Abstract
Introduction
Organizations exist as complex hierarchies and competing priorities that shape and drive the culture. Weaved within this are the dynamics of subcultures. Vision and priorities originate with leadership and resonate through the organizations. Specific to health behaviors, both the larger culture and smaller subcultures influence people’s habits and attitudes towards health and the well-being programs. Understanding the leadership vision and perspectives of supervisors and employees is a key component to measuring culture. Subcultures represent the levels, layers, and circles of influence within an organization. They can exist by work location, job type, work group, social interaction, or common interests. Subcultures can form around work as in work groups or around interests such as walking clubs.
A supportive culture is not just about well-being programs, but also about habits. How does the culture support or undermine peoples’ habits and efforts to be healthy? As mentioned, in the opening commentary to this issue of The Art of Health Promotion (TAHP), people spend the majority of waking hours at work. The work environment and culture have a significant influence on people adopting and sustaining healthy habits. 1-4 A common practice of bringing in cakes and baked goods can significantly derail efforts to eat healthy. Conversely, walking meetings or walking groups at lunch can be helpful and motivating. Workgroups and subcultures operate differently so understanding the culture and common practices that exist allows for communications and strategies to be enacted for the greatest chance of success.
Culture surrounds us so ubiquitously; its influence can be hard to conceptualize. Using the analogy of swimming in a river, if people have multiple factors in their culture that are nonsupportive of health habits, it is like swimming upstream in a river. Individual efforts accomplish less forward motion and one tires quickly. On the other hand, if one is able to swim with the current, efforts are supported and enhanced by the surrounding current. Measuring culture and subcultures is akin to assessing how hard people have to work or “swim” to be healthy.
Culture is complicated but measurement and enacting strategies that account for its influence leads to more effective well-being programs, improved reach into the population, and a better experience for employees seeking to improve their health.
Start with Your Company’s “Why”: Understanding Leadership
In the past, companies implemented well-being programs for cost savings. While still often part of the equation, contemporary initiatives have a broader value proposition. 5 For many leaders, health is a key component of safety, job satisfaction, retention, and attraction of top talent. The need to simultaneously support an aging workforce and attract and retain millennials is an almost universal challenge. Competition for skilled, qualified employees is significant, and people are more likely to leave work situations that are not supportive of their well-being. 6 -8
Starting with the “why” means understanding leadership priorities and the perspective of stakeholders. Without directly addressing those interests, well-being initiatives often struggle due to lack of buy-in and resource allocation. Capturing the viewpoint of leadership, managers, and other stakeholders through discussions informs the priorities and barriers that exist.
Key questions for leadership include: What are the challenges in your company/location/business unit/team? What priorities are you interested in addressing? The “why” is fundamental as it drives communications, positioning, and metrics used to assess progress and success. As one chief financial officer said to me, “In our whole population, if we help a handful of people manage their diabetes or chronic condition, that won’t show up on the bottom line in our health care claims, but we changed their lives. And that is a significant accomplishment.” Understanding and addressing leadership priorities, including those of local leadership, is a key part of measuring culture.
Using Quantitative and Qualitative Data
In assessing subcultures, both quantitative and qualitative data are useful. This is partially due to the complex nature of culture and subcultures themselves and due to varying needs of stakeholders within an organization. Quantitative data provides scores and values. Measuring support in the culture allows for comparison across segments and shows areas of strengths and opportunities. Validated surveys exist for assessing how well the culture supports health and provide a systemic framework to inform strategies that impact culture. 9 -11 Such tools include factors like leadership support, policies, manager support, peer support, trust, stress, sense of community and other factors related to culture. Leadership often appreciates metrics to inform strategies and are typically more willing to allocate resources when strategies are supported by quantitative data (numbers).
Qualitative data in the form of open-ended comments from the survey, focus groups, or leader discussions provide detailed information to identify barriers, valuable aspects of the current well-being initiative, and strategy ideas. 12 By involving leaders in the process via discussions, buy-in and support are more likely. The survey data are useful to inform content for discussions and focus groups. For locations or groups with higher scores, focus groups and leadership discussions may be targeted toward what is working well and delineates aspects that can be emulated for other groups. Even in supportive cultures, there are things to improve. For lower scoring groups, focus groups and leader discussions yield insights as to barriers, lack of awareness, or access to resources. Geographic region or other factors may be a factor in that a well-being initiative designed for one area does not work in another. In some cases, company-wide policies can interfere with well-being engagement. For example, productivity metrics may suit an automated plant, but be less suitable for a less automated plant that produces custom products. A culture of health survey may show lower scores for the latter example, but the qualitative data from either comments or discussions or both will give insights about underlying reasons. A policy that has nothing to do with wellness programs can affect health and well-being engagement due to increased work demands on supervisors and employees, increased stress, and reduced morale. Without a culture of health assessment and a process to identify barriers, underlying dynamics often go unseen and programs suffer from low participation or lack of results.
By way of process in measuring culture and subcultures, an independent third party offers privacy protection and confidentiality. While culture assessments typically do not include health information, it typically makes people feel more willing to share openly if their individual information is not collected directly by their employer.
Preparing to Measure: Defining Subcultures in Your Organization
To optimize data collection, it is important to use existing data and knowledge of the organization to define possible subcultures. This will be a “best guess” because through measurement and the discovery process, it is likely that others will manifest that were previously unknown. Nevertheless, obvious targets for subcultures to consider in measurement include: age, gender, location, job class, work shift, and type of work. Even in locations where the majority of work may be of a singular type such as manufacturing, there are other job types such as office staff and maintenance to consider. Thus, location alone is not sufficient to identify subcultures.
Initial identification of subcultures informs the process of measurement. Downstream analysis of subculture groups are limited by what data are actually collected. For example, perspectives of night shift workers versus day-time employees can only be assessed if that information is available in the survey data either by connecting to an administrative file or by including that item on the questionnaire. For categories such as job type, the information may be available from administrative records or may need to be included as a questionnaire item. Supervisor versus employee classification is often sufficient as it informs groups by which interventions can be targeted. Some organizations have hundreds of job classifications that are too unwieldy for useful analysis and may need to be collapsed into larger groups to explore subculture differences. Group size and implementation focus are 2 considerations when measuring subcultures. For example, people in departments may have different cultures, but if there are less than 10 people per department that will be too small for useful analysis, protection of privacy, and to inform interventions.
Measuring Culture and Subcultures to Understand Needs
While culture covers an expansive array of areas, focusing measurement on factors specific to influencing health behaviors and attitudes yields specific areas to address. Main areas include leadership support, policies, manager support, coworker support, and overall climate. Climate includes factors like stress, sense of community, workload, job satisfaction, and trust. They all impact how likely people are to take advantage of resources that support health. As depicted in Table 1, locations within the same company can vary widely. In this example, the percent of individuals overweight correlates with how supportive the culture is for health.
Measuring Subcultures.a
a Heat map of culture scores for separate company locations. BMI correlated with culture scores. Culture sections: above 80 = high (dark green); 65-79 = medium (yellow, orange, light green); below 65 = low (red). For percent overweight: lower numbers rate better with US average as benchmark. 13
When data were analyzed by supervisor and employee subgroups, supervisors were more positive toward workplace well-being and the culture (data not shown). However, employees did not view their managers as supportive towards health or the well-being programs. This was largely due to high work demands and stress in the manager group. Wellness coordinators were able to reach out and provide additional resources for managers. Manager participation in well-being initiatives was also encouraged to make their support more visible.
In this example, the environment was the lowest scoring section for all locations. In further analysis and examination of the open-ended comments, several factors in the environment were undermining people’s efforts and attitudes toward the well-being initiative, including healthy food availability. The resulting action strategy was two-fold in working with the food vendor and providing information on packing healthy lunches and snacks. Wellness champions worked to create peer networks to support healthy eating. Another gap identified in the survey was awareness of well-being resources. Thus, additional information on the well-being resources and the rewards program was provided. Other barriers included work demands and overtime. Some locations represented manufacturing workers and strategy ideas included those that could be integrated into the workday or group stretching at start of shifts (with manager’s approval).
Understanding Subcultures: Worth the Effort
well-being initiatives succeed or fail based on the culture in which they are implemented. Only by understanding the subcultures, will strategies be implemented and communicated in the most effective way. When you are able to measure culture, strategies and communications tie more closely to employees’ day-to-day reality and resonate better. Insights can be leveraged in terms of what is working well and where barriers exist. My supervisor encourages us to take the stairs and do stretch breaks. He is so encouraging and non-judgmental. It makes a difference for our whole workgroup. (Anonymous employee)
Just as important is understanding and amplifying strengths. In the same organization, measuring culture showed that managers were more supportive of well-being initiatives than was realized. Employees communicated how valuable the programs were to them and what they felt worked well, including the onsite wellness coordinators and coaches. While participation rates and quantitative metrics are valuable, a sole focus on them does not account for the less tangible factors such as appreciation for the company’s efforts. Many times, companies are simply not aware that their well-being efforts positively impact employees’ lives.
Conclusion
Measuring culture by collecting quantitative and qualitative data and taking the steps to understand perspectives of subcultures takes time and effort. However, it pales in comparison to effort spent on communication campaigns, well-being programs, and initiatives that are not successful due to culture misalignments. Measuring culture by groups or subcultures yields valuable information for wellness directors, coordinators, and champions on how to approach wellness in their organization. Furthermore, data on culture are empowering as it reveals where efforts are successful and making a difference.
In workplace well-being, so much emphasis is often placed on participation, risk reduction, and cost reduction. However, successes may also be measured in making people’s lives better. That is not always apparent unless one takes time to understand what is working. Measuring subcultures is really about understanding the multiple perspectives and realities that exist within an organization. The case studies that follow in this issue of TAHP illustrate how pertinent subcultures are to strategies and the importance of addressing different needs within an organization. By measuring and getting to the granularity of an organization’s unique cultures and needs of subcultures, well-being initiatives can be implemented so they resonate with employees in an authentic way and have greater impact.
Dr. Mary Marzec, PhD is a Senior Researcher and Consultant with Virgin Pulse.