In the early 20th century, Russian literature underwent an enormous shift. This movement was characterized by artistic renderings of common things in extraordinary new ways. It was called “defamiliarization”. It might sound simple: take something that you see every day, a tree for example, and describe it. But not with ordinary characteristics. Instead, imbue your description with a fresh insight, something that no one else may have seen before. In many ways, this exact exercise is what is being asked of health care reform in general and of wellness programs specifically.
As discussed in Part 3 of this series, the current system of wellness program definition and methodology is fragmented and measurements of effectiveness are imprecise. Though most programs ostensibly fare well, companies are beginning to question program utility and to reconsider the cost/benefit of implementation. Additionally, participation rates in these programs are consistently mediocre at best and health care costs continue to rise despite a heavy emphasis on health promotion. When one stares too long at a given object, it loses its detail; it is time to sharpen our focus once again on wellness programs and to investigate the related notion of well-being. In this way, we may be able to undergo this process of defamiliarization and ultimately see these programs in a novel way that is both financially sound and highly useful.
Let’s start by examining the landscape. By rifling through the endless data that exist on wellness programs it quickly becomes clear that there is very little uniformity. These programs vary widely in intensity, duration, comprehensiveness, and implementation. Worse yet, up to 83% of studies designed to assess these programs lack basic criteria such as pre-intervention data (Condly, 2003). There is furthermore no concrete definition of outcomes (Goetzel, 2008). In most wellness programs, a majority of employees aren’t even eligible despite their willingness to take part (WB, 2009).
The first step in this process is to create a stable base from which to work. There are three parts to this process: 1) use current data from the few well-designed meta-analyses and randomized controlled trials to develop a model that can accurately pinpoint certain elements of a program to assess its significance; 2) define well-being in a manner that allows not only for broad acceptance but also for easy accessibility and the opportunity to evaluate effectiveness; and 3) reexamine current program ideology to determine what these companies, and of course their employees, want.
In our Health and Wellness team here at Widmeyer, we are in the process of completing all three of these steps. In doing so, we have already uncovered potential ways for companies to improve their programs and to maximize returns on investment even more while improving employee satisfaction. We will outline three of these factors here.
Communication
It has been shown that a company can improve employee morale simply by saying it has a wellness program (Parks, 2008). However, while 99% of employees agree with having programs, 98% complain about various aspects of them (IRF, 2002). Communication becomes integral to improving this disparity. For numerous reasons, the major focus in the US for wellness programs is reducing healthcare costs; yet, over half of workers don’t believe that their companies are having difficulty with this issue and 34% fail to see how it affects them (WB, 2009). As mentioned in Part 2, technology advancements can play an enormous role in many facets of improving communication. At a baseline, clearly demarcating the need and purpose of programs is essential.
Personalization
One problem programs have encountered stems from a lack of conveying individualized messages. When added to communication deficits, it is easier to understand why participation in these programs is astoundingly low, despite substantial investments to increase numbers. Those companies that are able to brand themselves internally have a much greater chance of success. Examples include Union Pacific Railroad, General Motors, and Caterpillar (HB, 2009). Identification with a company is important on multiple levels and may be a large factor in presenteeism. This term refers to employees who have low productivity while at work and is juxtaposed to absenteeism, or employees missing work due to illness or leave. Sixty percent of total costs associated with employee illness stems from presenteeism (Cornell, 2004). This statistic is surely one that could be altered.
Incentives
Each year, United States employers spend billions of dollars on non-cash incentives. When cash incentives are included the total is estimated to reach $117 billion. With that amount of money floating around, results should be crystal clear, right? Unfortunately not, as the utility of incentives are still questioned (IRF, 2002). For example, it has been shown that many incentives focus on individuals rather than teams, which translates into a 19% rather than a 47% improvement in performance (Condly, 2003). Additionally, many incentive programs in the workplace and in health care are antiquated, drawing on old methods to achieve contemporary goals. Companies like ChipRewards are bucking this trend, offering innovative tools to help employees and patients connect their behavior to direct reward that is both relevant and desirable. Furthermore, web-based interventions have been shown to be cheap and help maximize return on investment (Aldana, 2005).
These three examples are merely the beginning and can easily be expanded. The idea of well-being is deeply rooted in multiple areas and as discussed, not easy to quantify. However, it is clear that well-being leads to good relationships and work/health outcomes, rather than the other way around as most companies and providers have assumed. It is important to understand how to bridge the current disconnect and integrate notions of well-being into wellness programs to maximize outcomes for all stakeholders involved. As mentioned, the first step is to create a model of what is available and to examine the environment in a new light. The concept of defamiliarization may just aid in this process, as we approach this topic from unique angles and determine where we go from here.
