*Please note that the write up that follows is an edited version of the video recording.
Organisations have a legal responsibility to look after employee health, for example by preventing exposure to occupational diseases and undertaking health surveillance. Employer interest in health and wellbeing provision, driven partly by the ageing population, sickness absence levels and a sense of corporate responsibility, has grown over the past ten years.
We brought together four industry experts to discuss key issues, including how to maximise take-up and cultivate long-term buy-in.
LOUIS WUSTEMANN (LW): Why should employers prioritise employee health and wellbeing?
CAROLYN YEOMAN (CY): We know there are huge business benefits. If we can take a strategic approach to wellbeing, we can demonstrate it at all levels, that return on investment. Traditionally, the problem with the entire wellbeing area is that organisations tend to think they can't measure it and that it's quite intangible. It's not. We know that, when we look after and care for our staff, they are more productive, they take less time off work, there's less presenteeism.
ALEXIS POWELL-HOWARD (APH): Employers are starting to recognise that their resource is their people. It is important that they engage with their staff and look at what they need and not just assume what they need. That's part of it. They should also recognise that there isn't a quick fix. It needs to be part of a systemic approach.
Dr Carolyn Yeoman, operations director, OCAID Wellbeing
Dr Carolyn Yeoman is an organisational psychologist with more than 20 years' industry experience in the health, safety and wellbeing field. Before joining OCAID to head its wellbeing business, Carolyn spent two years with the work-related stress policy team at the Health and Safety Executive. She has co-authored a book about employee assistance programmes.
If we just purchase an employee assistance programme or train mental health first aiders-¦ we don't see a return on investment.
HELEN SMITH (HS): The companies that have a strong and well-embedded health and wellbeing strategy are the ones that have the desire to be a high-performing company, to increase their productivity and to be competitive in the marketplace. Your staff are your greatest asset so recruiting and retaining the best and having those people fully engaged is one of the most critical things for businesses to survive.
JAMES MANSBRIDGE (JM): If you look at absence rates, it's things like stress and anxiety that are the biggest causes. If the battle for safety has been largely won in this country, certainly when it comes to mental health and wellbeing we are just beginning.
LW:What would you say to an employer who said, "My responsibilities don't stretch that far. That's not a productive use of corporate resource"? Or that these services should be provided through the NHS?
JM: Even from a legal perspective you are responsible for the welfare of your employees. Welfare encompasses mental health. Companies have shown huge returns on investment. One of the companies we worked with said that, for every £1 they spend on wellbeing, they get £7 back.
HS: Some of the organisations we have worked with have said that, for every £1 you spend, it can be anything between £2 and £34 returns. It's the enlightened organisations that are seeing that and investing in it.
CY: If we just purchase an employee assistance programme (EAP) (see p 44) or train mental health first aiders-¦ we don't see a return on investment. But where organisations take that strategic approach, look long term and assess where the need is first and what is going to work in an organisation, where the problems are, that's when you put in the interventions to match those hotspots and you start to get those returns on investment.
APH: There are also things which you do struggle to measure [that do have a huge impact] like discretionary effort.
LW: If you have a good corporate culture, line managers will tell the organisation when they are seeing things like [discretionary effort]. They know when people are working well.
CY: It is the same with presenteeism; it's hard to measure. It's difficult when someone is just sat at their desk. They are physically there but they are not performing.
JM: Engagement is a key factor. Employers should be measuring more. Overall, 89% of employees disengage with their work. It's not a good statistic.
Alexis Powell-Howard, founder and managing director, Fortis Therapy and Training
Alexis Powell-Howard is a British Association for Counselling and Psychotherapy (BACP) accredited psychologist, clinical supervisor, trainer, mediator and coach. She runs Fortis Therapy and Training , which provides mental health and emotional wellbeing services to businesses, organisations, schools, local authorities and private individuals.
I'm a great believer in word of mouth. If you put something in, it works, and people like it... That will spread across the team and more will want to be involved
HS: When we asked companies why they had put a health and wellbeing strategy in place, it's very much around improving employee engagement and organisational culture-¦ It needs to link with what your organisational objectives are and what you are trying to be as an organisation. Every company is different. You can't parachute somebody else's health and wellbeing strategy into your own.
Laying the foundations
LW: So where would you start?
HS: I would look at your company vision and organisational objectives. Where do you want to be? What data do you already have? Whether that's from exit interviews or engagement surveys. You can look at what your competitors are doing. You should look at where the gaps are in your benefits and write a strategy on that, which meets everybody's needs. You need to know what budget you need but also what you are going to measure.
CY: You can benchmark at that point. We have an indicator called stress factor, which we use with organisations that helps them to understand where they are. It takes all the data they have but then asks, "Where are your hotspots?"; "Where are the people who are most stressed in your organisation and are there any specific needs in that strategy for them?". There is so much groundwork we have to do before we get to that point where we put in place that intervention.
APH: We talk to senior teams about what they think is going on in an organisation. Then we talk to the workforce and often there is some tension. Part of this is about not imposing something on to the workforce without their engagement. Engagement is the core, the beginning point. There may be some quick wins that clear the path for people to do their jobs far more efficiently. It's also about a strategy that can help them over a period of time.
JM: That's a key point. You are trying to embed a culture of wellbeing. A lot of organisations don't know where to start. They run initiatives, or they say, "We've noticed more staff off stressed recently, so let's give everybody stress management training. Let's get our line managers trained up to notice signs of stress". It's OK for a week or so when it's fresh in the mind but it's easily forgotten.
Also, as people leave and new people come in, it's forgotten. It's because the organisation hasn't decided, "This isn't something we do in the short term; this is who we are, this defines us now. We are going to get a wellbeing culture in here". That's the first decision you have to make.
APH: You've got to come away from this idea that people go on [a] training [course], they get a certificate, put it in a drawer and carry on as before-¦ There often isn't a cohesive approach. There is a pocket of champions over there and another here. If you don't know who they are, there's no way of finding out.
That's why the strategy is really important. You communicate it on your intranet and in meetings. It becomes part of what's happening in the culture. People know who to go to if they are struggling. Mental health first aid definitely has a place in that strategy, but you really want prevention rather than cure. That's what wellbeing is all about.
Helen Smith, chief commercial officer, Benenden Health
Helen Smith has more than 16 years' experience in the health and wellbeing sector and previously worked for Engage Mutual Assurance. She joined Benenden Health in 2013 as head of sales and marketing. She became chief commercial officer in March 2017 and oversees Benenden Health's commercial activities. Her wider remit includes product development.
You can't parachute somebody else's health and wellbeing strategy into your own
HS: Workforces are so complex these days. We do a lot of work with multi-generational workforces. Some organisations have five generations. What a baby boomer might need from a health and wellbeing strategy is very different from what a millennial might need. It's [about] going and asking, then being agile and adapting the initiatives.
LW: Can we talk about what the early wins could include?
HS: Once you've established a strategy and spoken to the workforce, what worked for us was having health and wellbeing champions across the business as well as mental health first aiders. They made themselves known. They went to team meetings. Many of our colleagues had teenagers who were very stressed and that was then stressing out their parents who were coming into work. We developed a toolkit for dealing with teenagers' stress. We put it on our intranet. That had an effect of, a) we listened and b) we did something tangible about it.
CY: Another quick win can be a high-impact wellbeing day. At the beginning when you've set your strategy, you can make a big fuss about it. All employees are invited. There are lots of pop-up stands all around, for example where people can have their blood pressure taken. All of that creates that buzz. It allows people to start to engage with the strategy.
APH: Sometimes the quick wins are things you would never imagine -- irritations that people are working with every day. Their chair isn't comfortable, or the computer isn't working as quickly as they would like. It's quite stressful when things don't work in the way they need to. They take minimal time and costs to sort them. Again, staff think, "Ah, you are paying attention to what's important to me". Then you build on that.
JM: It has to be driven from the top, but businesses need to trust their employees as well. A lot of stress is put on people because they are not trusted and they are checked up on too much. That [trust] might be in terms of a flexible working policy or not being too rigid on the hours they keep in an office. Also, having a senior person, maybe the CEO is the right person for this, to front such a campaign at the beginning and say, "We are serious about wellbeing". That can drive engagement quite quickly.
APH: If the people at the top aren't on board and don't see the value-¦ you're never going to make the shift. It will be implemented but it won't have the motivation to keep it going forward.
Winning over CEOs
LW: Any employment initiative has to compete with other priorities for funding from the chief executive. How do you make a strong business case for financing a health and wellbeing one?
HS: I think it's £8bn lost last year to absenteeism and £16bn lost to presenteeism. You start to break that down to companies-¦
James Mansbridge, head of digital learning, British Safety Council
James Mansbridge has worked for the British Safety Council for three years. He was previously a digital learning developer and trainer in the telecoms sector. James became interested in digital learning while working in the Far East. After teaching maths and physics, he moved into a senior leadership role and led a digital learning programme in Bangkok, Thailand.
One of the companies we worked with said that, for every £1 they spend on wellbeing, they get £7 back.
JM: It's sometimes difficult to show to an individual company what their return on investment is. How can I prove to them that they've saved this much money, or they've retained talent better? You need to be good at measuring those things beforehand so, if someone says, "Could you write me a business case?", it can take some time to go away and come back with some meaningful numbers.
APH: You are also looking at attrition. Most businesses aren't that great at doing exit interviews. Most aren't interested. We go in and ask, "What is your absence [record like]? What are your disciplinaries like?". The things that show people aren't happy. We do mediation work because relationships are breaking down. In terms of a business case, if I can say, "There will be an improvement [if you introduce a health and wellbeing policy] and here's evidence from another organisation we've worked with", they can apply it more. If we look at the general figures, absolutely there is a business case, it's evident, but many managers still think, "That's not my business, that's not going to happen to us".
HS: On top of that, if you are losing good talent because you aren't looking after your employees, it's a cost to the business to recruit [to replace them]. Also, if you want the best talent in your business so you can be the best business, potential employees are looking at the wider benefits. Particularly millennials, they aren't just looking at the benefit package. It's all around, "What's the culture? How do you look after people?". It's a mixed picture. We go into companies and help them to write the business case because we recognise it is critical. There are eight or nine key measures, some more tangible than others.
CY: Using our stress factor [tool] we are able to work out a potential loss in productivity. By looking at people's stress levels, how they are performing and their levels of engagement, we have been able to put a figure on that. It's almost a measure of presenteeism. They are not being productive. [We can say,] "This is potentially how much money you are losing every year because they are not engaged, they are not well, and they are not healthy". It is something you can use again and look at in two or five years.
APH: You can also look at how they use appraisal systems in their organisation. That can give you an indication of how invested they are in their people development: whether employees are engaged with their objectives; whether they are doing blanket objectives across the organisation or making them individual; who is engaging and who isn't.
LW: What interventions deliver the most value?
CY: The one that has had the biggest impact is line managers. Often, it's not their fault but there are lots of line managers in that role who are not trained [to deal with health and wellbeing issues]. We take an engineer who is great at his job and say, "Let's promote you to be a line manager". He may be a brilliant engineer but may not have that emotional intelligence which he or she needs to be a line manager.
A lot of the really big impacts in the wellbeing space at the moment are around working with our line managers to give them the skills they need to understand how their leadership style affects their team and to understand why they may have issues with members of their team. We tend to manage people in a way that we like to be managed ourselves but not everybody is the same. Equipping our managers with that emotional intelligence and their own resilience is key if we want to move forward with wellbeing strategies.
Often people are promoted because they are very good at what they do but their managing people becomes a whole different ball game
APH: Part of the role is very pastoral. Often people are promoted because they are very good at what they do but their managing people becomes a whole different ball game. It's not because managers don't want to do it well; it's because they don't know how to do it well. The more confidence they can have in how to manage those difficult conversations is always going to have a positive impact. Relationship building [between managers and staff] is really important.
HS: It's also making sure the infrastructure in an organisation supports everybody, so that they can support line managers -- whether that is having an EAP or a helpline. It's having an honest and open culture and also knowing who is there to provide support, whether that is internally or having external partners.
JM: We have almost got to teach people how to communicate face to face again. How to talk to someone else in the business. People become reliant now on sending emails to another person in the next row of desks. It comes back to this trust issue. It's, "I need a record of that". Why? If you trust each other, you can have a quick chat. You should be able to assume that person is going to do what they said they would do.
LW: What have you found are the best value-for-money interventions?
HS: My company offers affordable alternatives to health insurance. You can have very expensive health care interventions but being able to have a package that is affordable and covers things like EAPs. When used correctly they are very good. So is having access to GPs when you are at work so you don't need to take time off, which brings on further stress. Health assessments are also useful to identify themes in the workplace. We did some work with an organisation that had a very heavy smoking population, which we discovered through the health assessments and brought in some smoking cessation programmes.
APH: On the management side, this could be having themes on your intranet that link through to what you are doing in the organisation. It could be putting on lunchtime sessions on a regular basis or after work. The workplace is a great environment to offer staff the chance to try bite-sized interventions, things like nutrition, mindfulness.
JM: Digital learning, formerly e-learning, used to get a terrible press. But, in terms of wellbeing, there are a lot of resources available that you can put on a system and make available to everybody and accessible at the point of need. Classroom training works well but two months later it can be forgotten. You can put resources like mental health risk assessments online and it's easy for people who work remotely to access them. The set-up cost is significant but the cost per person is very small after that. Another advantage is that it gives an organisation a huge insight. Even if it's anonymous, you can see what resources staff are accessing. Why are they looking for information on how to combat stress? A platform like that offers huge value for money.
LW: Looking at the individual components of a health and wellbeing programme, is there any way to separate them out and work out their contribution?
CY: That's quite difficult. In reality what you are doing is evaluating the strategy. When you are looking at individual interventions within that, you are looking at anecdotal evidence and feedback, so it's not true data but it's equally valuable.
Unless you do interventions in a sequence and you take measurements as you do it, you can't identify exactly what contributions each one makes. It's knowing you've got your strategy right. That overall, what we are doing fits with our staff, organisation and culture and that we can show in this two- to five-year period that this has been the impact.
APH: A really good way to show an impact from a staff perspective is to do case studies. Pick staff across the organisation and look at where they were at the beginning and track them throughout. What made a difference to them and what didn't. What impact it has had on them. Then you can look at that in the overall picture of everything else you are gathering.
Part of this is about not imposing something on to the workforce without their engagement
HS: It's like doing a marketing plan with all the different campaigns. You have to see them all holistically because they don't work on their own.
JM: Getting feedback is really important but listening to it [is vital]. If people know they are going to be listened to, they will tell you what works really well and what maybe doesn't work so well. It's a strategy, so over time it has to constantly evolve. It's always rolling, and you are tweaking it, but as long as your scores are going up in the right direction...
CY: We worked with an organisation that introduced gym membership for everybody. Most staff were based in offices and they valued it. We did discussion groups with employees across the organisation and we went into this warehouse and the morale was much lower than anywhere else. It had had completely the opposite effect. They said, "We work in a warehouse and we run around all day". It had demotivated them because they didn't feel the organisation cared. Managers hadn't asked them what they'd like. They were coming up with very simple things like being brought breakfast once a month. This goes back to this need to understand the different groups of people.
LW: How do you get the maximum number of people engaged?
HS: Competitive participation works but only if it is done correctly. Inclusivity is important. The obvious ones are slimming clubs and weight loss or step challenges or mindful challenges. Also linking it to national awareness days. You can piggy back on a lot of the social media activity. It's also important to ask staff what is important for them, to get them involved.
CY: We shouldn't underestimate the power of the boards, senior managers and line managers. Where staff see them engaging with it, getting involved and talking about it. That keeps it in employees' minds and that it is also important to the business -- that the employees are important to the business.
APH: Businesses are very good at having a marketing strategy and telling everyone outside what is going on but internally they could do with a similar thing. It's that proactive approach and encouraging managers to make it a priority in their team meetings and the conversations they have. I'm a great believer in word of mouth. If you put something in, it works, and people like it, then that's the best advert. That will spread across the team and, before you know it, ten more people want to be involved.
JM: You have to show that you are going to maintain [whatever you launch]. You've just decided you are going to embed a wellbeing culture and perhaps it's a 60-day campaign. Every single day, someone from the executive has to write something and publish it.
People take time to form habits, so you have to do something every day until it becomes habit. When new staff join, they don't need to be told by the director what the company does because the person next to them will say, "This is what we do".
Avoiding the pitfalls
LW: It's been implied in what you've been talking about, but it would be useful to focus on it explicitly: what do health and wellbeing programmes look like when they go wrong? What are the traps companies fall into?
APH: It's senior leadership not listening to staff and assuming they know what is wanted. If senior leaders try to impose something, you are going to have so many defences going up. Another pitfall is not having a well-thought-out strategy. There may be a launch but nothing to back it up. Then you fall into that apathy. If the commitment and energy isn't there, it doesn't work.
HS: If it's not authentic or considered and just adopting somebody else's strategy for the sake of it, it isn't going to work for employees and management who are looking for a return.
CY: Take the stress risk assessments which the UK Health and Safety Executive suggests you should do. A pitfall of that type of approach is if you identify where the stressors are in your organisation but you don't do anything about it. Or you ask staff to complete a questionnaire and take part in focus groups to tell management what's wrong and there's never any feedback telling staff, "This is what you told us, and this is what we're going to do".
Another pitfall is the lack of regulation around mental health first aid and, to some extent, EAPs. Both have the potential to damage employees if they are used incorrectly or if we've got a mental health first aider or counsellor for an EAP who is not appropriately trained or competent.
As part of compliance, we should be making sure that any intervention that we provide is fit for purpose. At the moment we are not auditing and evaluating EAPs. There is no supervision. As a mental health first aider, you are out there in the organisation on your own. There is the potential to cause more harm than good.
APH: I'm a psychotherapist and have had years of training. Sitting with people at that point of crisis is really tricky work. Sometimes it's challenging for me so if you have someone with a qualification from essentially a couple of days' training and an organisation sees that as ticking a box that they've done it, it is not appropriate for the person who is in the role or the person accessing that service to not have some sort of supervision in place. That's a very heavy role to be in without having a structure around them. Although it's not supposed to work that way, in reality that is the way it works in some organisations.
JM: It's failing to decide what you want to get out of it at the beginning. That means not being able to measure progress effectively.
Also, a lack of commitment. You start to do something and then let it fizzle out because you haven't embedded it properly. Not everything is going to work so don't be put off by small setbacks that make you think it's the wrong approach. It's also important to give yourself enough time [to achieve what you want to achieve].
Also giving someone who already has a lot of responsibility an extra piece -- "You are the OSH person, you are now responsible for mental health as well on top of what you already do". You are setting them up for failure.
LW: Is employer involvement in employee health and wellbeing here to stay?
CY: The more case studies and research we get, and the more we can talk about the benefits, it's got to be here to stay.
APH: The health part of health and safety now needs the attention. Millennials are coming through who want a different work-life balance... We can see the health implications if we don't take that interest.
HS: When people start to see those organisations that embrace health and wellbeing strategies as the high-performing companies and the winners in the market, we'll start to see it being embedded.
JM: They are absolutely here to stay. One of the main reasons is the changing workforce. Younger people are more interested in, "What's this place like to work?", "What is the employer like?". It isn't just, "How much are you going to get paid?". So, if you want your company to be a good place to work, you can only do that by continuing to heavily invest in wellbeing.