SPEECH TO THE GREATER HOUSTON BUSINESS GROUP ON HEALTH

APRIL 16, 2019

Slides for the Speech to the Greater Houston Business Group on Health

I am honored to address you today.  I particularly want to thank Chris Skisak.  My subject is how CEOs should create “cultures of health” in their organizations.  

The first slide is from a 2016 Global Wellness Institute study, and it succinctly captures this speech’s theme:  CEOs can either create a virtuous cycle through a supportive culture that produces great health, which reinforces that culture, or a vicious cycle of poor management that leads to poor health, which causes organizational results to deteriorate.     (Slide 2)

Dr. Ray Fabius, from whom you will hear more later, has created a portfolio of public companies with strong cultures of health.  He tracked their performance over a multi-year period.  This 40-company portfolio has significantly outperformed the S&P 500 index over that time.

Most CEOs understand their talent’s value.  They focus heavily on recruitment, retention, development, and loyalty.  What’s missing is sufficient focus on employee health and well-being.

Great coaches and managers understand that great athletes unable to play because of illness or injury are of no value.  Injured or ill athletes not at full strength are of far less value. They make sure athletes are ready to play at full capacity.

Illnesses or injuries that cause excessive absences cause all organizations to function at sub-optimal capacity, and for large self-insured employers, health benefit costs can make an otherwise profitable business unprofitable, or, at a minimum, significantly reduce profit margins.

CEOs treat employee health and wellbeing and healthcare cost containment as separable issues.  They are not.  Moreover, they delegate health management to HR and Benefits staff members, outside benefits consultants and third-party administrators because they fail to understand that what they do matters far more. 

I will describe what matters most to employee health and well-being and what CEOs need to be doing differently to maximize employee health, well-being, productivity, development, work quality, and loyalty.  I will describe very different key performance indicators and actions than what CEOs are customarily presented by consultants and benefits administrators.

No successful organization-wide program succeeds when fully delegated to staff functions.  Enterprise software programs routinely failed in their early days because CEOs delegated them to IT.  They only succeeded when embraced as organization-wide imperatives led by CEO-empowered operations officers.  “Cultures of health” must work the same way.

Social determinants of health

There has been a great deal of research on “the social determinants of health.”  Worldwide thought leaders, such as Sir Michael Marmot, who did ground-breaking research with the British Civil Service, and Dr. Tony Iton of the California Endowment, concluded that 80-90% of what determines someone’s health happens outside the healthcare system.

The Robert Wood Johnson Foundation has sponsored research which demonstrates the biggest single factor in both life expectancy and health is where someone lives.  For example, residents of the Trinity Garden neighborhood in Harris County have a life expectancy at birth of 66 years, whereas residents of Clear Lake, 35 minutes away, have a life expectancy of 89 years. 

https://www.rwjf.org/en/library/interactives/whereyouliveaffectshowlongyoulive.html

CEOs cannot directly change where people live, although many employers have done a better job figuring out how they could change the health-related risks of a community.  I am proud that, at Pitney Bowes, we made measurable improvement in the neighborhoods in which our employees resided.  In the South End of Stamford, we helped the City clean up blight and supported real estate developers who had a vision consistent with community well-being.

Commuting stress

Organizations treat commuting as a problem for which each employee has responsibility.  However, CEOs who want the most productive, happy, healthy employee will look at commuting differently.

Author Carolyn Beaton summarizes research that demonstrates that employers can reduce the stress of commuting in several ways.

https://www.theladders.com/career-advice/the-long-commute-how-long-is-too-long-and-why

Arrival and departure time flexibility enables employees to use public transportation, which, in turn, makes commuting time more productive and less stressful.  Making shower and locker room facilities available increases the attractiveness of biking and walking as commuting options.  Providing commuter benefits to employees to make public transportation or micro-transit options like Uber more financially attractive also reduces the financial stress from commuting. 

Why is this important?  Many studies around the world, the largest of which was conducted in the UK, found the following:

“The study, led by the University of Cambridge, RAND Europe, Mercer, and Vitality Health, …. examined over 34,000 British employees across all industries. Researchers found that workers with longer commutes were 33% more likely to suffer from depression, 40% more likely to have financial worries, and 12% more likely to report issues due to work-related stress. Stemming from this high-stress lifestyle, these workers were also 21% more likely to be obese and also more likely to get less than seven hours of sleep each night.”

https://www.businessinsider.com/long-commutes-have-an-impact-on-health-and-productivity-2017-5

The second data point of which CEOs should be aware is the length, variability, and stress level associated with commuting.  Carolyn Kylstra of Women’s Health Magazine cataloged what stressful commuting does to your body:  rises in blood sugar, cholesterol, depression, anxiety, blood pressure and a decline in fitness. 

Each job category carries health risks with it.  CEOs need to focus on reducing the health risks embedded in each type of job.

Almost every job carries some kind of health risks.  Some job categories have more obvious risks.   In a listing of 47 job categories, these were attributes of both physiological and psychological risk.   Some job categories have more obvious ones. Truck drivers sit too long and experience excessive exertion from operating their vehicles, and they are often away from the comfortable routines of home.

(See Slides 3 and 4)

Those responsible for public transportation vehicles, deliveries, pick-ups or on-call service assignments also have added stress if their jobs require rigid adherence to difficult schedules.  A 2011 study of San Francisco municipal trolley operators showed that the job requirements to which these drivers were subjected added significant stress and health issues to their jobs. 

https://unhealthywork.org/threat-avoidant-vigilance/a-day-in-the-life-of-a-san-francisco-municipal-trolley-car-driver/

Customer care center operators fielding customer complaints have jobs with built-in stress.  Their jobs get even more stressful if they are not equipped to solve problems, or if caller waiting times are too long.

Healthcare professionals have inherently risky jobs.  They interact with unhealthy and often heavily overweight patients.  Giving them assistive technologies reduces their wear-and-tear, as does improving staffing levels to create less time-sensitive stress on them.

Retail workers stand all day, which is bad for their backs and legs.  Having floor padding or giving them opportunities to sit periodically will reduce wear-and-tear. 

A regular part of the CEO’s job should be to reduce the health risks of the largest chunks of their employee population.  At Pitney Bowes, one chronic health and business issue arose because several thousand customer service technicians had assigned territories in which they were responsible for service calls, equipment deliveries and pick-ups.  We made their jobs more stressful by assigning targets for the number of calls we expected them to complete.

As traffic congestion increased, they spent more time in automobiles.  Their performance and health suffered.  We responded.  First, we eliminated territories and dispatched them to whatever call was closest to where they were, which reduced driving time by almost two hours a day.  Second, we outsourced equipment deliveries and pick-ups to firms better equipped to handle them.  Productivity improved, as did the health of our customer service technicians.

Third, we also reduced their workloads by helping customers solve more problems over the telephone, which gave technicians more time to work at their in-person calls.

Every organization should look at the predominant job categories and should have specific plans for reducing health risks inherent on those jobs.

Employers should focus on those people, processes and practices that add unnecessary stress.

CEOs often review the results of employee engagement surveys, but may not realize that low scores on survey questions are leading indicators of future health problems, especially in jobs that are already high-risk and high-stress.  Although this Gallup study is 4 years old, its findings are still valid today.

https://news.gallup.com/poll/187865/engaged-employees-less-likely-health-problems.aspx

The mental health numbers are comparable.

“Overall, 52% of employees say their work lives positively affect their psychological well-being, 21% feel the effect is negative, and 27% say there is no effect….  Conversely, just over half (51%) of actively disengaged employees feel their work lives are having a negative effect on their psychological well-being, compared to ….just 6% of engaged workers.”

TalentMap surveyed employees to discern what mattered most for employee engagement.  Wellness programs were nowhere near the top of the list. 

Professional growth and development drives engagement.  Organizational vision drives engagement. Leadership drives engagement. Innovation drives engagement. But dimensions that include a wellness program, the work environment, safetywork-life balance – those do not tend to be drivers of engagement. They tend to be taken for granted as nice to haves.  … the jury is still out regarding wellness programs alone directly improving employee engagement.”

https://www.talentmap.com/workplace-health-wellness/

25 years ago, an outside firm studied a Pitney Bowes customer care center with low customer satisfaction and high healthcare costs. 

Our center was understaffed and had inadequately trained employees.  The firm described it as having a “high burnout” rate.  Low scores in response to the following standard question “Do you have the tools to do your job?” are likely burnout indicators or predictors.

Negative survey answers to any of these questions highly predict future health problems:

Stressful environments lead to behavioral health and other chronic disease problems.  CEOs need to focus particularly on jobs which already have high health risk associated with them, and identify key performance indicators and actions items to address them.  There are both organizational performance and health benefits in doing so.

CEOs need to address other customs, processes and practices adding unnecessary population health risks.

Unhealthy food and beverage offerings

What employees eat and drink while at work significantly affects their health.  We closely managed the food available at our cafeterias, meeting sites, vending machines, and outside conferences.  We also discouraged evening meals with customers, vendors and partners at outside restaurants, because we could better control food and alcohol consumption if we hosted the meals.

At our conferences, focus on alcohol control also yielded another benefit: fewer sexual harassment claims and recreational activity injuries.

Excessive sitting

Dr. James Levine, a Mayo Clinic practitioners, has said that “sitting is the new smoking.”

https://www.startstanding.org/sitting-new-smoking/#

Ryan Fiorenzi of Startstanding.org has cited this statement from Dr. Levine:

“Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death."

Fiorenzi summarizes research demonstrating that excessive sitting (averaging more than 4 hours a day) increases the risks of obesity, Type 2 diabetes, back, neck and sciatica pain, cancer, and cardiovascular disease.

Slide 7 illustrates the cumulative effects of excessive sitting on different parts of the body.

We redesigned facilities to encourage more walking and less sitting and standing.  We also supported outside charitable walking and running events because we wanted people to engage in healthy physical activity. Because we understood the environmental impacts on physical activity, we supported public transportation, land-use changes that created more walkable neighborhoods, and public safety improvements.

Companies can now track the frequency and duration of meetings.  CEOs should be actively looking to reduce the frequency and duration of meetings and to force break times.  As a consensus-driven culture, Pitney Bowes used meetings to make decisions, but caused everyone to sit too long and to eat too much.

“Always on” email and text messaging practices

A 2017 Forbes article pointed out that uncontrolled email usage has many negative organizational consequences. 

https://www.forbes.com/sites/johnrampton/2017/09/27/10-reasons-your-late-night-emails-are-destroying-your-business/#111d01ad27c3

Too much after-hours email reduces productivity, interrupts sleep and recharging time, and costs organizations extra server capacity.  It distracts people from the work they should be doing.

Joan Amble, formerly American Express’ principal accounting officer,  required employees who wanted to send emails between 8 pm and 6 am on weekdays or on weekends, holidays, or vacations to get high-level approval, which was seldom granted.

Sylvia Ann Hewlett, the President for the Center for Talent Innovation, recently noted that “the number of high-echelon workers experiencing stress has more than doubled in the last 12 months, rising from 33% to 78%. Symptoms range from "crashing" at the end of the day (70% vs. 43% six months earlier) to an "emptied out" sex life (37% vs. 30%).” 

https://www.forbes.com/sites/sylviaannhewlett/#30f2ad4c3397

Late night emails also disrupt sleep, as a 2016 study reported in Men’s Health magazine pointed out.

https://www.menshealth.com/uk/health/a749614/late-night-phone-use-stops-you-sleeping/

A 2016 study by the London-based Future Work Center describes sending and receiving emails all day and evening as being toxic.

https://www.telegraph.co.uk/news/2016/03/22/psychologists-warn-constant-email-notifications-are-toxic-source/

CEOs may not think of controlling or managing evening and weekend emails as health promotion tools, but when sleep is interrupted, all sorts of negative health consequences occur, particularly in increased chronic disease incidence.

Two surprisingly significant health-related metrics

When CEOs are given lengthy healthcare cost reports from benefits consulting firms or 3rd party administrators, a long list of programmatic recommendations often accompany them. 

The power of data should be harnessed for better self-insured employer health management, but we often focus on less useful data.

Opportunity #1: Having a primary care physician

As Dr. Fabius has taught me, one of the highest impact actions organizations can take relative to healthcare is to ensure that all employees have strong relationships with primary care physicians, especially one that meets the requirements of patient-centered medical homes.  Those without such relationships, who wander into the least efficient and most expensive parts of the healthcare system, the emergency departments, or directly to specialists with a fragmentary knowledge of the patient, are “medically homeless.” Authorities as diverse as the Mayo Clinic, the Cleveland Clinic, and Dr. Atul Gawande, have agreed on the importance of primary care provider relationships.  I am a Board member for the Community e-Health Consult Network, which enables primary care providers to manage specialist relationships more tightly through secure email communications.

The Cleveland Clinic describes the benefits of having a dedicated primary care provider this way.

“…..people who have a primary care doctor do better in managing chronic diseases, spend less time in the hospital and less time away from work, and are more satisfied with their care.”

https://my.clevelandclinic.org/health/articles/16507-the-importance-of-having-a-primary-care-doctor

Opportunity #2: Aggregating data and proactively diagnosing and treating behavioral health problems.

Behavioral health issues are the biggest hidden opportunity for both health and business performance improvement.  According to AiR Care Health Solutions, a behavioral health services provider, over half of all employee behavioral health problems go undiagnosed and untreated.

There are two reasons for this: (i) most organizations make counseling services available, but they are reactive in reaching out to employees; (ii) the data that would help expert service providers identify untreated behavioral health problems does not reside in a single place.

Undiagnosed behavioral health problems often do not show up in medical claims or pharmaceutical databases.  These are useful data points, but only when combined with absenteeism, work performance, and employee engagement data.  This data, in combination, is often needed to identify an untreated problem.

Service providers need to reach out proactively to identify previously undiagnosed behavioral health problems.  Once that happens, the physiological issues that have caused medical and pharmaceutical claims often disappear.  CEOs need to make it clear that individuals should engage actively with seasoned behavioral health professionals. 

They also need to ensure that their organizations are proactive, not reactive.  When an airline pilot committed suicide by crashing an airplane, which happened with a GermanWings flight in 2015, that was an obviously unaddressed behavioral health problem.  However, many more mundane workplace accidents result from the behavioral health effects of stress, as a 2016 article in Safety and Health Magazine details.  If an organization attacks the sources of stress successfully, there is an economic return in workplace performance and safety.

https://www.safetyandhealthmagazine.com/articles/14300-stress-and-worker-safety

The CEO has to create a “culture of health” throughout the organization.

We know that CEO cannot be the only champions for employee health and well-being.  How do CEOs create cultures of health in organizations?  There are many paths to creating the culture of health, beginning with the use of the key performance indicators I have identified.  However, to make “cultures of health” stick in organizations, the CEO has to embed whatever performance metrics he or she chooses deeply into organizations’ leadership infrastructures. 

Dr. Fabius uses a “culture of health” checklist which includes:

Others will inevitably manage these items, although CEOs need to hold someone accountable.  Most important to CEOs are the first two items: is the company’s Board of Directors and are members of senior management focused continually on the “culture of health” in that organization? 

As Slide 9 indicates, there are many data points on which CEOs and other members of senior management should be focused.  The least important of them are claims and pharmacy data.  (Slide 9)

I have been on the Eaton Corporation Board of Directors for over 20 years, and was the Chairman or CEO of Pitney Bowes for 12 years.  Both organizations cared deeply about employee well-being.  Eaton routinely reports on important organizational safety metrics every time management and the Board come together.  What gets measured and reported gets managed! 

Final observation

It should be a “no brainer” for CEOs to focus on employee health and well-being.  It is not a major investment of CEO time, but a highly valuable one. 

As a former CEO, I often thought about many of our financial reporting processes like the story of the man looking for his lost car keys under a lamppost.  When asked whether he had lost them there, he said no.  When asked why he was looking there, he answered: “That’s where the light is.” 

We should look for the keys to health where they are likely to be found, not where we can most easily, but fruitlessly, search for them.  Success is to be measured by having a healthy, high-performance organization with low healthcare, disability and workers compensation costs, and low absenteeism. 

Thank you for your interest and attention!