Well-Being and Evolving Work Autonomy: The Locus of Control Construct Revisited

What Becomes of Cultures of Health?

This evidence about WFH preferences and potential advantages for employees and employers is emerging at a time when occupational health and wellness researchers have increasingly factored in work culture as a precursor to successful population health improvement. In a previous editorial, I discussed similarities between individual and organizational resilience and considered how different cultures adapt to change. ³ Might trends toward post-pandemic, novel work arrangements compromise cultures or even upend how culture is defined? To assess what cultural changes are afoot, researchers should channel renowned health promotion researcher Dr Lawrence Green’s view that “if we want more evidence based practice, we need more practice based evidence.” ⁴ For example, practice-based research will likely be needed to determine what constitutes a culture of well-being in organizations where workers only convene in person occasionally.

Underneath broader questions about evolving cultural norms I expect researchers will surface evermore questions about connections between changing work arrangements, health, well-being, and satisfaction. How does remote work affect loneliness and how will this vary by personal characteristics or beliefs? Do flexible work environments shift social ties from the workplace to communities? What impact will reduced commuting and increased telecommuting have on work and life satisfaction? How do preferences relating to online vs office-based work relate to personality differences such as extraversion or introversion? This editorial aims to encourage research submissions to this journal relating to well-being as it is impeded by, or improved by, the new ways we work. Relating to this, I revisit the multi-dimensional health locus of control construct and ask whether control beliefs could magnify the positive or negative well-being effects of the new ways we work.

Some have associated hybrid work policies with benefits such as greater work autonomy and more control over daily health practices. Others believe hybrid policies foretell chronic changes in work expectations that bespeak social isolation and stressors from blurred lines between work and life. Some anticipate hybrid policies will liberate employees from the boundaries of office hours and overwrought managerial oversight. Paradoxically, others lament the loss of boundaries and predict that hybrid work policies will usher in an era where work is omnipresent. Many of these outcomes will relate to practical adaptations in telework, use of technology, and management practices. I anticipate that the most meaningful information for decision makers will come from research that examines how hybrid policies differentially impact various sectors, job types, and worker preferences. In addition to potential differential affects relating to personalities and beliefs, how might flexible work policies produce unintended health disparities between genders, races, or socio-economic groups?

Under the leadership of co-editor Dr Rachel Henke, the “Knowing Well, Being Well” (KWBW) section of this journal has already dedicated one issue to the kinds of questions above. In her editorial on “Shifts in Health Behaviors amid the COVID-19 Pandemic,” Henke notes that “the pandemic has resulted in measurable changes to our health behaviors and new awareness, policies and innovations to support mental health and work-life balance.” Making the point that the pandemic brings both threats and opportunities, Henke discussed the habit discontinuity hypothesis and the evidence that “behavior change interventions are more effective when delivered in the context of major disruptions to habits.” ⁵ The hypothesis also holds that major disruptions can dismantle healthy habits. To wit, expert contributors to that November 2021 issue showed how the pandemic has substantially increased mental health problems, alcohol use, screen time and poor nutrition practices, and reduced physical activity and sleep time. Even disruptions in dreams and more frequent nightmares were discussed.

A concluding comment from one of the KWBW contributors, Jennifer Moss, seems particularly germane to the need for more research relating to changes in work and well-being. Moss suggested that “2021 will be remembered as the first time pay would come second place to well-being in the battle for attracting and retaining talent across the global workforce.” ⁶ A 2022 LinkedIn survey of job seekers already affirms Moss’s forecast with 63% saying work–life balance was their top priority, more so than compensation (60%) and culture (40%). ⁷

Is a Social Contract Transformation Afoot?

The longer the pandemic festers and the larger the “great resignation” grows, the more likely it is that a sweeping reassessment of the workplace social contract will occur. How will employee well-being and work satisfaction be reimagined in an era where the allure of the workplace setting is fading? It may well be the case that the current moment is ground zero for employees’ voices getting heard. Researchers can be at the vanguard for assessing what people value most from work and what they need from workplaces or whether they deem workplaces dispensable. For remote workers, are higher wages, more training, or more autonomy the most relevant job satisfaction benefits? How do these benefits compare to fitness centers, yoga classes, or healthy food choices provided at the office? For blue collar or front-line workers without work-from-home options, how will benefits related to greater flexibility about when and how long they work or other ways of gaining personal agency compare to other benefits? Researchers could also be asking whether such transformations in the social contract are more closely aligned with what we have long known about motivation: autonomy and purpose are every bit as powerful as mastery when it comes to decisions about how and where we work. ⁸

Current frustrations related to hybrid meetings have already sparked fascinating research questions. Is angst about remote meeting management simply a symptom of pandemic fatigue or a more telling forecast about the level of autonomy that is desired as evidenced by the “great resignation”? It has been argued that hybrid meetings educe the worst of two work worlds. Those in the in-person environment are forever forgetting to engage with those online or, worse, they simply do not have the facilitation acumen and tech savvy to make remote attendees feel included. Regret and guilt ensue. Those participating remotely fear they are missing out on the group dynamics occurring among in-person participants or, worse, they feel they have second class status when it comes to being heard or acknowledged. Resentment and resignation (figurative and literal) ensue.

Might fixing remote meetings contribute as much to mental well-being as promoting greater access to employee assistance counselors? One fascinating emergent research question, for example, asks whether the positioning of cameras and the size and duration of screen shots of meeting participants are the culprits behind Zoom fatigue. Bailenson and colleagues argue that prolonged direct eye contact is producing “non-verbal overload.” Could something as seemingly benign as the size of faces on screens and the angles of the front-on views of faces be so unnatural as to produce stress? ⁹ And how should technology adapt to accommodate the more natural casual eye contact that occurs during in-person meetings? Others are asking whether hybrid meetings that ostensibly suit the preferences for introverts may instead be exacerbating social isolation. Are extraverts more likely to find ways to compensate for the loss of face-to-face meetings? Will introverts come to miss, and mentally suffer from, the built-in social connections that occurred during onsite office hours? ¹⁰

Locus of Control and Freezing Eggs as a Perk

If we are indeed in the midst of a transformative social contract between workers and employers, a question at the heart of the matter relates to whether the new contracts will foster shared decision-making. Who decides what is best? One of the most thoroughly researched psychological constructs, Rotter’s “Internal-External Locus of Control” scale, holds that we vary in what we believe about what controls our lives. Related to these beliefs, we differ in our preferences about deciding on matters, even those that directly affect us. In matters specific to health decision-making, Wallston’s “Multi-dimensional Health Locus of Control Scale” has been studied extensively to assess the benefits and limitations of shared medical decision-making, consumer-directed health benefits, and informed consent in acute care. The doctor–patient relationship shares much in common with employer–employee dynamics. A doctor holds specialized skills and knowledge about medical practice and the affect decisions can have on health status. Patients vary in their risk tolerance and beliefs relating to how much they control health outcomes. A business executive has skills and accountabilities relating to business success. Employees have varied views on what they are able and willing to offer the employer and what they expect in return.

In the interest of supporting more effective shared decision-making in health care, health locus of control (HLOC) researchers have tested survey items and found four common domains of beliefs. People with high internal HLOC believe they have a strong influence over what will happen in their lives. Others hold HLOC beliefs that chance, the doctor, or other people have greater influence on their fate. Patients with strong internal HLOC beliefs favor playing an active role or an active-collaborator role in decision-making. Those with low internal HLOC (high chance or doctor HLOC) beliefs are more likely to favor a passive role or a passive-collaborator role in medical decisions. Specifically, those with high internal control beliefs will say, “I prefer to make decisions about which treatment I will receive” or “I prefer that my doctor and I share responsibility for deciding.” Conversely, those with low internal control beliefs or chance beliefs are more likely to say, “I prefer that my doctor makes the final decision, but seriously considers my opinion” or “I prefer to leave all decisions to my doctor.” ¹¹ For health systems with a goal of providing patient-centered care, the HLOC construct is a valuable measure for understanding how patient preferences can guide decision-making.

If the new social contract aims for a closer alignment between employer and employee needs and preferences, how should differences in employee control beliefs be factored into decisions? My hope is that researchers will develop and test new ways, perhaps inspired by the HLOC construct, to show how business and policy decisions can be improved with input from employees consistent with their employees’ varying control beliefs. When author Jennifer Moss was interviewed about how to reduce workplace burnout, an example she first reflected on was how egg freezing as a health benefit provides a window into the tension between individual preferences vs corporate interests. ¹⁰ I assume egg freezing is an uncommon benefit offering, but it nevertheless provides a disturbing but fascinating window into the foibles likely to accompany changes in today’s social contracts. What should we make of an employer who offers to freeze eggs (cryopreservation and storage of human oocytes) for non-medical reasons? A pretty generous benefit? A way to keep women at work longer by delaying childbirth? A means of leveling the playing field between professional men and women? A simple reminder that paternalism still permeates benefits designs? I am not qualified to debate the ethics of such a benefit but, per the theme of this essay, it most assuredly provides a compelling argument in favor of heavily factoring employee locus of control needs and preferences into health benefits design decisions.

Confusing Control With Order

At a conference I recently co-hosted, a breakout group was discussing whether mental health services were effective in addressing the “second wave,” the psychological toll being felt from the pandemic. “We can’t yoga our way out of this,” one participant quipped. It is a pithy way of challenging the health promotion discipline to ask whether we are achieving a healthy balance between individually oriented interventions vs collective well-being strategies that are more structural or environmental. A recent literature review of the “best practices” for workplace mental health support, derived from scientific articles from the past two decades, identified eight categories of evidence-based practices. The categories affirm the need for a balance between individual supports, such as “robust mental health benefits” and “mental health resources,” alongside environmental supports, such as a “healthy work environment” and “workplace policies and practices.” ¹² So, what becomes of workplace mental health practices when your place of work is also the place you call home? Relative to an employee’s locus of control, how will employee preferences and beliefs change when their commute is twenty steps rather than twenty miles?

Managing the people that produce goods and services has been steeped in control mechanisms and work processes that account for what gets done, where, when, and by whom. Says author Margaret Wheatley: “All these years we have confused control with order. So what if we reframed the search? What if we stop looking for control and begin the search for order, which we can see everywhere around us in living dynamic systems?” ¹³ Wheatley is not alone in contemplating that finding new ways to control people and processes undermines the chance for creating altogether different ways to succeed. Today’s leaders are steeped in debates about the right number of days employees could work from home vs working at the office. What ratio will preserve or increase productivity without foiling creativity and collaboration? “ROWE” (Results Only Work Environments) is a mechanism for organizing work that long preceded the pandemic’s influence on flexible work arrangements. Jodi Thompson, a former Best Buy human resources executive who co-created ROWE believes such debates are, well, she puts it succinctly: “We know that companies have been trying to do flexible work schedules for 50 years. And it’s stupid.” Thompson says, “The old model of flexibility is broken. People don’t want flexible work schedules. What they want is complete control over their time.” ¹⁴

A results-only approach to work certainly qualifies as a search for a new kind of order. What implications flow from no vacation times, no times on or off the clock, and no managerial directives other than delivering an outcome? Such a fee-for-service model leads to increased employee autonomy but also begs the question about legal differences between an employee and a contractor. If the new social contract spawns contractor-level autonomy, then would old contract questions relating to health benefits designs, cultures of health, and employee well-being become, well, stupid? Unlike debating who works when and where, ROWE principles hold that: (1)“Every meeting is optional. Being accountable for delivering results is not.”; (2)“Core hours or schedules are not dictated by managers.”; (3) People never talk about how many hours they work.” ¹⁵ One way to view this is as a social contract where ultimate autonomy is exchanged for unfettered accountability. Is it a social contract that confuses control with order? Those with high internal locus of control may find this a welcome new order. But is it one where well-being and job satisfaction are no longer the purview of the employer, the services purchaser? And those who believe their fate is mostly out of their hands may simply see this new contract as a new form of control. They may start yearning for the good old days.