Abstract
Recent data on our progress in workplace-based health promotion should keep us grounded as we consider whether we are on track to planned destinations. One recent survey suggests employees view worksite wellness as a valuable employee benefit but another survey suggests employees are dissatisfied with their employers’ wellness offerings. What explains these differences? Is the program driven by a plan? Is the plan relevant to the company’s priorities? Was the plan developed using participatory planning principles?” A participant centered health promotion initiative means deciding a destination and planning how to get there alongside those you aspire to serve. This approach is far more likely to lead to alternative routes and, often, untested sources of data for finding the way. The urgent opportunity for workplace-based program planners is that of strategic planning that is guided by a continuous review of credible metrics such as those offered in best practices scorecards.
My hiking buddy Jeff Schnobrich and I chose spring as the best time to take on the challenge of a through hike of Minnesota's 270-mile Superior Hiking Trail. The cooler days of May and fewer biting bugs were a prime motivation but the upside I did not anticipate was the everyday intimacy of experiencing spring up close. I called this month-long journey my “pilgrimage to the present” with a goal of living in the moment and assessing whether I could quiet a mind that tends to live too many months ahead of each day. From tiny green buds enlivening muddy brown trails to sweeping red and orange blooms awakening gray forest canopies, when such vibrant change was afoot it was easy to be present. But hiking all day also meant sameness set in and it was during those hours that Schnobrich and I got lost. Not only did we lose touch with the wonders of each moment but not paying attention to here and now meant we literally lost our way. Getting lost seems quaint and serendipitous if you are strolling through Amsterdam or Zanzibar. You get a coffee, chat with some locals, and meander your way back. Leisure travel reinforces the notion that “it’s the journey, not the destination.” But with 45 pounds strapped on, getting lost for hours on gnarly, steep trails is anything but charming. In through-hiking, when you have distance goals to make and supporters you are accountable to, arriving at your destination is paramount.
The health promotion profession abounds with rich moments and attaining and maintaining excellence as a discipline means we can’t let sameness set in. The audacious promise of the health promotion field is that we can affect positive health improvement at the population level. As if supporting positive changes at the individual level weren’t challenging enough, fostering well-being for organizations and communities means working in concert with cultures that are forever sprouting into something new. When change is a constant, looking for signs that you are on course or getting lost involves more than occasionally reviewing data related to a plan. As often as not, plans need to change and reviewing markers of progress in a quality improvement context is, by definition, a continuous process.
It was only a few days into the Superior Trail when, exhausted and exasperated, Schnobrich said, “How is it that two guys with advanced degrees and years of hiking experience keep getting lost?” Schnobrich’s trail name is “The Burro” in honor of his boundless stamina. Although getting lost made us feel like, yes, wild asses, it remains that the Latin root for being humbled is being “grounded.” Or, as my Dad would say, “Experience isn’t the best teacher but it is the most thorough.” So as humiliating as it felt to be lugging heavy backpacks on unforeseen detours, staying grounded and humble is also the reason the wild African Burro has been revered as an indefatigable beast of burden for the past 5000 years. To be sure, losing our way offered lasting lessons about the foibles of ostensibly credible sources of data. Maps are accurate until they’re not after loggers decimate wide swaths of trail. GPS pinpoints you precisely but worthlessly if not synched to a visibly accessible trail.
Recent data on our progress in workplace-based health promotion should also keep us grounded as we consider whether we’re on track to planned destinations. As companies have increased their investments in employee health promotion, their motivations for doing so continue to evolve. 1 One recent survey of 2320 consumers suggests employees view worksite wellness as a valuable employee benefit. It is a “good business investment” according to 47% of employees and 43% reported that wellness programs made them “feel better about the company.” 2 On the other hand, another survey indicates more than 60% are dissatisfied with their employers’ wellness offerings. 3 What explains these differences? Is the program driven by a plan? Is the plan relevant to the company’s priorities? Was the plan developed using participatory planning principles?”
Many of us formally trained in health education are steeped in concepts from Green and Kreuter’s PRECEDE/PROCEED planning model which offers a comprehensive approach to setting and achieving a destination in health promotion. 4 I’ve long characterized the framework, 40 years in use now, as both brilliant and prescient given how it anticipated the health promotion profession’s ongoing struggle to fairly balance individual and social responsibility for health. A new edition of this book is in progress and I’m proud to have been invited by the cooriginator of the model, Dr Lawrence Green, to contribute a chapter on applications of the model in occupational settings. I’ll keep readers of this Journal posted on the book’s release date.
In speaking with Shelly Wolff, a consultant involved with the survey that uncovered employee dissatisfaction with wellness, I was reminded of the interesting overlaps between the PRECEDE/PROCEED framework and the Kaizen/Lean production quality improvement principles that I have written about on these pages. 5 Involving key stakeholders is a tenet of both approaches but such is too often given short shrift by program planners and leaders who simply follow a well-trodden path. In contrast, a participant-centered health promotion initiative means deciding a destination and planning how to get there alongside those you aspire to serve. This approach is far more likely to lead to alternative routes and, often, untested sources of data for finding the way. Wolff addresses this challenge succinctly: “Employers that listen to their employees and formulate strategies that take their needs into account will have the most success redesigning existing programs and introducing new ones.” 6 The urgent opportunity for workplace-based program planners that I describe in the next edition of PRECEDE/PROCEED is that of strategic planning that is guided by a continuous review of credible metrics such as those offered in “best practices scorecards.”
The HERO Scorecard developed in cooperation with Mercer is one of several freely available scorecards with reference norms available in the public domain. 7 Having a strategic plan and written objectives is considered a “best practice” and is usually a standard question asked in scorecards. Surprisingly, organizations that have a clear health and well-being destination planned are in the minority. 8 Over 1800 companies have completed the HERO Scorecard and a study of users found that 44% of companies reported that they had no written strategic plan and only 25% of companies had a multiyear strategic plan. Perhaps more telling, of those who had a written plan, less than half (47%) felt that their strategic planning had been effective. 9 In another HERO study of 205 organizations who responded to scorecard questions about strategic planning, of those who had no written objectives, only 6% reported significant employee health risk improvement and 22% reported slight improvement. In contrast, 21% of organizations with written objectives reported significant improvement and 49% reported slight improvement. 10
Perhaps cocreating a destination and deciding on a plan is the exception rather than the rule because getting agreement on the best route ahead is just plain hard. Schnobrich and I found that fellow hikers were a reliable source of obstacles ahead, but, at the same time, they were downright unreliable sources of information about how get around them! Chats around campfires offered rich information about awesome vistas and hazards to avoid but we came to be wary of hikers’ recollections of trails they had traveled just hours before. And so it is with codeveloping well-being destinations that your fellow travelers can rally to finding together. As much as my through-hiking experience had me rejecting the “it’s the journey” bromide, more than ever I came to appreciate that other platitude that “good decisions require good information.” Choosing a worthy destination and analyzing information shouldn’t be hurried. Nevertheless, once you’re laboring under the weight of a heavy pack, like the precious time and resources you’ve been entrusted with to achieve your goals, analyzing key metrics and making data informed decisions can feel urgent.
Assessing whether you are on track can seem even more pressure-filled when doing it alongside hurried leaders and stakeholders for whom reviewing data is not a usual part of their decision process. As Schnobrich and I got quicker at noticing when we were lost and better at staying in the moment and on course, 2 books often came to mind as they offer complementary ideas about how data informs decisions. Malcolm Gladwell’s “Blink” offers captivating stories about how experts can instantly see what others miss. After weeks of walking in the woods, I came to appreciate how our eyes were indeed our most reliable source of information about the trustworthiness of the path we were on, if only we’d use them more carefully. Is it also the case that we are underutilizing our vision for gauging how well our health and well-being initiatives are aligned with the horizons sought by our organizations’ leaders?
Where Gladwell argues that more data don’t always lead to better decisions, others are showing how often we misinterpret data so that more data simply produces more misunderstandings. As much as there is a “dash” in dashboards, Nobel-prize winning psychologist Daniel Kahneman’s book “Thinking Fast and Slow” is an absorbing, albeit dense book, which affirmed my hiker’s observations that people’s memories and related judgments of the way to get somewhere are, shall we say, imperfect. The quick, decisive directions of well-meaning fellow hikers too often led to long, arduous treks to dead-ends. I’ve long held that strategic planning is the time to slow down and invoke disciplined reflection into our output-oriented work days. Kahneman, who is credited with leading the behavioral economics movement, has shown time and again that making judgments in a blink can as often as not send us down the wrong path.
A mindfulness exercise I practiced often to keep me in the moment while hiking was to silently verbalize my surroundings. “This is a dawn with rosy fingers like in Homer’s Odyssey. Close ahead is a red pine with amber roots as large as most tree trunks. Last season’s fallen needles have created a deep, soft, slippery cushion that is giving way to insistent light green ferns. Now I’m seeing this morning’s first glimpse of Lake Superior. It has a blue and white sheen that is identical to the sky’s complexion just now. I’m not certain where the lake ends and the sky begins.” How mindful are we each day of the ever-changing dynamics in the organizations we serve along with the moods and meanderings of the needs and wants of their people? Worksite health and well-being initiatives could readily become lost to organizational leaders and employees alike if they aren’t strategically aligned with the day-by-day destinations being pursued by the company or if we aren’t verbalizing how our journey is helping them achieve their destination.