burden.

Terry Sullivan: This is not completely motivated by cost. It's motivated by getting the talent. Look at what's happening in the labour market. Those in high-end knowledge jobs are mobile.

THE BUSINESS CASE
Press: Can workplace wellness be defended in return-on-investment terms?

Sullivan: There is a business case for this. But unfortunately that case gets muddled a little bit when we talk about cost issues. Cost issues can be dealt with through the price of benefits, as well as the health-related claims that arise.

So the production of health in the workplace, and the management of claim costs, are not the same thing. We have to keep our eye on the ball when we're doing that. It's really to do with competitive issues, related to benefits, by simply cutting costs. A lot of companies are doing that. There is a business case.

Press: Are we doing a good enough job communicating that business case?

Hackett: I don't think so. I think there's a real challenge in terms of showing that there are wins out there, and that they're achievable. We have to get more into managing our employees as a resource, as opposed to saying that they're a disposable commodity and there are more people where they came from.

As baby boomers age, and a lot less people are actively available in the workforce‹and as technology improves and a lot more training is required in order to compete aggressively--you're going to have to maintain the health of your workers. You're going to have to attract them with non-traditional means, and have a positive environment that they can work in and know that it's supportive. It won't necessarily be paternal, as it may have been 20 or 30 years ago, but supportive and understanding in order to reduce stress and make employees more productive.

Now, it's really easy to say there's less absenteeism, or there's less short-term or long-term disability. But knowing that someone's performing at a higher level, and the quality of the work that they're producing is higher because they are more fit or more alert, is a lot more challenging to measure. That's where the struggle is going to continue.

Wallace: This assumption that there is this pool of human resources that employers will continue to draw from--that is prepared to deal with the changing working environment today--is not correct anymore. But we tend to talk clinically, and that is different than business lingo.

Sometimes, walking into the office of the leadership, and trying to sell the program, you have to switch gears. Leaders want to hear the business case. So we have a tough sell, in terms of numbers and measurement, and also in terms of presentation.

Noble: At this point in time, in Canada, organizations adopting wellness in the workplace are on the leading edge. They're the ones that are going to have to demonstrate to others that this will work.

But it has to be endorsed by the financial people. Even if you get other forms of leadership to buy in, somebody has to sign off on the expense. And if you're competing in global marketplaces these days, as many businesses are, there's a lot of issues there.

Everyone agrees with what we're saying. They think this is a good thing--this is something that they should be doing. But getting them to sign on the dotted line, that's when there are all kinds of organizational obstacles to overcome. It 's a long haul.

Wallace: We are promoting programs that are the antithesis of what senior management--the person who is in the role of saying yes or no--lives. The reason this person that I am talking to about wellness is successful, is that he is committed to what he's doing. He probably travels 50 weeks out of the year. He's the antithesis, sometimes, of what we're trying to teach. That's a very hard sell.

Sue Pridham: We need to talk the business talk, and understand the individual foundations of each organization. Providers need to listen to what the key issues are within each organization, and look at aligning programs to their fundamental cultures. For example, most organizations have value statements. They have philosophies and they have cultural issues that drive that organization. They need to have programs to support those values. That's where senior management will start to pay attention.

THE SIZE THING
Press: How do you introduce wellness to a smaller organization?

Hackett: The first step is educating your employees, and getting them to buy in to the concept of wellness. We've talked a lot about having a mandate from management, but the reality is that your employees have to see the benefit, and be receptive to the training in the context of improving their ability to manage their own health and becoming an educated consumer. That is something that every employer, no matter what size, can provide the resources to encourage.

Wallace: It doesn't matter what size you are. One basic thing to do is the tobacco smoking cessation program. It's well known that the savings far outweigh the costs. And you can change your practice for managing stress. These sorts of organizational changes are basic, and they're not costly. The health risk appraisal is another good example. It's extremely important and not very expensive.

Pridham: Organizations should design programs that fit with their culture. Start from scratch, and find out what works for your employees. Sit around the room one day at lunch time with a flip chart and say: "What does employee wellness mean to this organization? How well are the employees right now? What are the things that we're doing today that contribute to employee wellness? What's working well for us? What¹s not working so well? If we were to make some changes, what might it look like?"

The key is to discover what is of interest to each employee in that organization. An internal advisory committee can move that program forward with specific recommendations. A strategic plan, that has goals and objectives, is recommended. It's not a matter of assigning a certain number of dollars to wellness. Wellness could happen without spending any money at all.

Sullivan: Think about what's happened with employee health. One hundred years ago, people got alarmed because machines were falling on workers. Thirty years ago, we began to understand that if people exercised more and consumed less salt, their health would improve. Companies began to pay attention to this.

In the last five years, we've begun to understand that the structure of the job can drive heart disease--as much or more than whether somebody smokes or eats fatty food. But this message is not out there. We have to educate employees and employers. That's the challenge. It isn't like choosing a tin of beans off the shelf--a fitness program or nutrition counselling. It is also the philosophy inside the organization.

Noble: Typically, the small business is run by an entrepreneurial-type of individual. If you can get the message to somebody that's running a company with 75 employees, they can take things from A to Z substantially more quickly than a larger organization.

As an industry, we've been going after the jumbo organizations that have huge political infrastructures. There are great opportunities to do things in small steps. These are the innovative leaders of the future--small business owners. They're going to create that new generation of companies, and if they've promoted the health and well-being of their employee populations, then hopefully some of these larger employers that have been less willing to move will look up and decide to do something.

Buffett: We're starting to move to the point where we're focusing on the employer, and the need for rethinking there. One of the most difficult things that a person has to do, as a business owner, is to accept the fact that the best people to tell you how to correct the flaws in your organization are the people who are down there on the floor working with the problem. The irony is they're the last people that we ever go to.

Most people don't see the organization as supportive. They see it as demanding. They find the work overwhelming. There are some very bright and capable people out there, and we need to be tapping in. That's all part of wellness.

Hackett: But that raises another issue. It's in vogue to say that there's stress. It's not in vogue for employees to admit that they suffer from stress. You get into issues of confidentiality, and that's one of the barriers to moving forward with a lot of these programs.

Press: If my employer asks me how I'm doing, I'm going to tell him everything's great. How much of a problem does that present?

Pridham: It depends on the corporate culture. There are certain environments where it's OK that you're a human being, and that you have vulnerabilities. There are other organizations that are politicized and highly competitive. You don't mess around. You tow the company line--you're always wonderful. The challenge is to come up with programs that maintain the person's confidentiality, but allow them to get the information they need.

Buffett: Some of what you've said makes a strong case for using external providers. You have a greater level of trust and comfort on the employee's part, a greater willingness to show up at a session perhaps geared towards depression or stress. They might otherwise be unwilling, particularly if somebody within the organization is in charge.

Pridham: There are a few programs that are particular concerning to employees. Health risk appraisals raise questions about where that information is going. Stress programs are another area where confidentiality is a big issue.

Hackett: There a socially acceptable illnesses and non-socially acceptable illnesses. I don¹t think you would get a lot of people at an alcohol self-help session at lunch time.

Press: Tell us about your experience at BC Tel (now BCT.Telus) Scott. What is it like to introduce new initiatives inside an organization like yours?

Wallace: When I entered the company, it was facing a downsizing of 2,000 people. Tougher competition was coming to the telecommunications environment in Canada. At the time, the stress program that they had in place consisted mostly of relaxation training. Based on what we know about health in stress management, that is not enough.

So what I initially did was partner with a firm in California, and develop an on-line therapeutic software program for managing stress. That brought up issues around confidentiality within the workplace. There were also budget issues, because when I came in, there was no budget to do anything new. I set up an arrangement where we would collect royalties from the external sale of the program. That helped.

We also began to implement, for employees, stress management work that had a broader focus--a focus upon cognitive behavioral changes as well as activity fitness, nutrition and some principles based on certain Japanese therapies. These were very well received.

Then I began to think about depression. Right now, what we understand about depression is that medical models and psychological models are equally relevant. Basically, we don't know very much about it at all. So I began training the trainer sessions, and there were some fabulous successes in managing change and its introduction.

THE BOTTOM LINE
Press: What is it reasonable for an employer to expect during the first five years of a wellness strategy?

Sullivan: Depending on what you're buying into, you might expect a different kind of engagement from the workforce. The truth is, almost any engagement with the people on the floor is likely to produce some improvement in, for example, absence and a range of other health-related problems. If there is a process that's put in place to scan feedback, you can expect to see some change.

Press: Do managers expect too much of a bottom-line return on investment from wellness initiatives?

Buffett: All of us have been guilty of misreading what managers want. If you listen closely--contrary to the way we have painted CFOs and others-‹that's not necessarily what they're saying.

They're saying: "Prove to me that an investment in this area will impact people's health in a positive way. Then we'll spend the money." If they can improve morale, improve attendance, if they've got a workforce that's excited about what it is that they're doing and if they change the whole environment in terms of how people perceive the organization, then that's a big win. That's the case that has to be made.

Pridham: Let's use the analogy of buying a car. You ask a lot of important questions about the mileage of the car and the maintenance program. In the broader scheme of things, they're not that important. But it makes you feel good to know the answers to those questions. Once you've bought your car, you don't even care about the mileage.

With wellness programs, there is that need to have something in their hot little hands that says: "In three years time, we're going to get $3 back for every $1 we've invested." It's kind of a security blanket, but that's not really the reason that they moved forward. If that really is holding them back, then we know that they're not a company that truly has embraced wellness.

Wallace: Most business leaders operate in a paradigm of long-term commitment and strategic planning. That's what we offer. We require long-term commitment, and in the long term, we'll see significant changes.

Buffett: One of the arguments that I have heard from naysayers, those casting CFOs in a negative light, is that these executives won't look beyond three years. The argument that I've heard from some people is: "Why would a CFO agree to a wellness program? He may not be there when the benefits begin to develop."

That suggests that those organizations wouldn't do anything to improve anything, other than the bottom line. We know that's not true. I don't have any clients that are coming to me eight months in saying: "Where are the savings?" Not at all. People come to me and say: "Wow, I can't believe the transformation that's beginning."

Press: But does that not make it difficult to market these concepts internally in recessionary years, or in organizations that have genuine bottom-line concerns?

Pridham: Absolutely. But again, it's not a short-term project. When you look back over 18 to 20 years, few of the groups that we were working with stopped their program as a result of some challenging economic climate. In fact, they recognized that this was going to help them ride through the tough times.

SIDEBARS

This is a relatively new phenomenon in Canada. People have known about preventative healthcare probably for longer than I've been alive, but in terms of how it is approached at the workplace, that is a recent development. We have a lot of work to do. But the potential is there for success.

Ed Buffett
Chairman and Chief Executive Officer, Buffett Taylor

I don't believe that we are a leader. We have been doing this for 20 years. What are organizations waiting for? What is taking so long? I believe a lot of it is driven by the healthcare system. As employers take on more responsibilities, and have to pay out more, they're going to start to pay greater attention to these kinds of programs.

There is tremendous opportunity. Organizations can't afford not to invest in the health of their employees. Over the next decade, we're going to see a huge shift in companies embracing these kinds of programs for a myriad of reasons.

Sue Pridham
Partner, Client Services, Tri Fit Consultants Inc.

I don't think the question of leadership is as important as the question of awareness. Are we as aware as other countries of the importance of wellness--of the human capital upon which we're drawing. We are quite aware, increasingly so, as our economy begins to compete on a global basis.

We're trusting people. We're not a complacent people. We have a uniquely successful and wonderful healthcare system. It has its own problems, but it is very successful. And we're drawing upon it, and liaising with it, as far as wellness goes. So we have a lot of things that are working for us. We have a long road to go though, and it's a complex area.

Dr. Scott Wallace
Clinical/Organizational Psychologist, BCT.Telus

Are we a leader? No. Which is unfortunate, because I think Canada had a reputation 20-odd years ago of being the leader in the early generation of wellness initiatives. A lot of the initial research came out of Canada.

Can we be a leader again? We have an opportunity, but it's directly linked to how successful Canadian business is going to be in a global environment. We're winning little battles, and over time those escalate. Something that looks like an exception becomes a rule. It becomes a commodity. One thing that even an unsuccessful Canadian business will do is follow. If it's clear that their successful competitors are introducing wellness initiatives, then they will follow.

Barry Noble
National Director, Managed Care, Manulife Financial

Our life expectancy and health indicators are among the best in the world. Does that have much to do with what companies are doing? I think so. Among our challenges is that Canadians have higher and higher expectations about their health. All of us want to have a higher quality of life. This is a good thing, because people will support wellness initiatives in every workplace--the managers as well as the people on the floor.

In the short term, it is going to be specific leading organizations that will do the job. These are the ones that will understand that it's not simply whether somebody goes to the gym or not, but the manner in which companies have structured job stations and decision and managerial processes. This is where the future is.

Terry Sullivan
President, Institute for Work & Health

We can't claim that we are leaders. But we do have the potential for greatness and leadership. There are opportunities, as Barry says, for small wins in the trenches. We can promote examples--in drug programs, in well organizations and in leaders on an individual basis.

Our challenge is to publicize these leaders, create icons and ideals that we can reach. Organizations will say: "If he can do it, so can I. He doesn't have anything in terms of resources that I don't have."

Judy Hackett
Manager, Group Healthcare, Eli Lilly Canada Inc.

The Romanow Commission has released its final report on the future of healthcare in Canada.

For Commissioner Romanow's recommendations, click here.

Click here for Senator Michael Kirby's report, "The Health of Canadians – The Federal Role: Recommendations for Reform."