Samuelson Key Observations ·...

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Wellness in the Workplace 2.0

10 Key Observations from Thirty-Five Years in the Field

What Got Us Where We Are Today…Won’t Get us Where We Need to be Tomorrow

presented for your intellectually driven consideration, emotionally driven engagement and—most important—your viscerally driven action

Michael H. Samuelson, CI Founding President & CEO

The Health & Wellness Institute Health Promotion & Disease Prevention Analyst

http://www.samuelsonwellness.com/

© 2011, Michael H. Samuelson, All Rights Reserve

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commentary...

Wellness in the Workplace 2.0

10 Key Observations from Thirty-Five Years in the Field

What Got Us Where We Are Today…Won’t Get us Where We Need to be Tomorrow

Introduction:

Okay, for those of you who do not know me or my work here’s a quick bullet bio:

• 12 Year Cancer Survivor & Thrivor • MA Degree in Education from the University of Michigan • Vietnam Era Veteran of the US Air Force • Former Public School Teacher, Counselor, Administrator • Co-Founded the National Center for Health Promotion in the late 1970’s • Founding President & CEO, The Health & Wellness Institute • Retired SVP, Health & Wellness Services, Blue Cross and Blue Shield of RI • Author of 5 Books on Health Promotion & Behavior Change • International Speaker on Leadership, Health Promotion & Cancer Awareness • High Altitude International Mountain Climber and Trekker • Adjunct Professor, University of Rhode Island, Health Management Services • Annual Guest Lecturer, The University of Michigan, Ann Arbor • Married 39 Years with 3 Children and First Grand Baby due in April (Yea!)

I give you this background information to show that the comments that follow are grounded deeply in both personal and professional experience, and not just the product of distant observation, casual research, coffee house debates and focused literature review. I’ve had the academic training, taught the classes, written the books, delivered the keynote addresses, conferred with esteem colleagues, built the health promotion companies and passionately lived the life.

Disclaimer: It is arrogant and presumptuous to suggest that a mere essay on lessons learned and suggestions going forward is anything more, than … well … an essay.

es . say \e-‐sa: an interpretive literary composition usually dealing with its subject from a limited or personal point of


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1st Key Observation…

All Hail the Benevolent Dictator

When Augustus, 1st, Emperor of Rome, wanted roads and aqueducts, the Empire got roads and aqueducts. When Maria Theresa wanted the children of the Austrian Empire educated and the creation of a unified judicial code, the children of Austria were educated and Austria had a unified judicial code (which eliminated the inquisition, burning at the stake and public torture, I might add). When Catherine the Great wanted an end to religious bigotry and recognition of basis rights for women, Russia entered a period of religious tolerance and the role of women was elevated.

Of course, the list of atrocities under each of these rulers would fill several pages also; however, …the point is this.

When you’re in charge, you get to make the rules. CEOs of today’s private companies, like their counterparts ruling ancient Rome and those sitting on the thrones of 18th century European monarchies, get to call the shots. If they want free-fruit Thursdays and a smoke free campus, all they have to do is say so. Of course it is also a fact that if they want chili-dog Tuesdays and junk food vending, they can have that, as well. As long as they conform to the letter of the law (and—in a union shop—provisions agreed to in collective bargaining), corporate rulers get to rule, absolutely.

Here’s the rub, in corporate America, the wellness culture of an organization can all change in a heartbeat. If you have a great boss who BELIEVES in the inherent value of an evidenced-based healthy worksite, INDEPENDENT of strict number-crunching-proof-specific-to-your-company, great. No problem; you’re one of the lucky ones. But what happens when out walks Joan of Art and in walks Attila the Hun, Ivan the Terrible, Bloody Mary or Vlad the Impaler?

Champions are great but unless and until evidence-based health promotion and disease prevention (EBHP) measures are woven into the fabric of your organization—read: written into your policies and procedures manual—your health and wellness program is at the mercy of boardroom circumstance.


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2nd Key Observation…

Think Like a CFO...Show Me the Money! As mentioned in the 1st key observation, health promotion champions who “get it” are great but if your company’s wellness future depends upon the support of one or two senior officers who live the life of wellness (graduates of the Jack LaLanne School of Management)…

YOU ARE IN DEEP TROUBLE WHEN THEY LEAVE

In these challenging economic times, more and more organizations are turning to their CFOs (graduates of the Joe Friday School of Economics) to set a new or corrected course of action. In every bean counter’s closet is a picture of Jack Webb and the flipside of their business card reads:

“ J u s t t h e F a c t s , M a ’ a m … J u s t t h e F a c t s ”

Okay, I realize this comes as a bombshell but CFOs lean (sometimes push and lurch) hard and strong toward the world of tight analytics and concrete facts. God bless ‘em all. We need that approach; the green eyeshade gang protects the fiscal conservative in all of us. HOWEVER, they tend to fall pretty flat when it comes to risk-taking, creativity and innovation. Due to a lack of evidenced-based standards and measurements, “Wellness Programs”—whatever that means—are often last budget items added and first to feel the blade.

Remember, for every Jack or Jacquelyn LaLanne jogging with the troops, there is a Joe or Joanne Friday sitting in a corner office with a sharp #2 pencil and an itchy finger hovering just above the “delete” button on their keyboard.

Learn to think like a CFO!


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3rd Key Observation…

The Other 16 Hours

Of the five sectors that influence objective health and subjective wellbeing (see illustration, above), the worksite—as a primary and singular focus—ranks at the bottom of importance when it comes to lifelong impact. Please understand that rank-order separation is razor thin and I am speaking in relative terms when I say the REAL challenge. When it comes to facilitating and promoting objective health and subjective wellbeing, all sectors are critical and there are challenges regardless of the venue or vehicle. Government policy, worksite culture, school curriculum, home environment and individual choice each present challenges and opportunities. However, when talking about maximizing whole person health, each spoke must work in consort with each other if we are to have significant and meaningful change. The spokes are both independent as well as highly inter-dependant contributors to personal happiness and social contribution. For the purpose of a short essay, I’ll simply refer to “Worksite” as one sector and lump the other four into what I’ll call “The Other 16 Hours.” Longer dissertations on the subject can be found in my past writings. Worksite Health Promotion (Wellness) First, a definition: well·ness, \ˈwel-nəәs\: a dynamic objective and subjective progression toward a state of complete physical, intellectual, emotional, spiritual and social wellbeing and not merely the absence of disease or infirmity. Incremental improvements can occur from pre-conception up to and including a person’s last breath

- msamuelson, the health & wellness institute


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At least, that’s how I defined “wellness” during my tenure as the Founding CEO and President of the Health & Wellness Institute. My guess is that each person reading this essay has their own variation. At any rate, now you know what I mean when I use the word. Using this definition, wellness at the worksite—by extension—is: ...any activity, policy, attitude, and physical plant circumstance that facilitates a person’s progression toward complete physical, intellectual, emotional, spiritual and social wellbeing and not merely the absence of harm. And, yes, I know, COMPLETE actualization is not likely to happen for most of us in this lifetime. It is the continuous progression of incremental (mostly small) improvements that we seek to achieve…and, particularly important to the Joe Friday CFOs, measure. So, how are we doing? Ah, yes how ARE we doing? Short answer: As an industry in toto, nobody really knows. Let me pull some quotes from The Art of Health Promotion publication, January/February 2010, “Best Practices in Evaluating Worksite Health Promotions Programs." If you have read this article, I encourage you to read it again. If you have not read it, read it. In fact, if you don’t subscribe to the American Journal of Health Promotion, I encourage you to do so. It's pretty hard to be in this industry or to intelligently comment on worksite health promotion without keeping up with the research. Here are four important highlights found just on the first page, alone: "Although there is a consensus that program evaluation is a key component of a 'best-practice' approach to designing and implementing employee health programs, it is less clear what constitutes best practice in program evaluation. A recent commentary..." "Not only do purchasers differ in their expectations about what constitutes program success, but researchers also note wide variations in the kinds of results achieved by WHP [worksite health promotion] programs." "Though there are reports of significant increases in employer-sponsored employee health programs, only a small minority of these programs are comprehensive." "What remain missing are commonly accepted standards and definitions that delinete what outcomes these best-practice programs will produce."


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The article defines areas that need measuring in order to determine overall program success. They include: • Engagement • Satisfaction • Health Behavior Change • Biometric Health & Clinical

Impacts

• Population-Level Health Risk Reduction

• Productivity Impact • Health Care Cost Impact • ROI

It goes on to talk about best practice models, programming criteria, expected outcomes, evaluation protocols and, how to use champions, evaluation, and budget placement to sustain (gain) stakeholder support.

Like I said, great article. I strongly encourage you to read it and others like it.

Okay, back to the question: When it comes to worksite wellness programs, how are we doing?

As a former school teacher, let me consider the research:

• overall, it isn’t clear what constitutes best practice in evaluation • purchasers differ in their expectations of what these programs will/should do • researchers note wide variations in wellness program results • lots of people are doing something but most efforts are rudimentary and/or

incomplete • we (as an industry) lack common standards and definitions needed to know

when we have a victory

I’m a pretty easy grader so I’ll give equal weight to both effort and execution.

B-/D = C- The Other 16 Hours (Life Other Than Work)


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I applaud the effort that has gone into worksite health promotion and—at the same time—I am very frustrated by the lack of progress we’ve made over the past 30 years. Certainly, there are exemplary programs throughout the country, usually led by a charismatic leader who “Gets it.” However, the health promotion industry, in general, remains fragmented, stuck in silos, and in danger of making the next 30 years a mirror image of the past, just with newer leadership and better technology. If we simply have fresh minds with new technology doing the same old stuff, well, Einstein’s definition of insanity comes racing to mind. Researchers like Goetzel, Prochaska, and Edington are doing a good job with data and, yes, employers like Volvo, MD Anderson, Healthwise and dozens more (notice I didn’t say hundreds more) are doing a good job of creating pockets of meaningful and replicable outcomes. That said, the wide brush paints a nation whose overall health continues to slip and slide in converse proportion to the dollars we spend. The lack of continuity, comprehension, measurement and standards at the worksite accounts for some of it but a closer look at the other four sectors may give us a clearer picture of why the US is the greatest place on earth to be when you get sick but far down the list when it comes to keeping you well. The US Healthcare Community A quick review: It doesn’t work—our current healthcare system—it doesn’t work. No secret, everyone is talking about it, our current healthcare system, it doesn’t work. Given an annual bite of $2.8 trillion in 2010 on a pace to hit $4.3 trillion by 2012, the U.S. healthcare treatment model is economically unsustainable. People are getting sicker earlier and staying that way longer, productivity at the worksite is down while employer healthcare costs are rising out of control. Teen smoking is creeping back up, obesity is epidemic, and 10 year-old kids are being diagnosed with “adult onset” diabetes. The current healthcare system isn’t just breaking, it’s broken. So, whom do we blame and who’s going to fix it? After all, finger pointing is a national sport, so let the blame begin (continue)! Actually, when judicious identification, removal, and replacement nets positive change, seeking and finding blame is both logical and helpful. In this case, however—our national healthcare crisis—who takes the rap? Who do we kick out? And, whom do we charge with solving the problem: The employers? The pharmaceutical companies? The physicians? The medical centers? The schools, The health insurance companies? The parents? The lawyers? The government? The answer is: Yes! Anyone else? Did you say, “us, all of us?” Well, if the plural is “us,” the singular must be… ME! What? Me? Now, wait a minute, not me! Sorry, but once again we realize that Pogo was right when he said to Porky, “Yep, son, we have met the enemy and he is us.” We did it and now, we (us, I) have to fix it. What did I do? Nothing. And, that’s a big part of why we are now facing a crisis,


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a crisis that demands immediate and, some would argue, radical attention. We, as a nation, do nothing or next to nothing on the prevention side of the wellness/sickness continuum while we continually and consistently support the supply side of the treatment industry. We consciously made and make choices that created, sustain, and grow this $2.8 trillion business. For most Americans, quality healthcare is a given, a birthright, an entitlement program where we are passive participants. For decades we have chosen one role in the healthcare game: To get sick. Fixing and paying? That’s someone else’s problem, someone else’s responsibility, and someone else’s dime. It’s been that way since FDR, through Truman, Eisenhower, Kennedy, Johnson, and so on, right up to today. No more. Why? Easy… no more money. Besides, the current system is busted, broken, it doesn’t work. Don’t believe it? Take a look… Follow the Money: The Cost & Reward of Doing Business Right of Center

Ninety-eight percent of the annual $2.8 trillion (and growing) spent on U.S. healthcare kick-starts and grows dramatically as you move right of center on the above graph. Certainly, everyone vested in the healthcare business espouses the value of keeping and/or driving people left of center toward optimal health (intellectually and morally, how could you not take this position?). The reality, however, is that the status quo—the treatment model—is sustained and advanced due to the enormous power, money and influence held by those who live and work in the treatment world.


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Follow the money and you will find centers of excellence (cancer, diabetes, heart, arthritis, stroke, etc.), treatment-focused research grants, enormous malpractice judgments (and corresponding liability insurance rates), practitioner incentives skewed toward quantity vs. quality, medical device hardware and software, specialty pharmacy and all things curative. Where are the dollars for prevention? Good question. Here are four more good questions: Where are the meaningful government policies that protect all citizens by advancing health literacy? How do you shift the momentum of massive amounts of money, power, and influence to the left on the resource distribution continuum? Where are the parents and how do you get them to create a safe and healthy home and to understand the power they have as role models? Where are the Schools and how do you get them to remove deep-fat fryers, sugar stacked vending machines and to promote student health with the same intensity as math, science and english? Answer these questions and take action! So, when it comes to the other “16 hours,” how ARE we doing? Again, I’m a pretty easy grader so I’ll give equal weight to both effort and execution.

C-/D = D+ This means with the C- for Wellness at the Worksite along with a D+ for wellness outside the worksite I give the US Health Promotion effort a very generous “D+” as an overall grade. You can thank tobacco control efforts for the positive swing bump.

I Give Health Promotion in The US a Very Generous “D+” as an Overall Grade

Okay, I do so with — believe it or not — great optimism! We can push this grade up IF, if, if…we pull our heads out of the sand, learn from the past, avoid gratuitous pats on the back for mediocre results, create meaningful success standards, and get very active in our schools as well as our local, state, and national policy debates.


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4th Key Observation…

The Two Most Important Words in Worksite Wellness Are:

So What?!

The Samuelson Change Model...

Change is a Linear and Sequential Four-Phase Process.

Change! No matter how badly we want it for ourselves or for others, sustainable, meaningful change—continuous incremental benefit to self and others—is a process, not an event.

Change progresses from intellectual, to emotional, to visceral before it become cellular.

~ Intellectual Phase: We are Informed (passive) ~ Emotional Phase: We are Engaged (active) ~ Visceral Phase: We are Moved to Action (active) ~ Cellular Phase: We are the Change (passive)

Or, another way of putting it:

“Until you stir my soul and shake my bones you’ll only have half of my attention, at best.”

Until management experiences “The Great Ah-Ha!,” the answer to the grand, existential question: “SO WHAT?” will remain suspended out in Vaporland, just beyond their grasp. Something left for another day.

Here’s how it works: The Intellectual Phase is where credible data is collected and presented to management in a logical and rationale way.

• “According to JAMA …”

• “The American Journal of Health Promotion reports…”

• “Latest studies published in the New England Journal of Medicine…”


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• “American Dietetics Association recommends…”

• et cetera, et cetera, et cetera…

Information is critical of course—awareness is the first step in the education process— however, global reports sans personal context are nothing more than numbers on a page, sound bites from in a Chamber of Commerce speech. Interesting, but fairly quickly filed away or pushed aside by more immediate pressing needs. The Emotional Phase kicks in when the information strikes a neighborhood cord; something close to home but not actually MY HOME. You have a greater piece of management’s attention but if the news doesn’t directly impact your shop, the boss will quickly defer to the “I’m really very busy right now…someone else will take care of it … and it probably isn’t that bad, anyway” School of Denial.

• “According to WSJ the ________ industry (our industry) continues to suffer as the direct result of healthcare costs…”

• “Industry experts say that beginning Q2, 2014, the cost of healthcare will be double the cost of all other cost employer budget items, combined…”

• “Financial Times reports that the unattended wellness needs of today’s older employees will force the end of pensions for younger employees and place an even higher strain on Medicare, Medicaid and Social Security.

• “The Economist predicts that entitlements and employer mandated health benefits will drive more companies to pursue offshore operations and partnerships resulting in an even tougher job market for American…

____________________________________________

“All pretty scary stuff and I sure hope THEY (whoever THEY are) fix it. Meanwhile, we’ve got a major shipment to get out by Friday so...

let’s get back to work, people.” ____________________________________________

The Visceral Phase kicks you in the teeth and lodges in the belly when the “Boogie Man” smashes through your corporate front door. No more theoretical. No more: “There but for the grace of God… .” No more tomorrows. It is your shop, your health, your money, your family, your job, your life.

NOW you have my full attention.

__________________________________________


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“I’m sorry, what was it you were saying about… and, what do you need? What

action can I take…NOW?”

CEO Memo to All Employees: “Due to expanding costs and shrinking revenue, it is with great sorrow and deep concern that I make the following announcement…”

Months Before the Memo… Wellness Coordinator: “Boss, all the studies show that obesity is on the rise, stress levels are going through the roof, and that the World Health Organization puts the red, white and blue way down on the list of healthiest nations." Boss: “Um, interesting, but, so what? How are those new treadmills working out?” Weeks Before the Memo… Wellness Coordinator: “Boss, obesity leads to joint problems, higher absenteeism, depression, and increased healthcare cost and lower productivity.” And, did you hear, Johnson & Sullivan Company said that their Q4 record loss was directly tied to increased healthcare costs and lost time on the line due to lifestyle-related illness? If these losses continue they expect to close two plants and lay off up to 200 workers. All because of healthcare costs! ” Boss: "Sorry to hear that about J&S. Good folks, but so what? I still see black ink, here. By the way, how much do we pay you?"

Days Before the Memo…

CFO: "Boss, could I have a word with you. Next year’s forecast figures have just been revised and there is a significant problem.”


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Boss: "Yeah, sure; so what’s up? WTF … #&%^#$%+ !!!" _____________________________________________________________

Okay, dramatic but you get the point. When it comes to health and wellness, NEVER present information or make a budget request without first asking and answering the SO WHAT? question. Get to the visceral action stage before it’s too late. Align your information and requests with your company’s business objectives and COME WITH A PLAN…not just with a problem.


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Without an Irritant, There Can Be No Pearl…

Let the Spitting Begin! Let’s be honest. It’s much easier—and certainly safer—to sit back, complain, and wait for others to take action than it is to do something. That is, of course, unless you have passion, commitment, laser determination and God on your side. Well, actually, skip that last one. She’ is on everyone’s side. At least that’s the pitch that supports the military-industrial complex (we should have listened to Ike) and looks nice on all of the banners. Let’s just stick with passion, commitment and laser determination. When these three driving forces are present you can’t sit still, you can’t wait for someone else, and you can’t shut up. You stir and spit, shout and stomp your feet. You seize the torch that has been passed to you and your generation. You are Emperor Napoleon Bonaparte. You take the crown out of the Pope’s hands and you crown yourself. Time is fleeting, daylight is burning, there are causes to advance and worlds to conquer! "Emperor" too much? Okay. How about CI? Chief Irritant. You are the sand that produces the nacre that builds the pearl. So, let someone else sit back, complain, and wait for others to take action...just below the surface there are pearls in-waiting and you are the irritant that makes it all happen. Let the spitting begin! Caution: Sophocles was right, “No one loves the messenger who brings bad news." As I have stated before, there are times when the boon, the prize, the newly found wisdom you bring to “fix things” is rejected. No matter the treasure, it is still disruptive in a world that knows not, or little, of its existence or value. What you may view as “The Answer” may well be viewed by others — particularly those in control — as the newest problem (read: YOU) to be dealt with, swiftly. It’s no fun being spat upon. Trust me, on this one. I’ve been there. I’ve stimulated copious amount of spray, toweled off, and lived to irritate again. Being a CI is not always an easy ride but I like to modestly think—modestly—that along with picking up a few dents in my armor, I’ve also triggered the formation of a few pearls here and there...


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10 Ways to Succeed as a Chief Irritant…Without Really Trying:

1. Fasten Your Armor (you’re going to need it)

2. Pursue Your Need for Popularity Elsewhere

3. If You’re Not the Boss, Find a Champion in the “C” Suite

4. Practice “No-Oblique-Speak”

5. Compromise on Tactics…Not Ethics or Integrity

6. Irritate Without Judgment or Arrogance

7. Beware the Ides of March (et tu ______ )

8. Have a “No Jerks Allowed” Rule…Embrace the Spirituality of Imperfection

9. If you think everyone around you is a jerk…Look in the Mirror

10. Repeat after me, “Spit is Good”


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2001 to 2011: Same 10 Common Concerns

What follows is a small section from a full report I wrote in 2001 on "The State of Health Promotion." I'm sorry to say that 10 years later the same concerns remain.

___________________

This is not meant to be a genie-in-a-bottle, but more to provoke thought and creative team solutions. Participation “We’ve got great programs, dedicated health professionals and supportive management — so why is participation so low?” Unfortunately, the “other guy,” “fate,” and “someday” syndromes are part of human nature. The norm reminds us that until a measurable event occurs — a teachable moment — people deny the need for prevention services. This phenomenon is independent of knowledge and understanding; the cause is emotional. “Yes, I smoke,” goes the story, “but I’m going to quit, soon; honest.” “Of course I’ve put on a few more pounds, but this is the way life is. You gain weight as you get older. One of these days… .” “I don’t drink any more than most people; besides, I can hold my booze, pretty well.” “I know I should get more exercise, but right now, I’m too busy.” The above excuses are all grounded, not in fact, but in desire. The consequences of poor lifestyle choices are all real, however, they are not the person’s reality; not, at least, until there is an event. This, the event; the heart attack, stroke, mental breakdown, divorce papers, child in crisis, bankruptcy, onset of type II diabetes, knee replacement, etc., triggers a marked increase in both motivation and activity. The activity is emotionally driven by fear, pain, and the stark reality that, indeed, it can happen to me. I am, now, “the other guy.” Unfortunately, as the symptoms subside often the newly discovered good health practices seem less urgent and the individual begins to slip back into the world of “should,” and “someday” and the cycle repeats. The bad news is that illness, age, and corresponding disability will increase disease management (DM) activity. However, incidence of disease and the need to manage that disease is not where we want to see growth. We need to foster


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growth on the prevention side of HP. To increase prevention participation, we need to broaden our target market and focus on all the components of optimal health, and, we need to understand the role of staging and readiness to change. Segmentation “Our organization is increasingly diverse. So, with a limited budget, how do we provide programs that are gender specific and accommodate differences in age and culture?” The “Great Melting Pot,” as the United States was called at the dawn of the 20th century, consisted, primarily, of Western Europeans, however, today’s melting pot is truly international. Asia, Latin America, Eastern Europe, and India are the jumping off points for millions of today’s immigrants. In addition to diverse cultures, the workplace often houses up to four different generations of workers; kind of a Pearl Harbor to Pearl Jam mixture of memories, attitudes, and expectations. To be effective, DM/HP programs must respect and reflect the history and sociology of health and lifestyle practices relative to age and culture. The days of cookie-cutter programs are over — or, certainly should be. Before throwing programs and activities at your employees you need to identify an individual’s needs, interests, beliefs, and position in the stage model. In addition to understanding the dynamics of organizational culture and individual change, research shows a direct correlation between desired outcomes and degree of individual tailoring. The more the individual feels that the program is speaking to him or her, the more vested they become in the process. It’s the old story of which news bulletin grabs and holds your attention, more: ▪ Typhoon Strikes the Coast of Japan ▪ Hurricane Bearing Down on the Caribbean ▪ Miami Prepares for “The Storm of the Century” ▪ Funnel Cloud Spotted North of Town: Take Cover, Now! Efficacy “What expectations should we set for our DM/HP programs and how should we measure success?” It is important to remember that change is a process, not an event (more about this, later). Certainly, when it comes to the DM aspect of HP, we can look to specific biometrics as one indicator of success. However, in management as well as prevention, the initial key indicator is participation. Regardless of anything else, programs must promote and reinforce entry and progression through the continuum of change. Any movement along this continuum should


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be measured and viewed as success. By limiting success criteria to bio-metric indicators you not only set your programs up for perceived ROI failure but, also by definition, you limit the breath of your program offering to that small segment of the population who is ready for a specific intervention strategy. In tobacco use, as an example, you miss the 85% of smokers who are not ready to begin a formal intervention program but are primed for more education or need assistance in maintaining their non-smoking status. Which tobacco control program is more successful: one that has 30 out 100 attendees tobacco-free at the end of one year, or a program that moves 600 out 1000 tobacco users from the point of NEVER wanting to quit their habit to thinking seriously about changing in the next 30 days? As with so many options, they both have merit. But keep mind that without the “pipeline” component, you will never have more than a handful of tobacco users ready, willing, and able to walk away from their addiction. A successful (efficacious) process includes a strong feeder component. Recruit, measure, and tout participation at all levels of change — awareness, education, intervention, and maintenance! Reaching Dependents “We know that a considerable percentage of our healthcare costs are incurred by dependents. What can we do in the areas of DM/HP?” Dependents range in age from birth through retirement years. And, at each age, they can cost your organization, time, money, and energy. Any DM/HP process that does not include dependants is fraudulent — not just inadequate — fraudulent. To presume that your DM/HP efforts will have a significant impact on organizational health and dollars without including dependents is misleading and grossly insufficient. Not convinced? Take a look at your prescription drug utilization and your healthcare claims. Because of expanded limited access, I suggest you take advantage of the 24/7 feature of electronic healthcare. By using qualified public domain information and carefully selected e-vendors you can greatly enhance the health and lifestyle of dependent populations. In particular, take a close look at programs specifically designed for teens. Teens are huge medical claims waiting to happen. Short-circuit these costs by targeting their unique needs. Vendor Selection Criteria “We are bombarded with individuals and organizations selling health-related products. How do you sort out the good, bad, and truly ugly?” Twenty years ago, there were a handful of quality programs available through


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national vendors. Choice was not that difficult. Today, with the advent of the Internet and the flood of scientific data, there are hundreds of vendors anxious to for you to buy their services. An upcoming article will deal specifically with this topic. However, for now, keep in mind that a vendor should be much more than a provider of drop-off products and services. They need to be comprehensive, accessible, flexible and experienced. Sound simple? It’s not. Due to limited dollars, you need as much quality one-stop-shopping as possible. You do not have the time, dollars or energy to have multiple contacts for each of your offerings. Find an experienced multi-component provider and stick with them. They will not only help you with paperwork and sanity, they will also help with triage, cross-over, data collection, analysis and strategic planning. Like a good pharmacist, they will also help you avoid unhealthy DP/HP interactions. An excellent provider will have a pattern, philosophy, and support network that is consistent throughout their offerings; this will help you, immensely. A good vendor is, at a minimum, equal to one FTE. Follow-On Programming “Most of our employees have multiple risk factors; what should they do first and how do we help them maintain momentum once they get started?” After some basic data collection, you probably have an idea as what is most important—and therefore, should-be-first—on someone’s list of disease prevention and management needs. So, what? Need is only a part of the decision process. Interest, access, learning style and belief in success are critical factors to consider when beginning a change program. Hypertension, diabetes and high blood pressure may signal weight loss for someone who is morbidly obese. However, if distress is blocking visions of success, maybe a good stress reduction/management program is the way to go, first. On the other hand, maybe someone has recently loss a close friend or relative to lung cancer and their teachable moment has arrived. If finances are in runaway mode, maybe financial responsibility is the first step (yes, this is part of comprehensive DM/HP — check your VISA charges if you doubt this…). There are a number of factors that influence the whens, whats, hows, and whys of DM/HP. The more barriers you can remove and the more control you give to your employee the more likely the individual is to begin a program, stay with it, and springboard their success into other areas of change. Resources “Funds are limited. How do I provide comprehensive services without adequate resources?” Look around. Borrow from other departments. Use the graphics person to help you with a promotion campaign, tap the IT folks to help develop and maintain a


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database, and pick the brain of your VP of sales to help you develop the right pitch. A lament often is heard is, “I can’t do it all!” Of course you can’t and if you try you will fail. The common mistake is to place too much emphasis on acquiring operating dollars and not enough on controlling expenses. Budgeting & Funding “I seem to be on the short-end when it comes time for budget approval. Any ideas?” In brief, it is important that you keep your budget request reasonable, measurable, and tied to the corporate mission. Also, find a champion; someone in senior management who inherently recognizes the full value of a solid DM/HP program. And, most important, the tone, structure, and presentation of your budget request must look and read like any other business unit’s budget. ROI “My boss is a numbers person and wants to know how much everything costs and what kind of return we can expect from our investment.” I’m tempted to make a comment regarding your corporate furniture, wall hangings and landscape but I will resist. Of course, management must believe there is value in what you’re doing and you need to show numbers. The best way to do this is with the data collected from a business similar to yours and refer to it. As shown earlier in this paper, national leaders like Johnson & Johnson and the companies studied in the HERO study (Chevron, Health Trust, Inc., Hoffmann-LaRoche Inc., Marriott Corporation, State of Michigan, and State of Tennessee) have already demonstrated both the costs of high risk employees and the ROI associated with comprehensive DM/HP programs. Refer to authoritative resources such as the American Journal of Health Promotion for detailed studies. Quite honestly, if someone wishes to shoot down any project based upon the inability to pin ROI to the penny, it can easily be done. It usually boils down to the fact that management either believes in an extrapolated data position and in the intuitive logic of DM/HP or they don’t. Costs “Cost is always an issue. How can we deliver quality services and watch our dollars, at the same time? Cost is always an issue and it should be. The good news is that it is a buyers’ market and you do have room to negotiate. Unit price is one way, however, I recommend you use your leverage to expand service more than lower price. As


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mentioned earlier, you should find a vendor who is willing to provide more than drop-off products and services. All vendors should provide an open-line support person who will, in effect, become your staff person, someone who will guide you step by step with the introduction, marketing, delivery, and evaluation of whatever product or service you may purchase. Price is usually fairly fixed, however, service is another matter. Most top-notch vendors appreciate a client who is sincerely focused on using their products to the best of their ability. It makes you both look good. To sweeten the deal, offer to be a reference and an advocate to the vendor’s prospects.


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Wellness for the Ages: From The Beaver to The Bieber

Over the past 25 years, one of the highest demand speeches and workshops I do for corporations is called:

“Pearl Harbor to Pearl Jam”

Wellness for the Ages Certainly, much attention is given to the psychology of change. Unfortunately—my 35+ years of field observation tells me-—the sociology of behavior and behavior change remains shortchanged. This particular talk outlines the importance of avoiding cookie cutter approaches to wellbeing programming and for management to recognize the impact of both generational and cultural differences at the worksite. According to audiences, the presentation is interesting, insightful, amusing and very practical … lots of “AH HA!” moments. The last time I gave this addresses was last Autumn in Newport, RI, for a group of about 60 corporate wellness and HR folks. I’m pleased to say that the talk was well received. However, as I considered the makeup of the audience, it dawned on me that the-times-they-are-a-changing. Well, more to the point, the-bookends-they-are-a-changing. The “Veterans” (Greatest Generation), 1916 -1924, are sadly all but gone from one end of the corporate spectrum and “Generation Y” (Millennials), 1981 - 1997, are about to share the stage with “Generation Z” (The Internet Generation), 1998 - 2010. With a tip of my hat to Steve Cook from the Health & Wellness Institute (it was his suggestion), the talk remains basically the same but it now reflects a significant tick of the clock. Going forth, the talk and workshop is called:

“The Beaver to The Bieber”

Wellness for the Ages multiple generations at work… Tom Brokaw’s favorite cohort is now part of the background story as they join the Ellis Island Generation that came ashore at the turn of the 20th century. Although no longer part of today’s active workforce, the influence of these two generations MUST be considered and understood if we are to maximize the


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exponential power of our multi-generational human resources. When designing wellbeing programs and policies it helps if you have a basic grasp of what rings real for each generation: Events, Themes, Relationships, Rewards & Motivation: What occurred on the world stage that helped form each generation’s psyche? What do they look for in a relationship and how are they motivated?


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So, how about the Silent Generation (1925 – 1945)? Most of these Korean War Era Americans are retired but many sit on boards, own stock and still influence the worksite. Do you know what moves their needle and what shaped their dreams? And, how about those Generation X, Y & Z folks? Do you really know their likes and dislikes? If you think all of your employees think alike, dance to the same music, and march to the same drummer, just ask a Baby Boomer to explain the poetry of rap and ask a Net Gen member to list their three favorite doo-wop groups and tell you “Who Wrote the Book of Love?” multiple cultures at work…

“From Anthony and Rachel to Juan and Mei-Lien”

Wellness for Everyone Of course, it’s not just generational but also heritage, custom and culture that needs your attention. In 1907—the year of the highest number of immigrants—over 1,000,000 adventurers were processed at Ellis Island. Here are the top ethnicities of immigrants who passed through Ellis Island between 1899 – 1937: In addition to those Americans whose ancestors came here via the horrors of slavery or those who identify themselves as Native Americans, the majority of you reading this posting can trace your roots back to western, central and eastern Europe. The world I was born into in the 40’s and where I was raised in the 50’s was directly and indirectly influenced by this “Melting Pot” of heritage and culture. But what about today’s new influences on culture, interests, and attitudes? Where are they coming from? Here are the top countries of origin of the US foreign-born population as recorded in 2007:

Sources: US Bureau of the Census


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Question:

At your worksite, are you taking care of The Beaver & are you ready for The Bieber?

How about

Anthony & Rachel…Juan & Mei-Lien?


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Learn the Ways of the Sherpa

“Our actual ultimate root is in our common humanity

…not our personal genealogy.”

- Joseph Campbell

Disclaimer: While I did the normal kind of hiking as a kid and a little bit more when I was stationed with US Air Force in Alaska in the 60s, I still consider myself a novice when it comes to high altitude trekking and climbing. That said, I am certified in technical climbing by the Alaska Mountain Guides and Climbing School in Haines (photo above taken during training on 2000), I’ve trekked to the Mt. Everest Basecamp and the Summit of Mt. Kalapathar in Nepal in 2001, and reached the summit of Mt. Kilimanjaro via the Machame route in 2006. Currently I’m in training for a South American Andes trek this summer to Machu Picchu taking the Salkantay Mountain route with the great folks from International Mountain Guides (IMG). I’ve also done training hikes in Colorado and a couple up-and-downs on the misleadingly rugged Mt. Washington in New Hampshire.


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Why Climb Mountains?

Very nice, Giusto, beautifully said… Yes, all that he said (perhaps not the pipe smoking part…) and more. One of the “and more” things for me are the leadership lessons that I observe each time I head off with a mountain guide. Whether it’s a leisurely hike to 15,000’ on the Missouri Lakes Trail overlooking Beaver Creek, navigating a whiteout on the Davidson Glacier in Alaska, communing with yaks in the High Kumbu of Nepal, or crossing the Baranco Wall to the Karanga Valley in Tanzania, I pay close attention to the head guy…the leader…the boss…the guide…The Sherpa. And, yes, the true “Sherpa” is a member of an ethnic group that hails from the high mountains of Nepal—I had the pleasure of trusting in and learning from Ang Nima Sherpa while on the Mt. Everest adventure—but, for the purpose of this essay, I will refer to all guides as sherpas. Also, I’m going to pick Africa for this posting but the principals of leadership and the lessons learned apply to all of my trekking adventures. Diversity and Sherpa Leadership


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“Machame, also known as the “Whisky Route, —no doubt in order to set it apart from the “Coca Cola” Marangu route—is an option not for the soft-core [trekker]…”

- Mt. Kilimanjaro Travel Guide


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Riddle: Defying the odds, how do you get ALL twelve men and women ranging in age from 16 to 61, from diverse socio-economic-political-occupational-geographic backgrounds, to travel to Africa, trek to the 19,341’ summit of the highest free standing mountain in the world (that last foot is a killer) and—most important-—all return home safely to hike, trek and climb again? Answer: Sherpa Leadership A good sherpa is agnostic when it comes to diversity. His leadership skills and success are not influenced by your religion, ethnicity, country of origin, occupation, age or gender. He doesn’t care…and neither does the mountain. The sherpa does care about the mission, your commitment, training, endurance, flexibility, whole-person health, integrity, humanity, humility, team spirit, heart, guts and soul. He is a blind integrator of cultural backgrounds and beliefs and the ultimate discriminator of ability, drive and determination. The mountain doesn’t care about any of this. Contrary to popular myths, mountains are not moved by your goals, aspirations, hopes, past history, future dreams, hardships, talents, money or even your integrity or humanity. So, when you are heading off to the mountains (wherever they may be) put your trust in leadership…not, the mountain. One cares, the other simply is…


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The Good Sherpa has…

▪ experience ▪ verbal and nonverbal skills ▪ love of people

▪ training ▪ assessment knowledge ▪ superior network

▪ goal setting skills ▪ 6th sense ▪ knows when to carry your pack and when to give it back

▪ passion for the journey love of nature


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The Good Sherpa values…

▪ client wellbeing 1st, last & forever ▪ client’s expressed goals ▪ strategic team selection

▪ impeccable field support ▪ the “no jerks allowed” rule ▪ direct, clear communication (no oblique speak)

▪ the principal of “accept, respect & secure” ▪ the power of the possible ▪ mountains not caring

▪ the reality that ego & hubris kill people ▪ the power of the spirit and weakness of the flesh ▪ the fact that form always follows function

▪ the fact that basecamp is for discussion…the path is for following directions ▪ on the mountain there is no room for metaphor, ambiguity or hyperbole ▪ metrics

▪ an emerging strategies approach ▪ a life of healthy uncertainty


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Howard Beale Isn’t the Crazy One and Mr. Spock is Dangerous

Where's Howard?


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You know Howard. He’s the “I’m not going to take it anymore!” guy, the oh-so-angry, fictitious news commentator from Paddy Chayefsky’s award winning movie, Network (1976).

_______________________

“I don’t need to tell you things are bad…everybody knows that things are bad.

It’s a depression. Everybody’s outa work, or scared of losing their jobs…the

dollar buys a nickel’s worth…banks are going bust…shopkeepers keep a gun

under the counter… punks are running wild in the street, there’s nobody

anywhere who knows what to do and there seems to be no end to it!

…we know the air is unfit to breathe, and our food is unfit to eat…we sit watching

our TVs while some local newscaster tells us that today we had 15 homicides

and 63 violent crimes as if that’s the way it’s supposed to be!

We know things are bad! Worse that bad! They’re crazy, it’s like everything

everywhere is going crazy so we don’t go out anymore! We sit in the house and

slowly the world we live in is getting smaller and all we say is “Please! At least

leave us alone in our living rooms, let me have my toaster and my TV and my

steel-belted radials and I won’t say anything. Just leave me alone!”

Well I’m not going to leave you alone.

I want you to get mad!

I don’t want you to protest and I don’t want you to riot. I don’t want you to write to

your congressman because I wouldn’t know what to tell you to write. I don’t

know about the depression and the inflation and the Russians and the crime in

the street.

All I know is that FIRST – you’ve got to get mad! You’ve gotta say ‘I’m a human

being, God damn it! My life has value!’

So, I want you to get up now…

I want all of you to get up out of your chairs…


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I want you to get up right now and go to the window, open it, and stick your head

out and yell: ‘ I’m mad as hell, and I’m not going to take this anymore!’

I want you to get up right now. Sit up, go to your windows, open them and stick

your head out and yell ‘I’m as mad as hell and I’m not going to take this

anymore!’ Things have got to change! Friends; you’ve got to get mad! Then,

we’ll figure out what to do about the depression and inflation and the oil crisis…

First, get out of your chairs, sit up out of your chair, go to your window, stick your

head out say it:

‘I’m mad as hell and I’m not going to take it anymore!’

____________________________________

You go, Howard! Tell ‘em like it is!

This year marks the 35th anniversary of Network. Co-incidentally this is also my 35th year as a health and wellness professional. It’s amazing (somewhat disheartening) that—other than objects of distraction—Paddy could have tapped out those words this morning.

Those of you who know my work know that I view the process of change as a linear, sequential process: intellectual (information), emotional (engagement), visceral (call to action) and cellular (habit formation). The KEY stage is the visceral stage. Or, as Howard would say, the “I’m mad as hell and I’m not going to take it anymore!” stage.

Sustainable change does not occur

until your soul awakens and your bones start shaken.

During all of my years in the field, I’ve seen tons of data and periodic bursts of emotion but VERY little soul-awakening, bone-shaking action. And, as for sustained change — please — don’t make go get Howard…he’s still really ticked. The question is WHY? Why do we not see, feel, and believe that the health platform is truly burning? Why can’t we hear the crackle…why can’t we smell the acrid smoke? Is Howard right? Do you really think this (the health of our nation…our children) is the way it’s supposed to be? Or, perhaps he is right and you simply want to be left alone with your TV, toaster and steel belted radials.


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Mr. Spock is Dangerous I just participated in my umpteenth health promotion conference; many of the same faces, many of the same PowerPoint slides … more studies coming soon. Yes, Yes, YES! Research is important but it’s time to shift more of the science of life research to art of living research. Facts without context are meaningless.

Until we can answer the corporate and personal “So What?” question…the “Why Should I Care?” question…we will remain trapped in this endless cycle of information and transient emotion. Until we objectively tee-up the AH-Ha moment that subjectively awakens souls and shakes bones we are in danger of doing more harm than good.

We don’t need any more tinder wood…We need sparks!

Excuse me; I have to stop now. It’s time for some fresh air.


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Don't Confuse Connectivity with Intimacy

Stop for a second and consider the possibility that

the more touch-points we have…the less in-touch we’ve become.

The other day, I heard a TV reporter ask a 20-something woman how often she talked on the phone. Her response was, “Almost never.” She, like most of those under forty, prefers texting to actual phone calling. Her response as to why she texts: “I find that texting allows me to avoid the awkwardness that comes with actual interaction.”

No, seriously, that’s what she said. As for the reporter, not an eyebrow was raised or a follow-up question was asked.

“…allows me to avoid the awkwardness that comes with actual interaction.”

Is it just my white hair that finds this alarming or are there others of you out there that are just a little creeped out by her answer? Yes, I understand the value of texting and instant messaging and I realize that the sheer numbers of contacts and connections has increased significantly. This part is all good. The creepy part is that—knowingly or not—I think she nailed it.

Have we exchanged intimacy and actual interaction for expediency and ease?

As for the full spectrum world of technology, it’s been said that computers like IBM’s “Watson” will never totally replace humans because they cannot convey the subtly and nuance often used to deliver the true meaning behind our messages. All of us have dozens of shades of smiles, frowns, voice inflections, intonations, body postures, eye shifts, lifts and squints that add color, texture and clarity to our interactions.


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As a university lecturer, mentor and trainer of hundreds of health promotion professionals I always stress the importance of crystal clear communication. The order of preference for personal communication is:

▪ Actual Face-to-Face

▪ Electronic Face-to-Face (FaceTime, Skype)

▪ Audio (formally known as telephone)

▪ Video Message

▪ Audio Message

▪ Descriptive Personal Email

▪ Text Messages (Think 140 Characters or Less)

Wait, before anyone calls me old — “chronologically superior” — or out of touch (that would be ironic), let me again praise technology and its value in wellness, health promotion and daily living, in general. I love it for peer support, reminders, data uploads, medical monitoring, rallying action, spreading information, quick hellos, and growing social networks. It truly is remarkable and we’ve just scratched the surface. Hot damn, hallelujah and bring it on! My kids have the best hand-me-downs you can imagine. At this very moment my daughter is anxiously waiting for me to pick up my new iPad2 so she can have my “old” iPad1.

But please, please, please, along with high tech, keep fostering and building high touch. I thoroughly enjoyed watching the computer kick butt on Jeopardy but it’s hard to imagine “Dinner with Watson” coming to a theater near you. Also, all the emoticons in world can’t replace a hug, a knowing look or an actual smiley face from a real little kid. I don’t find interactions with them awkward, at all.

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