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Corporate wellness: an evidence based guide for employers

Wellness is defined as ‘being healthy in body and mind, especially as the result of deliberate effort’. It’s an approach to health that emphasises preventing illness and maintaining good health, as opposed to simply focusing on treating diseases.

Modern corporate wellness programs extend beyond traditional ‘health and safety’ and ‘occupational health’ schemes to tackle ‘lifestyle’ risks associated with modern work. These risks cluster round the gradual, almost silent, development of long term conditions (LTCs) including heart disease, diabetes, obesity, anxiety and depression.

LTCs or ‘chronic’ diseases now account for the bulk of health spend and time off work in developed nations. According to the King's Fund, LTCs now account for 50% of all primary care appointments in the UK and 70% of all hospital admissions.

The trend is global and accelerating. The World Health Organisation (WHO) estimates that, by 2020, LTCs will account for almost three-quarters of all deaths worldwide.

In the US, workdays lost due to LTCs now cost employers $153 billion a year in lost productivity; cost estimates that include ‘presenteeism’ (when a person is at work but unable to perform at full capacity) are even higher, ranging up to $1 trillion.

Just like work related accidents, LTC are largely preventable.

Creating a culture of wellness

Most experts agree that a ‘culture of wellness’ is what corporates should be aiming for; a holistic system where the 'pillars' and 'essential elements' listed below blend seamlessly, and where wellbeing is propagated at all levels of the business as if it were built into the company’s DNA.

This is no simple ask. Today most wellness initiatives tend to be ‘siloed’, often within a poorly used employee benefits system, rather than being - and being seen to be - central to an organisation's fabric, behaviours and mission.

This is not just a question of organisation. If it were the high-tech health and benefits hubs that have proliferated within HR departments over the last decade would have fixed the problem.

Much more important are issues of leadership, philosophy and approach.

There is a wealth of evidence-based material on designing effective workplace health programmes. Most include the following traits:

Pillars of corporate wellness

Health and safety: Not sexy but fundamental. These interventions are underpinned by statutory requirements and good corporate governance and policy. They protect against work related accidents and injuries. They should not restrict everyday physical activity.

Management of ill health: Reactive by nature, this is the big money maker of the corporate wellness sector. Health insurance, absence management, and rehabilitation management programmes dominate. It is generally held that corporates spend too much in this area and not enough on prevention.

Prevention: The area of corporate wellness that is changing fastest. Traditional components include biometric screening, wellness weeks, on-site gym facilities and smoking cessation schemes. Common problems revolve around the evidence base for biometric screening (there is not much of one for those under 45) and staff engagement, especially with gyms and other ‘sports’ based activities.

Essential elements of corporate wellness 

Engaged leadership. High level leadership is critical, reflected through action as well as words. Company Boards should embed staff wellness objectives in the organisation’s business plan, making it a key operating principle for which specific leaders are held accountable.

A human centered approach. Effective wellness programs are inclusive. As the US Centers for Disease Control and Prevention (CDC) puts it: 'Effective programs thrive in organisations with policies and programs that promote respect throughout the organisation and encourage active worker participation, input, and involvement. A Human Centered Culture is built on trust, not fear'.

Tailored design. Wellness programmes should be specific to the individual workplace and the needs of staff. Successful programmes recognise diversity and are designed to meet the needs of both individuals and the business. One size will not fit all - flexibility is therefore vital.

Holistic and joined-up. Effective wellness programmes take a comprehensive view of human health: behavioral health, mental health and physical health are all part of ‘total health’. Individual components should be strategically aligned, so the sum of the program’s impact is greater than its parts. It is strategic rather than technical join-up that is most important.

Supportive work environments. There is a growing focus on building and office design in corporate wellness. This stems from a growing consensus that ‘lifestyle’ conditions are ‘environmental’ problems and that we spend so much of our time at work. The CDC has recently launched Fitwel, a evidence based certification standard for healthy buildings and offices.

Practical tips

Start small and scale up. Wellness schemes should be comprehensive but a step-by-step approach is recommended. Start with the basics, for example, sedentary behaviour or work related accidents, and work up. Schedule interventions logically and according to where the published academic evidence base is strongest.

Focus on what is sustainable. Changing a behaviour is one thing, sustaining that change quite another. A common mistake is to launch initiatives that cannot be sustained from a resource, infrastructure or policy perspective. Creating healthy habits is the key. See more on behaviour change below.

Be consistent. Staff perception of the workplace as a healthy environment is important and obvious contradictions will not be missed. A program that seeks to encourage better nutritional choices while operating food outlets that promote junk foods are likely to flounder, for example.

Involve your staff. Consult and involve employees in program design, implementation and evaluation - it’s the best way overcome ‘them and us’ type barriers. Creating networks of health champions has been found to be an effective strategy for changing culture and behaviors.

Consider incentives. Rewards can be a powerful motivator but need to be structured carefully to avoid unintended consequences. Focus more on recognition than hard financial gain and take care not to create a culture of winners and losers. Celebrating participation is key.

Measure and adjust. Set objectives and KPIs in the knowledge that improved health outcomes, especially around LTCs, may be hard to determine in the short to medium term. Softer measures around staff engagement can serve as short term proxies. Be willing to abandon pilot projects that fail.

Return on Investment

Return on investment (ROI) is a contentious subject in corporate wellness.

The big health authorities, including NICE in the UK, calculate that a well designed and operated wellness program will reduce sick days by up to 30%, while at the same time producing an array of less tangible benefits around staff retention, productivity and reputation.

However, a slew of articles in the American press in recent years have called out providers for making unsubstantiated claims and, as a sector, the case for corporate wellness bringing down employee healthcare costs as a whole remains unproven.

The most comprehensive studies reveal a mixed bag. There is no standard ‘plug and play’ model that can be trusted to deliver ROI. Success hinges on good programme design and implementation.

Perhaps the best evidence for this comes from a study published in the Journal of Occupational and Environmental Medicine. It found that winners of the Koop National Health Awards for workplace health outperformed the stock market by a factor of 3:1 from 2000-2014.

The Koop Awards are not just another ‘healthiest companies’ listing. Named after the late Dr C. Everett Koop, US Surgeon General from 1982 to 1989, they are independently adjudicated and were established specifically to reward organisations that can demonstrate they have:

  • reduced the need and demand for medical services

  • met the objectives of the CODs Healthy People's workplace targets

  • created net healthcare and/or productivity savings as a result of improving population health

Koops award winners in the study included Johnson & Johnson, The Volvo Group, FedEx and Citibank. In the 14-year period tracked, Koop Award winners’ stock values appreciated by 325% compared with the market average appreciation of 105%.

The study authors concluded: 'This study supports prior and ongoing research demonstrating a higher market valuation - an affirmation of business success by Wall Street investors - of socially responsible companies that invest in the health and well-being of their workers when compared with other publicly traded firms'.

Corporate Wellness

Behaviour change

Effective behavioural interventions have three key prerequisites - capability, opportunity and motivation.

Capability. The target group’s psychological and physical capacity to engage in the activity concerned. It includes having the knowledge and skills required. A common mistake is for ‘sports’ minded executives (the natural cheerleaders for corporate wellness) to assume a level of physical prowess in the workforce that does not exist among the majority of staff.

Opportunity. All the environmental factors that make the behaviour possible, or prompt or facilitate it. Crucial within a corporate environment is that staff have the time to do what is being asked of them. Where time is a factor, focus on behaviours that can be integrated into the working day.

Motivation. The mental processes that energise and direct behaviour. It’s important to note that these are not just conscious or ‘rational’ processes. Much behavioural motivation is subconscious, driven by habit and environmental and emotional ‘nudges’ or queues.

Corporate Wellness

Behavioural economics or ‘nudge’

In 2009, the UK Cabinet Office commissioned the Institute of Government to produce a guide to the use of behavioural economics in policy making. The resulting report, Mindspace, sets out nine of the best evidenced subconscious influences or ‘nudges’ on behaviour.

Mindspace has been widely used in government and the private sector over the last five years with impressive results. It is especially useful in the area of workplace wellness where creating healthy habits is key. The table below lists the nine triggers, their description and example applications.

TriggerDescriptionExample
Messenger We are heavily influenced by who communicates information Explains the importance of senior leadership in corporate health. Points to the power of ‘health champion’ or ‘healthy buddy’ networks.
Incentives Our responses to incentives are shaped by predictable mental shortcuts such as strongly avoiding losses Consider rewards (eg free fruit delivered to your desk) but structure carefully so not to create an atmosphere of winners and losers. Randomised/lottery prizes for active participants work best.
Norms We are strongly influenced by what others do A trickle can quickly become a flood. If you get some people cycling to work or using the stairs others will follow. If you can say ‘ most staff in our business walk between meetings ’ then do so.
Defaults We go ‘with the flow’ of pre-set options If getting people health news via email is a priority, make it the default option when staff join the business. They should take the initiative if they want to opt out.
Salience Our attention is drawn to what is novel and seems relevant to us Probably the simplest and most powerful to implement within a workplace. Hide junk foods, pushing healthy options to the fore. Visibly flag-up stair entrances and other opportunities for physical activity.
Priming Our acts are often influenced by sub-conscious cues Prime people to better regulate food portion size by using smaller plates and glasses in food outlets. Reverse on fresh veg and fruit counters. Also prime with knowledge. If your staff know waiting for the elevator takes 3 mins on average but taking the stairs just 1 min, they will be more likely to take the stairs.
Affect Our emotional associations can powerfully shape our actions Staff case studies are an excellent way to spark an a motivational emotional association with a health intervention.
Commitments We seek to be consistent with our public promises, and reciprocate acts If someone commits or pledges publicly to do something, such as getting off bus a stop early they are more likely to do it. If this is reciprocated with a buddy (I’ll do it if you do it too) it becomes more powerful still.
Ego We act in ways that make us feel better about ourselves We behave in ways that boost our self-esteem but our view is seldom objective. For example, we consistently overclaim when asked about the amount of physical activity we do. But we are more likely to do it if it’s obviously seen/recognised by colleagues, the more senior the better.

Common mistakes in corporate wellness

1/ Staff bring LTC’s into the workplace

Probably the single biggest obstacle to creating a culture of health within a business. The organisation’s leadership recognises that ‘lifestyle’ conditions such as type 2 diabetes are a problem for the business but - deep down - they feel responsibility sits with the individual.

This is an error, both factually and strategically. Most of us spend between a third and a half of our waking lives at work. What we eat and drink, the physical activity we achieve and the habits we adopt are all directly shaped by our employer. And that’s before you factor in our tendency to define our self worth - a key determinant of mental health - by reference to our success at work.

Organisations which accept this have a good chance of success. They recognise their influence on staff health and therefore their ability to affect change. Those that don’t will struggle.

2/ Physical activity is just a PC term for sports

You do not need to be an athlete or a gym bunny to meet the recommended guidelines for physical activity.

The recommendation for physical activity is 150 minutes of moderate physical activity such as brisk walking or pushing a lawn mower a week. Vigorous physical activity such as jogging or stair climbing counts twice, meaning you can get away with 75 minutes a week. You should also do at least 30 minutes of muscle building activity a week such as gardening or weights.

The problem with equating physical activity with sport is that it puts others off. Many people have deep seated negative associations with sport, often stemming from childhood. Physical activity interventions which stand the best chance of widespread uptake will not involve: 

  • Performing in front of others

  • Having a special skills set (running, throwing, kicking etc)

  • Special clothes and changing in front of others

  • Putting aside their free time

Conversely, the best physical activity interventions are those that can habitually integrated into the working week and which bring reinforcing additional benefits such as time savings.

3/ Health checks - the more the merrier

Health checks are not a panacea. Screening staff for health problems has a ‘common sense’ appeal but unless deployed selectively can do more harm than good.

Health screening can cause serious unintended harms. Such harms may relate to the intervention itself (xrays, blood infections etc) or, more commonly, by producing false positives that lead to unnecessary stress, investigation and treatments.

The golden rule in health screening is that a test should never be given to a population group unless it can clearly be shown that the benefits outweigh the risks.

In the context of corporate wellness, it is vital that this calculation is made with the individual in mind and not the business.

Summary 'pros and cons' of corporate wellness

Potential benefits

  • Improved staff health, physical and mental

  • Cuts the direct and indirect costs associated with staff sickness and absence

  • Improves staff loyalty and engagement, reducing hiring and retention costs and improving productivity

  • Boosts corporate reputation and standing among staff, clients and stakeholders

  • Creates a wider good - by helping your staff stay well your business is benefiting society

Downsides

  • Requires senior management time and ongoing investment

  • It needs to be done properly, ill-considered implementations may be received negatively

  • Results will take time to filter through - a company’s health profile cannot be changed overnight

Where StepJockey fits

StepJockey fights sedentary behaviour in multi-storey offices by quicky and simply promoting habitual stair use among all staff. 

It is solidly evidence based and used by corporate wellness specialists worldwide to complement and enhance wider corporate wellness programmes. 

Our unique smart signs and gamification platform enable employers to make their offices visibly healthier and more active without the need for large-scale capital investment. Benefits include:

  • more active and engaged employees
  • rich-data for wellness and CSR reporting
  • health, time and carbon savings 

StepJockey has labelled more than 13,000 staircases in over 100 countries. Clients include large corporates as well as many hospitals and public authorities.

For more information on StepJockey please check out our main business and corporate wellness pages. You will find more on the health benefits of stair climbing here.

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