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Book Review: The Healthy Workplace Nudge is a Must-Read

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Rarely does a book come along where you can see the author changing his mind about the conclusion as he goes along.  The Healthy Workplace Nudge, by Rex Miller (with Philip Williams, and Dr. Michael O’Neill) is such a book. (For politicos, here is another such book.)  Don’t skim the first few chapters — enjoy watching his journey to enlightenment. Like him, I myself took the same journey. Until about 2007, I didn’t just drink the Kool-Aid. I also mixed it up and sold it…until I did a little fifth-grade math, reaching a conclusion summarized in an observer’s blog post entitled Founding Father of Disease Management Astonishingly Declares “My Kid is Ugly.”

Like virtually everybody including myself (and every member of Congress in 2010), upon first hearing the wellness industry elevator pitch, Rex starts out by assuming that wellness must save money — it seems so obvious.  But the more he learns, through his extensive research, the more he realizes that the “pry, poke and prod” industry is a fraud. “My [initial] unfamiliarity with workplace wellness was a benefit,” he observed. As a tabula rasa, the more he looked, the more he saw: “A few studies have become major pillars of misinformation that have been repeated for more than a decade.”

Welcome to my world, Rex.

After that, the more he learned, the more he learned. Trying to get to the root of the ubiquitous $3-in-savings-for-$1-in-investment meme that permeates the field and predated Katherine Baicker’s subsequently retracted 3.27-to-1 ROI, here’s what he discovered:

When I reached the global health and wellness director for the most cited case study, he admitted he did not know where the numbers came from or even who had actually created the report. So the result seemed to be a very high profile…urban legend.

Meanwhile, back in the company of my new castaway friends, the misfit provocateurs [Tom Emerick, Soeren Mattke and me], I kept hearing simple declarative sentences and sourced data. 

He is spot-on regarding the distinction. Here is how one of the Wellness Ignorati explains Koop Award-winner (and notorious opioid distributor) McKesson’s seemingly self-contradictory award-winning program results:

Health indicators in 2013 and 2014 were adjusted in the analysis, while several sensitivity analyses of the ‘inter-individual’ impact that used a matching approach confirmed the results… Lewis’s conclusion essentially compares apples and oranges by mingling overall summary statistics with an interpretive analysis section that’s descriptive. The latter is based on repeated cross-sections of McKesson employees.

By contrast, here is “Lewis’s conclusion” after observing the self-contradiction in the Koop Award application that prompted this Employee Benefit News smackdown, presented in a simple declarative sentence:

The average weight of McKesson’s employees can’t rise and fall at the same time.


As if Rex needed more data points, another red flag was being disinvited from speaking at one of the Wellness Ignorati-fests. This happens whenever a speaker subsequently admits to critical thinking after being “confirmed” to speak. Critical thinking is right up there with data, math, integrity, facts, analysis, grammar, wellness and me in the rogue’s gallery of damned spots the Wellness Ignorati attempt to wash out, out — or at a minimum pretend to ignore (hence their moniker).

That’s why allowing the noses of the Rex Millers of the world (among whose unforgivable misdeeds are quoting the Al Lewises of the world in their books) into their tents might nudge their bright-eyed and bushy-tailed, painstakingly sequestered, acolytes to use the internet, perhaps searching on keywords like “Koop Award.” If they do, they might learn that in 2016, the year after the Ignorati disinformed their flock that Koop Award-winning companies dramatically outperformed the stock market, the 2015 winner became 2016’s 14th-worst performer in the S&P 500.

Mr. Miller refers to the Ignorati as harboring “deep anger” about being exposed for “fabricating the data.”  Rex says he “doesn’t know the intent of using false data,” but I can clue him in: false data is quite useful if you are selling a scam (the LA Times‘ word, not mine).

Mr. Miller’s expert interviewing style even enticed Ron Goetzel to come tantalizingly close to admitting what we’ve spent four years in TSW demonstrating: that his whole career — claiming huge amounts of money can be saved by coercing lots of employees into claiming to eat more broccoli — is one giant fabrication. Mr. Miller quotes Mr. Goetzel as saying: “Changing behavior is very very very very hard.”

Yes, Ron, your cordially-welcomed-but-ever-so-slightly-overdue Eureka Moment is very very very very accurate. I imagine you’ll retract it soon, because on the other occasion when you were accurate — when your guidebook accidentally admitted wellness loses money — you immediately tried to disown your findings as soon as I congratulated you on their (apparently unintentional) accuracy.


The Nudge…and the Real Estate

The essence of Mr. Miller’s thesis is that hammering people with forced behavior change is very very very very pointless.

Having concluded that prying, poking and prodding employees does likely more harm than good, Rex moves on to a totally different way of doing wellness, which is to say, passively rather than actively. Clearly Rex put a lot of time and shoe leather into researching this book, and it shows. Many examples are offered of how little steps — simply moving different snacks to different places or making stairways more appealing than elevators — nudge behavior.

Way beyond that, the most notable advances in this book concern the built environment. He observes we spend 90% of our lives indoors, and yet little attention is paid to the effect of indoor space on health, wellness and productivity. I suspect more attention is paid to it than he gives credit for, but certainly we have all worked in or visited stultifying workplaces, workplaces where you can’t imagine wanting to hang out in any longer than necessary.

He proposes taking the built environment to the next level. Upgrading a typical building to the WELL Certification standard costs between $150 and $500/employee, all-in. Contrast that to the math provided to him by Tom Emerick that Walmart estimated for a wellness program: accounting for all the administrative costs, false positives, and lost productivity from health fairs and “workshops” totals thousands of dollars per employee. On the “credit” side of the ledger, every pound an employee lost cost Walmart shareholders $50,000.

By contrast, what goes into that $150 to $500 spent on the built environment get you? Suddenly every employee is “participating” in your wellness program, with no penalties or incentives needed. Not just the food in the cafeteria, but everything down to the air that circulates can be optimized for health and performance. “At their best,” he concludes, “buildings can be inspiring and invigorating–with little additional expense.”  For instance, office and factory interiors tend to be dry, which facilitates the spread of disease. They also often allow in little natural light, the lack of which can disrupt circadian rhythms. Both can be easily remedied, with humidification, and with lighting that mimics our circadian rhythms.

The beauty of his proposal on the built environment is that, unlike traditional wellness programs where even the promoters say you need to do everything right to get them to work (“Only 100 or so programs succeed, while thousands of programs fail,” according to Mr. Goetzel), you can solve this problem by throwing money at it…and not much at that. Mr. Miller does go on to point out the value of leadership, but I prefer solutions that anyone can implement, as opposed to solutions that require CEO behavior change, which is very very very very hard.

The built environment is one of several chapters he proposes on solutions, and all are worthy reading, but this section is my favorite because it was new ground at least to me, and because it is so accessible to the average company.  Even in existing space as opposed to new construction, a large chunk of what he is proposing can be accomplished for the price of a few years of a “pry, poke and prod” program. As one CEO who made this investment observes: “Hardly a week goes by when I don’t get a thank-you.”

In conclusion, go to Amazon and buy this book. Do it very very very very soon. Plus, the more copies he sells, the more Ron Goetzel will get very very very very mad.


4 Comments

  1. Sam Lippe says:

    Macbeth? Your cultural allusions have really taken a step up from your usual Seinfeld and Simpsons stuff. This is one of your best-written pieces ever. “Painstakingly sequestered acolytes” love it.

    Like

    • whynobodybelievesthenumbers says:

      I hope you mean “Painstakingly sequestered acolytes”? Love it.

      Not “painstakingly sequestered acolytes” love it, because I assure you they won’t love it, mostly because they won’t see it. I’m barred from their linkedin groups.

      Like

  2. williammcpeck says:

    Thanks Al for letting us know about the book.

    Like

  3. Michael Lagocki says:

    “The average weight of McKesson’s employees can’t rise and fall at the same time.”

    Greatness.

    I got to see much of this process up close and Rex did indeed go through the realization/change you described. Finding out the Wellness data was unreliable threw a monkey wrench in our plan. We were prepared to believe until it was pretty obvious that we shouldn’t.

    I am more convinced every day that the environment is a better place to invest than the programs. The environment stays, it’s obvious, it inspires. It’s a real investment in the truer sense of the word.

    The companies that we saw that did make a real wellbeing change adopted the concept as a full part of their culture. It was present everywhere. It became part of how they differentiated themselves as an organization. It became identity.

    Solid review.

    Like

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