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Dee Edington is known by many as the “godfather of health-risk assessment.”
For 35 years, Edington’s research at the University of Michigan Health Management Research Center has helped us understand how companies can improve employee health and wellness.
In his book Zero Trends: Health as a Serious Economic Strategy, Edington threw down the gauntlet to companies: Preventing disease by developing healthier work environments was not only the right thing to do morally, but also good business.
And now, he and his co-author Jennifer Pitts have published a new book, Shared Values – Shared Results: Positive Organizational Health as a Win-Win Philosophy that is taking this message to the next level: If a business wants optimal success, employers and employees need to find a shared value in pursuing optimal health and wellness; namely, positive organizational health.
To put the importance of the concept of positive organizational health into historical context, Edington described the history of corporate interest in employee health. “I don’t know if, in the history of American companies, there was a time when they were totally involved with health,” he told me. “But there was a time when they were more involved with people, the value of and taking care of people. And that happened mainly because of safety. Also companies didn’t have good rules around being safe and didn’t have good rules about children and working (child labor).
“The concern for people expanded during the 1980s and ’90s as a national strategy of disease prevention and promotion was developed, primarily related to cardiovascular disease and diabetes.”
In the 1980s and ’90s, corporations began to shift their emphasis to shareholder value. Once corporations’ attention turned to driving shareholder value “that changed the way executives looked at profit and the way that they looked at people,” explained Edington.
Edington began to observe the effects of a profit-driven mentality on executives attending the Executive Education programs at the University of Michigan Ross School of Business and how many had sacrificed their health for professional success. “The executives were in the 40-to-50-year-old age range, and they realized that although they had been successful up until now, the way they took care of their body and their business would not be sustainable as they grow older.”
Also, he realized that companies bought into the notion of sacrificing personal health and well-being for the advancement of the company. Some employers were willing to think of employees as dispensable in pursuit of the bottom line, and Edington felt that this approach was shortsighted on the part of employers.
“That was a very common feeling in the world of work from some senior-level people: Treating people like a peg you put into a hole to get things done,” Edington explained. “Retention and recruitment is key to business sustainability. Maybe there are some jobs where you can plug in somebody with a minimum amount of training. Regardless, every time you lose someone, there’s recruitment and training and development involved to replace them.”
But it wasn’t just employers. Employees were also willing to sacrifice their individual health and well-being to succeed in this corporate structure as well. “I think we’ve been so focused on the financial success of organizations, we’ve got this new idea of a 24/7 global economy,” said Edington. “Why should I sleep? Someone else is getting ahead of me!”
Edington described how this decision on the part of the employee can actually have the opposite effect. “I think it is important that we work hard, but there comes a point when you over-train,” he said. “And the harder you work, the further down you go. I think people believe they can overwork, and have sleep and rest deprivation, and remain highly productive. They often end up making mistakes, and they start getting into a pattern of taking the easy decisions, and don’t take the time to work hard to make the right decisions.”
Part of the rationale that employees may use to justify their unhealthy behavior is that they will stop when they retire. “I know a lot of people give up a lot of things, including their family. They give up their exercise, their hobbies and fun, their friends — because ‘I’m going to catch up once I get this work done.’ And they don’t realize their kids left home 10 years ago. They sort of lose touch with things … and end up with not being able to ever get to that satisfied life they expected.”
To address this issue, Edington explained a new approach to corporate wellness in his 2009 book “Zero Trends: Health as a Serious Economic Strategy.” “The contents of the book clarified the contribution of individual health and wellness at the workplace by not only explaining why health is a serious economic strategy, and that behavioral risk reduction would save companies money, but also that everyone in the company had to be on the same page regarding organizational health.”
From Edington’s perspective, the key to a healthy company is to focus on people — all of the people in a company. “Everyone has to understand the value of people — whether it’s front-line staff or a senior leader or the chairman of the board — and what people bring to the success of the organization,” Edington explained. “Everything that happens in the organization impacts the health of everyone in the organization (and vice versa): environment, culture, climate, policies, procedures, supervisors, co-workers. Much of what would be regarded as a healthy or unhealthy organization starts at the top, and this is repeated at every level of the organization.”
Over the past several decades, research has supported Edington’s perspective that the health of the people in a company can improve a company’s bottom line. For example, studies estimate that health care costs U.S. businesses $576 billion annually, excluding sick days and workers' compensation. As an example, mental illnesses, such as depression, may predict higher levels of job turnover, which can cost the company a great deal in recruitment and training.
Further, these costs may be preventable. Evidence shows that a range of psychosocial factors, such as stress, unhealthy eating and poor sleep can predict the onset of chronic diseases, such as coronary heart disease and diabetes.
Accordingly, there are many organizational factors such as job control, workplace safety, work-life integration and peer interactions that may influence these psychosocial factors, and thus ultimately influence employee and organizational health.
As a result, companies have responded to this research by trying to implement workplace wellness programs, which often focus on health education and access to exercise. Initial research suggests that these programs are useful. One meta-analytic review of 17 studies found that participation in an organizational wellness program was associated with decreased absenteeism and increased job satisfaction.
Yet Edington cautions that these results can be misleading and that the efficacy we see in studies does not always translate into “real-world” settings. In part, the reason is that these studies did not involve an assessment and modification of corporate environment, culture and climate as a whole.
“Most front-line wellness program staffs are well-trained in conducting the typical wellness programs and some in biometric screening, coaching or advising,” he said.
“But wellness is an unregulated field, and, as you can imagine, there are way too many shortcuts taken,” Edington said. “Typically, the staff is not well-trained in a deeper understanding of the values and expectations of the organization and the employees. Wellness and well-being solutions, [employee-assistance program] solutions and disease-management solutions are often treated as silos in helping people cope with the problem and not getting to the cause of the problem. We are finding that health and wellness are very complex psychosocial issues, as well as biological.”
And now, with “Shared Values – Shared Results: Positive Organizational Health as a Win-Win Philosophy,” Edington and Pitts are taking this philosophy to the next level. Rather than simply viewing health as the absence of disease and health care cost avoidance, organizations need to focus on positive individual and organizational health and total revenue enhancement.
“The rationale is that people, if they are in the best of physical and mental shape, will add to the financial value of the company. People are the driver of revenue and core value to the organization. Most companies would agree with that ‘people are our most important resource.’ Whether they act like that or not is another story. Positive organizational health is the umbrella within the workplace, building and elevating health to a higher level within the organization,” said Edington.
What is particularly unique about Edington and Pitts’ vision is that it brings together two distinct conceptual frameworks and literatures. Positive psychologists are recognizing that happiness, innovation and creativity are not simply the absence of mental illness, such as depression or anxiety, but rather a state of being that can be nurtured and learned like a life skill.
Several areas of research have established that health and wellness predict improved work performance. Thus, positive individual health is more than the absence of disease, but rather an opportunity for growth in multiple domains of functioning, such as purpose and creativity, that can translate into increased wellness and work productivity.
“Organizations with a win-win philosophy are keenly aware of the importance of a broader kind of positive individual health than standard wellness and well-being approaches previously addressed,” Pitts said. “In addition to physical health, this kind of ‘positive individual health’ includes mental, emotional and spiritual health; social and environmental health; and intellectual, occupational and financial health.”
“It also includes an awareness of the value of helping people experience far more positive levels of these health dimensions. It includes viewing health as more than the absence of disease ― understanding that health includes flourishing in many or all of these domains.”
“The implication of recognizing this type of broader health is that organizations can do much more to help employees flourish: Aligning the workplace environment, policies, practices and maybe most importantly, fostering more supportive relationships to best serve the health and well-being of employees. Practices like these will ultimately result in what we call ‘positive organizational health.’ Positive individual and positive organizational health are two sides of the same coin. They go together, hand-in-hand, and they are the result of a ‘Shared Values-Shared Results’ philosophy and strategy,” Pitts said.
Initial research suggests that positive health factors such as purpose predict improved health and productivity. One research study from the Midlife in United States (MIDUS) data followed more than 6,000 people over the course of 14 years, with more than 500 dying during the course of the study showing a lower sense of purpose predicted early death.
Similarly, one study of 1,042 employed people found that when their perception of their workplace was supportive of creative work, it was associated with increased job satisfaction and reduced job stress. Further, people who make social investments in work, relationships and community develop higher levels of conscientiousness. This conscientiousness appears to be associated with improved health behaviors and well-being, as well as increased longevity.
Edington feels that one of the consequences of not focusing on positive organizational health is the loss of employees. “People know your company, they know your people, and they understand what the product is, and they know your customers. That’s experience; and if you don’t value experience, every time you lose someone to turnover, it is going to cost you money for retraining and development. It’s going to cost the lost technology that they take with them, and the company knowledge that they take with them, and then you’ve got to build those business competencies somewhere else,” he said.
Research supports Edington’s perspective. For example, one study of 493 retail-sales employees examined the relation of perceived organizational support (i.e., “How much do I feel supported by the organization as a whole?”) and perceived supervisor support (i.e., “How much does my supervisor support me?”) to employee turnover. Results showed that both lower levels of perceived supervisor support and organizational support predicted higher employee turnover.
Edington explained that everyone in the organization needs to adopt the shared value of positive organizational health in order for this strategy to be successful. “Organizational buy-in has to go both ways. People have to buy into it, and the organization has to buy into it. There are a lot of values espoused by organizations and people, but in terms of work, people value respect, they value trust, and they value meaningful work,” he said. “If you discuss motivation in those terms and show people that they are highly valued, you develop loyalty and engagement.”
In addition, the same type of process is necessary in order to help the organization believe that the values stated by the employees are real.
One day, Edington said, he was at a restaurant with a benefit consultant and noticed a custodian cleaning the floor. He recalled saying, “Look at this place. Does that custodian understand the role that he plays in the success of this restaurant? If this place has spotless floors, clean toilets, clean counters, what is the impression taken away by the customer? It’s probably going to drive them back to the restaurant and bring their friends and their friends. You want to go eat at a place that’s clean and to see friends along with good food?”
“Of course. It is so important every level of the organization understand this and is recognized for the major impact they have on the business.”
Pitts explained how Edington Associates encourages positive organizational health. “The evolution of a Shared Values Company is a collaborative and inclusive process informed by a systems-level view of the influences on positive individual and organizational health. We believe we will be hearing more and more about co-creation, collaboration and inclusion in the evolution of healthier companies, in addition to the installation of commercial wellness programs,” she said.
“We talk about the value of convening ad-hoc employee design teams that use principles from human-centered design and group flow practices. We also emphasize the importance of deep exploration into healthy traditions, rituals and stories about positive practices that already exist in the company. Building on positive examples to develop and spread existing grass-roots initiatives and native approaches can strongly complement wellness programs.”
And the world is starting to catch on. The Bureau of Labor Statistics found that over the previous year, approximately 2.7 million to 2.8 million employees quit their jobs monthly. A recent report from Deloitte, based on surveys and interviews with more than 3,300 business and human resources leaders from 106 countries, stated that culture and engagement, and how to engage and empower people was a top concern cited.
This is reflected in the cultural landscape. Lists are emerging of which companies are viewed as providing the “healthiest” work environments. Similarly and perhaps related, companies that provide work-life integration are being identified.
Edington sees early signs that in America, we are coming to a more humanistic view. Shareholder value took over the humanistic movement in the 1980s, but now I think that’s somewhat coming back.
The whole country is starting to change by showing respect and trust for all people and providing and acknowledging meaningful work. Edington concludes by stating his belief in a phrase often attributed to Henry Ford: “Employees win when organizations win, and organizations win when employees win.”
Michael Friedman, Ph.D., is a clinical psychologist in Manhattan and a member of EHE International’s Medical Advisory Board. Follow Dr. Friedman onTwitter @DrMikeFriedman and EHE @EHEintl.
