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Culture of Health: What We’ve Learned - Transcript

We have a straightforward agenda for today. We'll start off by telling you a little bit about us, then go right into our major topic: what we've learned about the culture of health in working with hundreds of thousands of participants over 8 years in employee wellness. We'll talk about the ways that employers are trying to create the culture of health, and why most employers' current efforts are not succeeding. That's right, the reason we're all still talking about culture of health is that the standard employee wellness programs don't change the culture. Then we'll talk about how industrial employers have been remarkably successful in creating a culture of safety. Walk into any modern manufacturing plant, and the culture of employee safety will show itself, literally, on every employee's face. So we'll spend a significant amount of time looking at the lessons from employee safety that we can apply to employee health. Then we'll wrap up and offer some next steps if you'd like to talk with us about your wellness program and how to take it to the next level. You can see my contact information here in case you have questions after the presentation or want my team to follow up with you.

This webinar is bought to you by Extracon. Extracon is a wellness platform company. That means we provide our clients with a technology platform that connects the pieces of their employee wellness program. We are the glue that sticks together data from their health assessment and biometric screenings, onsite and online programs, and incentives. Our platform includes a number of tools for our clients to use in building the culture of health. We run the technology so our employer clients can focus on running a great, hands-on employee wellness program.

Our customers are on the forefront of building the culture of health, and the information you'll hear today is we've learned in working with our customers. We've been lucky enough to work with lots of well-known national employers such as Highmark, MARS, Sutter Health, University of California, Methodist Healthcare, Indiana University Health, and many more.

So now let's get started, by learning about the power of culture to influence health. Researchers like Dr. Nicholas Christakis and Dr. James Fowlers have done large-scale studies on the power of our friends, family and co-workers to influence our health habits. Dr. Christakis says, Your health is not just a result of your choices and actions, but also the choices and actions of people around you. That's the Power of Culture. His studies at Harvard University found that family, friends and co-workers affect employees' longevity, heart health, weight, and even happiness. You can read about them in the book, Connected. In one of their most famous studies, they found that a person's chances of becoming obese increased by 57 percent if that person had a friend who became obese, and increased 40% if they had a family member who became obese. Culture if powerful. Culture matters.

But many employers are finding it hard to build the culture of health. And it's not just the beginners. Most of the employers who ask us for help in building a healthy culture have had a wellness program for several years. So why aren't they changing the culture? To answer this question, I'm going to lead you through an example based on one of our clients. This client had a well-established health and wellness program in place. Every year, they're seeing results like these: 80% of employees complete the HRA, 70% of epmloyees complete the biometric screening, High-Risk participants are talking with the Health Coach. Disease Management is in place, EAP is in place. And they are paying out a $500 annual incentive for participants who complete these kinds of requirements. (CLICK) BUT……. All of their health outcomes are stalled. Their claims cost continued to go up. The number of Health Risks in their population isn't improving. They had the strong feeling that they were getting only what they paid for - employees completing some basic requirements. They couldn't get anything to take off on its own. They felt theyu were on the incentive treadmill where it takes more dollars every year just to stay the same. And when they look around the workplace, the signs are not pointing toward health. What kinds of signs were they seeing?

They had a company fitness center. It was being used in the hour before work and the hour after work. But anytime during the workday it was dead empty. Looking around the workplace, everyone used the elevators, almost nobody used the stairs. The walking path around the campus was used even less than the fitness center.

Like most companies, they had their share of breakfast meetings, lunch meetings, and sometimes even dinner meetings. The food was as predicable as it was unhealthy - doughnuts at the breakfast meetings, pizza at the lunch meetings. Most people got a soda from the vending machines to go with the meal. The client also had a beautiful cafeteria, but employees felt like they had to pick up their food and run back to their desk to eat lunch at the desk. There were a little upset that they'd spent so much money on this space for employees to talk and connect, and nobody used it.

And to be honest - supervisors and top executives were not leading by example. They gave some lip service to wellness, but the dollars and commitment were lacking. Only the wellness staff within HR were really leading by example.

So if you ask for help with your culture, about 99% of consultants and vendors will ask you to do a culture audit or culture survey. If you'd like to see an example, there's one available free through WELCOA. Unfortunately, these Culture Audits have not been the key to changing the culture around health. Why is that? Let's look at culture audits. Most culture Audits have three kinds of questions. The first type of question asks about policies and procedures. These are asking if you have wellness included in the company policies and procedures such as a no-tobacco policy, a policy allowing employees to exercise, incentives for wellness, and appointing a wellness staffer or wellness committee. The second type of question on most Culture Surveys is about access to healthy options. So do you have healthy foods in the cafeteria, places to walk or exercise on your campus, and onsite programs such as weight watchers at work. The third type of question asks about attitudes and beliefs. It is normal for people to bring healthy food to meetings, or is it just doughnuts every morning? Is it normal for people to take a break to exercise during the workday? Is it normal for people to show up in the morning well rested? So our client did the culture audit, and found that they already had the policies and procedures in place. They had already done a lot to provide access to healthy options. But - employee attitudes and beliefs had NOT changed. That's why they were seeing the empty fitness center, the full elevators and the doughnuts and pizza at the meetings. So the culture audit did not have the answers they were looking for. They had done everything on the checklist. So now the client came to Extracon and asked us…..

Why aren't we changing the culture? Right now, I'm going to give you a simple and very precise definition of culture. If there's one thing I want you to remember from today's presentation, this is it. Culture is what we see others do. Culture is what we see others do. If you look around the workplace and people doing something every day, that means it's part of your culture. So how do employees know what they're supposed to wear to work every day? They look around and see what others are wearing. I'm always surprised to see how differently companies interpret “business casual” or “casual Friday”. Every company has little unspoken rules that employees learn by looking around. And this really shows why our client had the empty fitness center, and why employees ate lunch at their desk even though there was a beautiful cafeteria to eat in. Employees were looking at what the other employees were doing every day. So if culture is what we see others do, you ‘ll know something is against your culture if people are hiding it. Let's talk about tobacco use. Thirty years ago, smoking cigarettes at your desk was a common part of company culture. You saw people do it every day, it was part of the culture. Now you don't ever see people smoking at the workplace - That's how we know the culture has changed. In fact, employees who use tobacco are often hiding it now. I have seen plenty of employees who hid a can of smokeless tobacco somewhere in their car or desk. They hide what they are doing, because it goes against the culture. Let's work through some examples to show how it works.

So here are some examples of how culture is what we see others do: If you have a culture of safety at your workplace then employees will see other employees wearing safety equipment like dust masks and eye protection. Employees will see other employees following safety procedures when operating equipment or moving heavy items. You have a culture of safety because employees see each other following the safety rules. If you have a culture of being on time, employees will see each other getting to meetings on time. Here's a story from a major US pharmaceutical company. They told all the new hires to be at the kickoff meeting at 8am. And at exactly 8am, they locked the doors and said….. For those of you that are here, welcome to your new job! The people who were late to the meeting will be looking for their next job somewhere else. That sent a powerful signal to employees about the culture. And you can think of many other examples of company culture touchpoints. We already talked about what employees wear to work. Some companies have a customer- first culture - Nordstrom's is famous for this. Nordstrom employees see their co-workers putting the customer first every day - even if it makes life more difficult for the employer. And finally, Health. We asked the question, “Why Aren't we Changing the Culture around health?” Let me rephrase that. At your workplace, what do employees SEE others DO around health? Do they see anything?

Or is your wellness program invisible? Let's say your workplace has all of these in place - high rates of completion on HRA's and biometrics. Lots of employees find out they have hypertension or high cholesterol and start taking medication to control these conditions. Your high-risk employees are talking with their Coaches. The EAP program is helping the employees that need it. You're paying out lots of incentive dollars. But every one of these things is INVISIBLE to the average employee. The average employee cannot see others do these things. These kinds of program simply DON'T have the ability to change the culture. Employees do not SEE EACH OTHER living a healthy lifestyle. And culture is what we see others do. So this is your very concrete answer to the most common wellness programs are not changing the culture.

Now I want to give you an example where we have been very successful in changing the culture. In corporate America we have been MUCH more successful at building a culture of safety compared to building a culture of health. I'm going to use the example of safety glasses that protect workers from eye injuries. Every walked onto a factory floor and noticed everyone wearing safety glasses? I remember working at General Electric in a factory where they built jet engines. I was working as a manager for computer systems, but I was curious to see the production floor, and I asked a fellow employee to show me around. Sure enough, the first thing he told me was that you cannot set foot on the factory floor without your safety glasses on. And he pointed to a bucket of safety glasses available at the entrance. They had a strong culture of safety around eye protection. Because wearing safety glasses is something we can SEE others DO, all day and every day.

So here's the checklist of how safety glasses became a part of the culture at GE and many other workplaces. Participation is VISIBLE. Everyone in the workplace sees everyone else wearing the safety glasses. Line managers LEAD BY EXAMPLE. It's not just the safety person wearing the glasses, it's the line supervisors too. Employees should RECRUIT each other and hold each other ACCOUNTABLE. If someone's not wearing the glasses, the other employees remind him to do so. Participants should do the new behavior TOGETHER with others. At every shift change, the employees all put on their safety glasses before the walk inside. Stories are shared. Toolbox talks for safety often include examples from employees who unexpectedly had something fly into their face and were saved by wearing the safety glasses. And There are shared METRICS and INCENTIVES for group success. One of the first things you will see when you walk into most factories these days is a big sign showing how many days it's been since a jobsite injury. It's a big metric that's important enough to post on the wall. And there is often a celebration or a bonus if the whole worksite avoids injuries for the year. The shared metrics and incentives are a key driver for accountability and culture formation. So these are the ways to change the culture. But can we do this for health?

So now that we have our checklist, let me give you 3 big ideas to change the culture around health. First, Team Challenge programs for walking, weight loss, and other topics can be a big help. Let's look at why: *) First, these programs have a lot of visibility. Participants are wearing something - a pedometer or perhaps a wristband- that identifies them as a participant. Sometimes there are group weigh-ins or onsite walking events where participants can see each other taking action for health. One of our clients, the University of Phoenix, actually had their company President lead a team in the Challenge and do a blog about his wellness journey. So their challenge program was called Joe's Challenge because of their company President. That's the kind of visibility that changes the culture. *) Because these are Team programs, participants recruit each other to join and hold each other accountable. So peer recruitment and accountability are key features of these programs. *) And because the programs are online, there is a website where participants can see how their progress stacks up against their friends, teammates and other teams. These programs offer realtime data online so participants can see who's engaged and who isn't. Just like the safety glasses, participants can see who's in the game. Second, it's time to upgrade your Wellness Champions program. Wellness Champions are people in your organization who are not in HR, not in benefits, but who are volunteering to lead by example and help you build the culture of health. The wellness champions should be given dollars and event kits to lead meetings and events that support your wellness programs. They should start a Team in your Team Challenge Programs. They should be the focal point for collecting and distributing participant success stories. And you need enough of them. The goal should be to have every employee within 1 degree of separation of a Wellness Champion. That's right, every employee should know someone at work who is a wellness champion. It's not enough to have a handful of wellness champions trying to reach thousands of employees. Third, it's time for group metrics and incentives around health. We gave the example of group metrics and incentives for safety - based on everyone at the worksite avoiding injuries. This gives us a clue to what we can do in health and wellness. For example, why can't we post the percentage of employees at a worksite or department who have completed the HRA and biometric screening? And why can't we celebrate success if the worksite or department reaches the participation goal? If we want people to promote health to each other, let's make the group's numbers more visible and let's have group incentives to back up the rhetoric.

If health behaviors happen outside of work, then we need to surround employees with a healthy culture when they're at home. That means we need to Involve Employees' Families as equal participants. This is the most practical way to extend the healthy workplace culture into the evening and weekend hours when so many health behaviors actually happen. You can't surround employees with a healthy culture outside of work unless you get the families involved. And I want to make sure we talk about following HIPAA and other privacy rules. We've discussed some ways already, and I just want to explain how these are OK under the privacy laws. First, sharing employee success stories is absolutely OK since you are getting permission from the employees to share the stories. People who have made healthy changes in their lives are usually glad to have their story shared. Second, many wellness platforms, including Extracon's Healthy Challenge platform, provide for permission-based sharing of progress from one participant to another. Since the participants are opting in and they are in full control, this is fine under privacy laws. Third, we talked about group metrics and incentives for wellness. Remember, wellness participation information is NOT Personal Health Information. Taking an HRA or doing a phone call with a Health Coach does not tell anybody whether I have a health condition or disease. So it is very safe to use these kinds of metrics at a group level. If we want to take culture change seriously, there are many things we can do within the boundaries set by the laws and corporate practice. But we have to start doing them! We cannot let barriers become excuses.

So here's the summary. Culture is what we see others do. That applies to what people wear, what time the show up at meetings, how many cc's they put on their emails, and every other aspect of life. Including health habits. The culture you have around health today, is whatever employees see each other doing. So if you see nobody using the stairwells, all the worst junk food served at meetings, nobody showing up to wellness events - that's the culture you actually have. Employers are struggling with culture of health because the most common wellness programs don't change the culture. The most common wellness programs are invisible. Think about HRA's, Coaching, Incentives, EAP. All of these programs have to be private and individual. So they are not your solution to culture change. If you ask your consultant or vendor about culture change, there's about a 99% chance they will start telling you about doing a Culture Survey or Culture Audit. Sometimes these tools can help you identify policies and procedures to change, or identify places you can add access to healthy options. But pretty soon you will have done everything on the Culture Audit checklist- and you still may not have changed the culture. We think you can really learn from the culture of safety. Employers have been highly successful in creating a culture of safety at work, and we went through a six-point checklist of how safety programs do change the culture. Participation is visible, line managers lead by example, employees remind each other to follow safety rules, safety procedures are done together with others, success stories are shared, and there are group metrics and incentives when a worksite does a good job at safety. Then we talked about how to apply these lessons to the field of health, using Team and Social Challenge programs, a network of Wellness Champions, Group Metrics & Incentives, and involving employees' families.

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