There’s a bit of revolutionary thinking that’s starting to emerge from our HR departments these days. It’s still in its infancy, but if we can embrace it, give it breadth and depth and a good hard nudge, it’s a concept that has the potential to completely change our thinking about optimal family care. It’s a concept HR departments are learning to call employee well-being.
Consider this scenario: You book off work with a pounding headache. You go to your doctor – a general practitioner – who sends you to see a neurologist. The neurologist sends you to get a CAT scan. When the CAT scan shows up nothing, your partner suggests you start seeing a therapist. Four sessions on with your therapist you stop, as this is all your employee assistance programme will cover and you just don’t have the money to continue. What your partner doesn’t know – and what you can’t bring yourself to tell them – is that your unemployed son is quietly pushing you towards financial ruin as he battles with a drug habit, which is why the money is running out before the end of each month. Bottom line: you can’t afford to pay all these people to help you solve problems you can’t seem to find a beginning or end to.
For outsiders to the story, it’s easy to see how interconnected all these elements probably are in this protagonist’s life. Unless the son’s addiction, the financial debt, the secret that’s being kept from the partner, and so on, are addressed, the migraines are likely to continue. But this is not how our care professionals currently engage with us. Our doctors try to help us address health problems; our therapists help us address emotional problems; and our financial advisers help us address financial problems, each in their own exclusive domain. It’s when we connect the dots and look holistically at the problem that the healing can really begin – and this is the critically important insight that employee well-being programmes are beginning to unearth.
Value to employers
Interestingly, employers have seen value in these concepts for some time. Well-being programmes, and now specifically financial well-being programmes, have emerged as the number-one trend in employee benefits in both the US and the UK. In South Africa, most employers have some form of well-being strategy embedded in their employee engagement initiatives. A number of surveys and studies provide compelling cases for why these programmes add value to maintaining or enhancing productivity in the workplace1. We can even calculate a return on investment (ROI) employers can hold up to their boards that shows the money spent on these interventions both saves the company money in human capital management costs and adds to the bottom line by increasing productivity. Other potential cost improvements are reductions in group life premiums and reductions in healthcare premiums.
The financial case has been made and the intent of this chapter is not to make it again2. From the employer’s perspective, the appeal of these programmes is that they address the ‘care conundrum’: how to ensure that employees maintain financial, physical and mental stability and vitality without the employer becoming overly paternalistic and intrusive. Value to employees From the employees’ perspective, the attraction of these programmes is that they aren’t paternalistic. Rather, they give employees an opportunity to structure what they need, how they need it, while (hopefully) at the same time guarding the integrity of employee data. Employees are beginning to appreciate how unique this value proposition is. For many families, this type of workplace wellness solution is a particularly effective way to access a holistic framework of care. It is this win-win benefit for both the employer and the employee that is making employee well-being programmes the hot commodity that they are becoming. Outside this environment, ‘care’ simply isn’t structured to be addressed this way.
Figure 4: The impact to the employer’s bottom line:
A paper by Greg Ward published by the Society of Actuaries in 2017 showed that when fi nancial wellness improves by just 10%, the projected annual savings for a large employer (1 000 people or more) are as follows:
For many families, this type of workplace wellness solution is a particularly effective way to access a holistic framework of care.
As we cautioned, we are only just starting the journey of discovery in terms of identifying how this framework could best be structured. No one has the complete picture just yet ... but the pieces are coming together fast. Some are being tackled by the healthcare industry, some by the financial services industry, and some by the EAP industry.
Perhaps one reason no one has cracked this servicing model is that these players are trying to tackle the problem through their own operating lenses, whether that be through the lens of their business models, servicing models, or technology and data management models. Therein lies the heart of the problem.
What would it take to make such a powerful concept really take flight? In trying to answer this bigger question, we look at each key component in turn and ask:
In the lengthy literature and research we have produced around well-being (see Benefits Barometer 2014: 'Fine-tuning the employee benefits system' and Benefits Barometer2015: 'Financial Well-being'), what makes well-being programmes distinctively different from employee assistance programmes is that they operate proactively to ensure behavioural change. Unlike employee assistance programmes, which tend to reactively provide support services when employees need them, well-being programmes start with how you are living your life. They focus on behaviours you could change or insights you could gain to increase your and your family’s general stability and well-being.
More than that, these programmes are about equipping individuals to successfully navigate life’s general challenges – whether these challenges are physical, financial, emotional or some combination of all. This is all about a process that helps people to change their thinking and actions around managing debt, their daily consumption needs and ongoing health and physical well-being, creating the basis for a work–life balance, and other actions that help them function optimally and achieve their goals.
From education to action
The only way we will know if the programme is working is if we can actually see actions following insight. That means these programmes need to be more than just educational exercises.
Let’s return to our medical analogies. Medical centres have become a powerful addition to the suite of medical care options. What has made them so successful at changing community-level health (and addressing the logjam of medical care that was being experienced at the general hospital level) is that they have facilitated access to various components of everyday healthcare on an outpatient, walk-in basis, all through one convenient touchpoint. You have access to your GP, your specialist physicians, the various testing labs (X-ray, CAT scan, blood tests, etc.), the pharmacy that will fill your prescription right there and then and, in some centres, an array of community health programmes such as prenatal care or child healthcare.
The point is, by making it easy for individuals to exercise each step in the process of addressing a physical ailment or pursuing proactive healthcare, the success rate for community healthcare increased exponentially.
Financial well-being should work on a similar model. We know that financial education by itself has failed to move the behavioural dial towards better financial capability. In Benefits Barometer 2014: 'Fine-tuning the employee benefits system', we spoke at length about what it would take to move that dial. When it comes to financial capability, the bottom line is that it’s only when an individual feels confident enough about their ability to make effective financial choices that they will take action and do the right thing to address their needs.
An effective workplace well-being programme isn’t just about offering on-site education and counselling. It’s also about making it as easy and cost effective as possible for people to take action that translates insight into outcomes. Actions could range from visiting a debt counsellor and setting up and sticking to a budget, to seeing a financial adviser or buying a financial product. The point is, the action is directly related to the problem the individual is trying to address.
Let’s go back to our medical centre example. We would be deeply concerned if we thought our medical centre doctors earned their keep from prescribing medicine through their centre’s pharmacy or stipulating that specific medical tests be conducted by the centre’s labs. By the same token, we should be concerned if the funding of the financial well-being aspect of our programme was also based on the sales of financial products. Yet, this is a business model that many financial services companies follow. It’s a model that, in the long run, will do more to raise concerns about the merits of these programmes than it will to allay them.
The reality is that the best well-being programmes will, by necessity, be particularly demanding of resources – both the human kind, in terms of time and effort required for programme development, interventions and ongoing coaching – and the technological kind, in terms of creating and maintaining the necessary digital delivery for continuous engagement. Who, then, should pay for all of this?
Here are the options – and the issues:
A comprehensive programme such as the one we have envisaged here would cost the employer significantly more than a superficial employee assistance programme. This makes the ability to demonstrate that the programme is having an impact that is translating into an ROI that much more important. But another debate here is whether getting stakeholders to commit, whether they be the service sponsor or the service receiver, demands that there be something at risk as well. When we are dealing with sensitive issues that demand behavioural change, a fully funded programme from the employer could open up the potential for moral hazard: why bother to change if your employer is always there to bail you out?
Getting any stakeholder to buy in to the value proposition of such programmes would demand that there were identifiable benefits to such an investment. This then takes us to the next condition for success of a sustainable wellness programme: the feedback mechanism.
With each of these stakeholders invested, how will each one know whether the investment has paid off? This is where these programmes can be particularly powerful. For an employer to know that the programme is working, for example, demands better feedback than utilisation rate calculations. And therein lies the challenge. What measures of financial well-being or physical well-being or mental well-being could be used?
Financial well-being at its best is the ability to manage the trade-offs necessitated by existing financial constraints so that an individual can achieve what matters most to them and their families.
Similarly, at the heart of mental well-being lies work–life balance. It’s something our HR departments tell us employees want most. How exactly is that measured, given that this would be interpreted differently by every single South African family?
If we understand and accept these points, we can start assembling bits and pieces of information and data that, when taken collectively, start painting a picture. It’s this collective picture that we can assess over time, on two levels: that of the employer and that of the employee.
The employer level
At one level, the employer needs to see a picture of the de-identified aggregate of their workforce through any number of different lenses and from any number of different perspectives. But the aggregate picture of ‘improvement’ needs to be translatable into a direct return on investment that can be shown to both current and potential shareholders.
The following (quantifiable) factors not only have an impact on lowering human resource costs but can also be measured against yardsticks of increasing productivity:
Each one these elements not only has an impact on lowering human resource costs but can also be measured against increasing productivity.
The employee level
The employee also needs to be given a picture of achievement, which can be assessed in the following ways:
These lists can go on and on as we capture more data sources for rounding out our insights into an individual’s degree of well-being for both themselves and their families.
Where the feedback becomes vital
Feedback provides oil that greases the ongoing machinery of well-being. It’s our verification and validation starting point. We are not just using feedback to measure success but also to provide an ongoing assessment of whether our engagements and interventions are translating into actions, so that we can constantly improve on our delivery.
What is the mechanism of engagement? Who owns and has access to the data?
An effective employee well-being programme lives and dies by both its mechanism of engagement and the data that can be sourced and aggregated to provide the basis for this engagement. This, too, is a work in progress for many companies, particularly at a time when regulations such as the Protection of Personal Information Act (PoPI) mean that this data must be protected at all costs. What makes this particularly difficult is the pace at which technology is developing better solutions to these security issues.
We’ve spoken at length about how technology will be changing the way we work. Technological developments such as blockchain will also challenge where personal data and information will be stored and who will have the ultimate control over who can access it. This is one debate that the consumer might actually end up winning. We are rapidly moving towards a world where personal data will no longer sit with a service provider such as your bank, medical aid, insurance company or financial services company, and be aggregated by ‘scraping tools’ that collect this information into one place for analysis. Instead, we will likely see a model where the individual owns all their data and allows access to it only at the request of the service provider (except when there is a legal requirement for the service provider to have such access).
Say what you wish about how long this conversion of data ownership is likely to take ... the one thing we know for certain about technological development is that it’s happening much faster than we ever imagined. Watch this space.
Alongside the great leaps forward in data aggregation are the advances we are making in understanding how people learn and what keeps them engaged with that learning process. The bad news is that we know we each learn in very different ways and respond to very different stimuli (and those aren’t differences that can be neatly categorised into generational bands).
This is a key insight for well-being programmes. Making these programmes scalable demands that we use some form of digital engagement. Developing an interaction framework that learns what the learner responds to then expands the engagement to incorporate this new insight is where these programmes must go. In Skills development – a new approach we delve further into one way that Alexander Forbes is already developing solutions in this area.
On one level, we should be heartened to see how many players in the financial services industry see financial well-being programmes and even holistic employee well-being programmes as important additions to their servicing capabilities. What this suggests is that the industry is finally seeing value in placing the client at the centre of focus. This should only be good news for the consumer. But let’s explore that premise a bit further.
Most financial services companies have evolved over the last 30 or 40 years to become more product-centric. With that product-centricity comes the legacy business model, data access and technology architecture models.
Potentially better positioned are companies that exist in the consulting and advice space. Here, an interesting model that is emerging is one where the consulting group works with the employer to assess what the workplace well-being needs would be for their specific employee population and industry. The consulting group then takes the responsibility for sourcing the most appropriate and cost-effective solutions or external partners required to meet the company’s range of needs. Further, they take responsibility for overall programme monitoring, for both the employer and the employees, to ensure that what has been recommended is delivering.
We think this may be the model of the future for well-being programmes. It’s a model that Mercer has been employing in the US and the UK, and employers appear to feel that it ticks all the right governance boxes. It also has the potential to produce outcomes that employee assistance programmes can’t address.
Most importantly, a model like this can provide the basis for delivering the vision we articulated at the beginning of this chapter: could employee well-being programmes not change the face of what it means to provide holistic family care?
We think this may be the model of the future for well-being programmes.
Well-being programmes make intuitive sense as an employee support and engagement model. More importantly, if employers are going to offer a broad range of benefits options to employees, (something that we will describe in more detail in Part 4), a well-being programme becomes an essential component, if only because it helps employees determine how to assess which benefit options provide the greatest value to them and their families. Think of holistic wellness programmes as providing a guidance and educational framework for decision-making.
This chapter has attempted to take the conversation a bit further by helping employers appreciate that there are important qualitative differences in how these programmes could be structured, and they need to be clear on the distinctions.
An important message is that unless these programmes provide properly integrated feedback to both employers and employees, the result can be a considerable waste of time, resource and money. In the next section we zero in on the healthcare component of a well-being programme as a case in point.
There are important qualitative differences in how these programmes could be structured and employers need to be clear on the distinctions.
The merits of employee wellness have been largely accepted by organisations worldwide. There is an acknowledgement of the interrelatedness between employee health and organisational health. Healthy employees are generally more productive, have lower rates of absenteeism, and are more engaged. They’re also better able to manage stress and change, have higher job satisfaction and a positive morale.
Organisations that focus on employee well-being seek to reap the rewards associated with a healthy workforce: lower absenteeism, fewer workers’ compensation claims, reduced disabilities, and greater workplace safety, productivity and performance – all of which contribute to a competitive and sustainable organisation.
A lot of time, energy and financial resources go into workplace wellness. In large companies, you often find a plethora of employee health management (EHM) programmes and employee-health-related costs, some of which include:
Owing to the magnitude of the employee health management portfolio, it is often divided among different areas within the organisation. Human Resources may deal with health policies, employee engagement and the psycho-social aspects of health; Benefits and Compensation may deal with health programmes, death and funeral benefits; occupational health and safety may sit in a different department and employee wellness and education in yet another. As a result, there is seldom any integration of data from the various EHM programmes.
Is your organisation reaping the benefi ts of the basket of EHM programmes offered? Are your workers healthier, happier, less stressed, and more engaged and productive as a result of your time, effort and expenditure? Are their health and well-being improving or deteriorating over time?
With the Protection of Personal Information Act, it is often very difficult to effectively integrate the data from EHM programmes in order to measure their relative success at an individual level. However, the data received from these programmes can be used to create a dashboard that provides the organisation with a big-picture view on employee well-being.
Integrating available EHM data with organisational metrics on employee engagement, absenteeism, disability cases and productivity will assist the organisation in better answering some of these questions. It will also assist with:
If organisations don’t integrate this data, it’s likely that EHM data won’t be used at all. For example, medical scheme wellness reports provide information on the many aspects of employees’ physical and lifestyle health. However, if the organisation doesn’t understand the impact this is having on the business, very little is done with this data.
There are many measurement models available to guide organisations on what to measure with respect to their EHM programmes. The Health Enhancement Research Organization (HERO) and Population Health Alliance (PHA) have developed a model which incorporates the following metrics:
Whatever metrics an organisation uses to review its EHM programmes they should assist in establishing a greater understanding of what works, what doesn’t, and which aspects of health to focus on to enable the organisation to achieve its strategic objectives with regard to employee health.
EHM programmes are dynamic, and successful EHM programmes go through a cycle similar to that depicted in Figure 5, which encompass the following steps4:
We’ve heard that the cost of healthcare is prohibitive. But has your organisation adopted a strategic and structured approach to implementing and running an employee health management programme? Measuring the effectiveness and efficiencies of EHM programmes is key to developing the right structure and refining your strategy to ensure it the programmes deliver maximum benefits to both employer and employees.
If you’re not already doing this, now is the best time to start.
1 See Benefits Barometer 2015 and PwC. (2017). Employee Financial Wellness Survey, 2017 results.
2 Robison, J. 2010. The business case for wellbeing, Gallup Business Journal (June 9, 2010) Foundation for Financial Wellness. Financial wellness: enabling a productive and healthy workforce.
3 Health Enhancement Research Organization; Population Health Alliance. 2015. Program measurement and evaluation guide: core metrics for employee health management.
4 Burton, J. WHO healthy workplace framework and model: background and supporting literature and practices. World Health Organization.