Since the publication of the UK government’s Working for a healthier tomorrow report just over a decade ago, there has been a growing acceptance that ‘good’ work has a positive impact on an individual’s health and wellbeing, and that healthy and well-motivated employees have an equally positive impact on the productivity and success of their organisation.
Unsurprisingly, this has sparked a rapid expansion of workplace wellbeing providers advertising to employers as purveyors of services capable of ‘improving the health and wellbeing’ of employees. A recent search revealed 41.2 million hits for ‘health and wellbeing at work providers UK’, with a diversity of approaches from established healthcare disciplines including ergonomics, psychology, physiotherapy, exercise and nutrition, and occupational therapy, through to manufacturers of office chairs and providers of ‘relaxation’ and ‘team building’ services.
All promise the employer enhanced productivity and offer testimonials, but overall create a baffling and complex array of options for purchasers as it is unclear whether there is any evidence base for their likely success in achieving improved health and wellbeing, or indeed whether they have the relevant qualifications to deliver such a service.
So just what is health and wellbeing? Originally defined as ‘the absence of disease’, in 1948 the World Health Organization broke new ground when it proposed a definition of health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.
This definition has recently been decried as outdated and possibly even harmful as it might be unattainable for the majority. A modern definition changing the emphasis towards the ability to adapt and self-manage in the face of social, physical and emotional challenges has been proposed. Against this backdrop, it is perhaps unsurprising that it is currently unclear how we should best define health and wellbeing, or measure it, and there is a real challenge for providers to be able to demonstrate they have ‘improved’ this outcome.
Struggling to show that health and wellbeing can be impacted, many providers promise benefits for ‘productivity’. This is also poorly defined and variably used as a term. At the easiest end of the spectrum, it is relatively straightforward to measure a percentage reduction in productivity when an individual’s work involves output per hour that can be readily measured. However, in our service-based economy, it is much harder to accurately measure output – how can reduced productivity be measured for a brain surgeon who has a hand tremor and kills his patient during an operation, compared with a poor performance by the conductor of an orchestra, an A-level English teacher or a wedding photographer?
Most of the existing tools used to measure ‘productivity’ rely on self-assessment by the employee of the percentage to which they think their own performance has been impaired by their health condition. Not surprisingly, these tools have been shown to perform poorly in comparison with each other and with objective measurement of performance.
Given so much uncertainty about measurement of outcomes and establishment of benefit for employers or employees, it could be argued that any wellbeing intervention could be regarded as beneficial. However, is there potential for wellbeing interventions to do harm, particularly if delivered by an amateur without the right training or expertise? Here again there is little evidence, but experiments with ‘participatory ergonomics’ have underlined the importance of the involvement of employees in any intervention designed to impact on them or their work environment.
Is accreditation the answer?
Undoubtedly wellbeing is a rapidly expanding field. Is a system of accreditation needed by which providers should be obliged to provide evidence of successful outcomes, and demonstrate that the benefits are carefully balanced against any risk of harm so the purchasers can more easily understand how best to invest their wellbeing spend?
Should providers have to show that they are properly qualified for the services they deliver and have kept their learning up to date as part of this process? Would this allow the best providers to emerge?
In the meantime, employers should consider carefully what is being offered commercially and involve their employees in any decisions regarding adopting new initiatives.
Jane Abraham is workplace wellbeing associate for C3 Collaborating for Health