Disclosure

• I have no relevant financial relationships with Physician Wellness the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity

Elizabeth Ablah, PhD, MPH • I do not intend to discuss an unapproved/investigative use of a University of Kansas School of Medicine commercial product/device in my presentation.

Intent of Initiative WorkWell KS Goal To create healthier worksites in Kansas So the healthy behavior is easy through worksite implementation of policies, systems, and environmental best practices to sustainably promote: 1) integration of worksite wellness into the worksite's infrastructure 2) physical activity 3) access to and consumption of healthy foods 4) tobacco prevention and cessation 5) well-being

The Problem The Problem(s)

WorkWellKS ?

1 WorkWellKS Stress

The Problem “A non-specific response of the body to any demand placed upon it… arises when there is an imbalance between demands in life, such as those related to work, and the coping resources available to an individual.” Stress

Bjornstad et al., 2014

Pressure vs. Stress Stress

 66% of Americans: work is main source of stress  Pressure can stimulate motivation, alertness (APA, 2007)

 “Extreme, persistent, and unrelieved  Approximately 30% of workers report pressure can lead to stress…” “extreme” stress levels (APA, 2008)

Giga, Cooper, Faragher, 2003

Causes of Stress Causes of Stress

Unclear job expectations  High work demands (Bjornstad et al., 2014)

Work/non-work balance  Low decision/job control (Trousselard et al., 2015; Bjornstad et al., 2014)

 Low support from supervisors, co-workers (Bjornstad et Children al., 2014)

Eldercare  Lack of support from supervisor (Offermann, Hellmann, 1996; Sosik, Goshalk, 2000; Giorgi et al., 2015)

2 Causes of Stress Psychologic Impacts on Employee  Requirements of the job do not match the  Depression capabilities, resource, or needs of the worker (Sauter et al., 1999)  Anxiety  Alcoholism  Role conflict (Giorgi et al., 2015)  Smoking  Decreased quality of life  Poor quality management (Seltzer, Numerof, 1998)  Poor self-esteem  Poor job satisfaction  Poor rewards (Catalina-Romero, 2015)  Poor motivation

Glise et al., 2012; Bergerman, 2009; Health and Safety Executive, 2001

Physical Impacts on Employee Physical Impacts on Employee

 Fatigue  Gastrointestinal problems  Hypertension  Sleep disturbances  High cholesterol  Dizziness  Ulcers  Eye strain  Cognitive problems  Headache  Illness  Appetite  Sickness absence among those who have more work (due to absent colleagues)  Musculoskeletal pain Nixon et al., 2011 Stansfeld, Candy., 2006); Kivimaki et al., 2002

Long-Term Stress: Stress Impacts on Worksites Physical Impacts on Employee

 Lack of recovery  Sickness absence and absenteeism

 Disturbed sleep  Presenteeism  Stroke  Poor productivity  Cancer  Employees more prone to injury  Obesity  Diabetes  Accidents

 Heart attack  40% of all job turnover  Coronary heart disease  Increased costs  Cardiovascular mortality Muchenhuber et al., 2013; Schultz, Chen, Edington ,2009; Bergerman, 2009; Darr, Johns, 2008); Levi, 1996; Howel, Sparks, Cooper, 2001; Shigemi et al., 2000 Kuper, Marmot, Hemingway, 2002; Goodspeed, Delucia, 1999; Yang et al., 2016; Swaen et al., 2004; Rosengren et al., 2004; Levi, 1996; Bosma, Peter, Siegrist, Marmot, 1998; Kivimaki et al., 2002 Marmot et al., 1997; Baker, 1985; Smulders, Nijhuis, 1999; Letvak et al. ,2012

3 WorkWellKS The Problem Mental Health

 Not just absence of mental health disorder

Poor Mental  Psychologic well-being Health  Literature on risk and protective factors

Risk Factors for Presenteeism Depression, Anxiety  “Diminished performance at work because of the  Consistent risk factor – role conflict presence of disease or a lack of engagement”  Clarity of goals and objectives  Choice of coworkers, contact with clients  Largest cause of poor productivity  Incompatible requests from two or more people

 Presenteeism is a risk factor for depression

Schulte et al., 2015; Hemp, 2004 Bustillos, Ortiz Trigoso, 2013; de Perio, Wiegand, Brueck, 2014

Finne et al., 2014; Conway et al., 2014

Protective Factors for Depression, Anxiety Depression

Consistent protective factors:  Most common psychiatric illness

 Support from immediate superior  Those who report job stress, bullying, lack of control in making work decisions experience  Fair upper management more depressive symptoms

 Positive challenges  Cause of disability, poor productivity, absenteeism, presenteeism Finne et al., 2014; Conway et al., 2014

4 WorkWellKS Depression and Worksite Focus

 Psychotherapy treatment and pharmacotherapy are cost-savings for employer

 Screening for depression is worthwhile business activity Well-Being

Evans-Lacko et al., 2016; Theorell et al., 2015

Well-Being Psychologically Healthy Workplace  “A flourishing worker who benefits from a safe, supportive workplace, engages in 1. Recognition satisfying work, and enjoys a fulfilling work life” 2. Employee involvement

 Maintain balance – professionally and 3. Growth and development personally

4. Health and safety  Health and basic survival, economic, environmental, cultural, social, and political

Xing, Chu, 2011; Schulte et al., 2015 5. Work-family balance Grawitch, Gottschalk, Munz, 2006

Determinants of Well-Being Outcomes Linked to

 Work-life balance Well-Being

 Workplace management  Health  Employee job control  Healthy aging  Psychological job demands  Increased productivity  Work organization  Lower health care costs  Effort and reward  Person-environment fit  Measured as: absenteeism, presenteeism,  Occupational safety and health workers’ comp claims, productivity

 Management of ill health Harter, Schmidt, Keyes, 2003; Schulte et al., 2015; Prohaska et al., 2011; Schulte et al., 2015 Budd, Spencer, 2014; Gandy et al., 2014; Grawitch et al., 2006 Schulte et al., 2015

5 Cost to Worksites

Making the Business  Employees who reported being depressed were 70% more expensive than their non- Case depressed counterparts.

WorkWellKS

Goetzel et al., 2002

Cost to Worksites Cost to Worksites

 Stressed workers were 46% more costly than  Employees who experience both depression their non-stressed counterparts. and high stress were 147% more expensive.

Goetzel et al., 2002 Goetzel et al., 2002

How Do We Change?

 Behavior is complex. How Do We Change?  Behavior change is even more complex!

 Knowledge is insufficient to prompt WorkWellKS behavior change!

 How do we alter our behaviors?

6 Social Ecologic Model Social Ecological Model

 Concurrent interventions at multiple levels are the most likely to be effective.

 And they are more likely to sustain change!

Psychologically Healthy Paradigm Shift Workplace?

 Employees will change behaviors as a  Change workplace reflection of the changing characteristics of their worksites.  Considered an alternative to targeting individual, stress management programs  Create a healthy work environment.

 Systemic change is preferable and  Organizational health promotion. complimentary to more traditional models

Kelloway, 2015; Grawitch, Gottschalk, Munz, 2006

The WorkWellKS Strategic Framework

WorkWellKS

7 Best Practices

 All recommendations included in this section are considered best practices!

X

Collect Information

 Compare employees’ abilities to job demands Collect Information from Employees  Assess work stress and potential consequences * Schedules * Absenteeism * Workload * Disability * Relationships with colleagues * Illness * Satisfaction * Productivity * Turnover

Provide Information to Employees

Not evidence-based

8 Big Picture Message: Stress Big Picture Message: Well-Being

Not evidence-based Not evidence-based

Big Picture Message: Mental Health

X

Not evidence-based

Prevention Programs: Prevention Programs: Professionalism Skills Relaxation  Problem-solving training  Relaxation training, including progressive relaxation  Meditation  Time-management training  Mindfulness class

 Yoga, tai chi  Job skills training  Onsite massage

 Onsite exercise or physical activity program  Resilience training  Provide a healthy snack, relaxation break

 Arts activity  Conflict resolution training  Group motivational interviewing to encourage daily PA and relaxation  Personal financial planning Murphy, 1996; Nurit, Michal, 2003; Macaluso et al., 2015; Ravalier et al., 2016 Renaud et al., 2008; Luthan, 2002; Rappaport, 1991 Letvak, 2013; Markwell et al., 2015; Karpaviciute, Macijauskiene, 2016 Wright, 2003; Fisher, 2009; Coffeng et al., 2014

9 Prevention Programs: Prevention Programs: Emotional Intelligence Restorative Breaks  Biofeedback Uninterrupted rest or restorative breaks  Cognitive-behavioral skills (re-evaluating thoughts, to engage in healthy non-work activities emotions, behaviors)

 Positive psychology

 Interpersonal skills training

 Assertiveness training

 Positive self-talk

 Viewing change and adaptation as positive Renaud et al., 2008; Luthan, 2002; Rappaport, 1991 Nurit, Michal, 2003 Wright, 2003; Fisher, 2009; Coffeng et al., 2014

Stress Management Program Stress Management Program: Targeting Managers  Cognitive behavioral therapy Upper and middle managers receive annual –based stress management training on how to reduce work stress:

 Assertiveness  Nature-based stress management

 Time management  Mindfulness-based therapy

 Conflict resolution  Stress support group

 Communication Van der Klink et al., 2001; Sahlin et al., 2014 Khoury et al., 2013; Klaltt et al., 2015

Stress Management Program: Participatory Action-Oriented

 Employees help to identify problems caused by work environment

 Employees join in intervention to improve X the work environment

 Results in greater support from supervisor and coworkers, less stress, and job satisfaction

Joyce et al., 2015; Kim et al., 2014; Kobayashi et al., 2008

10 Benefit Design Strategies Benefit Design Strategies Flexible Spending Health Savings  Insurance premium reductions Accounts (FSAs) Accounts (HSAs)  Not subject to federal  Not subject to federal  Co-payment reduction income tax. income tax.  Employees can use to  For employees with  Paid time-off pay for out-of-pocket high deductible plan. health care costs (e.g., copayments,  Consider potential benefit design ripple deductibles). effect!  Limited to $2,650 per year.  Can roll over each year.  Must use each year. FSA - 2018 Figures HSA - 2017 Figures

Design Approaches Benefit Plans to Cover

 Include at least one benefit design strategy  Mental health screening (e.g., premium reductions) to encourage employees to take a year-long mindfulness  Access to mental health class. provider/ treatment

 Reward employees for participating in  Access cognitive financial planning classes by contributing behavioral therapy funds in FSA. for overall mental health and to improve stress- related symptoms

Employee Assistance Program Benefits at Worksite (EAP)

 Separate sick leave from vacation leave  Employee assistance programs can provide resources for employees to cope  Mental health leave with stress

 Positive impact, desirable  Childcare on site

 Infants up to 6 months brought to work

Kirk & Brown, 2003; Brion, Karanika-Murray, 2014 Joyce, Pabayo, Critchley, Bambra, 2010

11 Benefits at Worksite

 Meaningful, and at least annual, employee recognitions X

 Internal promotions

 Financial rewards (bonuses, raises)

Grawitch, Gottschalk, Munz, 2006

Policies to Consider: Policy Adequate Staffing Policies  Does the worksite have a policy encouraging  The worksite has a sufficient number of employees to take 10 to 15 minute “rest” or staff in proportion to the required work. “booster” breaks?

 The worksite has a policy for minimum staffing levels.

Gaugier et al., 2001

Dababneh et al., 2001; Galinsky et al., 2000; Tucker et al., 2003

Policies to Consider: Policies to Consider: Self-Scheduling Flex-Time

 Self-scheduling – shifts are made  Flex-time – working certain number of available, employees are responsible for hours, with agreed upon starting and selecting and swapping shifts of interest finishing times

 Might include:  Required period (e.g., 10 am – 2 pm)  Bandwidths (e.g., 5:30 am – 5:30 pm) Gaugier et al., 2001

 Often used to facilitate family schedules and physical activity

Gaugier et al., 2001

12 Policies to Consider: Policies to Consider: Teleworking Gradual Retirement

 Gradual retirement – employees who are  Teleworking – working from home or other preparing to retire can reduce workload facility; using e-mail, telephone, other in phases technologies

 Use when sick, but productive

Gaugier et al., 2001

Gaugier et al., 2001

Policies to Consider: Policies to Consider: Voluntary Overtime Ban Mandatory Overtime

 Voluntary overtime – time and a half pay  Mandatory overtime - Forced overtime to for non-exempt employees when working maintain adequate staffing levels beyond ‘prescribed threshold’

 Major concerns with medication errors, quality patient care, legal liabilities.

Gaugier et al., 2001  Policy recommendation: Ban mandatory overtime

Gaugier et al., 2001

Policies to Consider: Policies to Consider: Stable Shift Policy Job Sharing

 The worksite has a policy to not rotate  Job sharing – two or more part-time employees on shifts (e.g., third shift will employees perform a full-time job, share remain third shift, unless a permanent remuneration change is made).

Gaugier et al., 2001

Rappaport, 1991

13 Policies to Consider: Sexual Harassment and Time for Mental Health Bullying Policies

 The worksite has a policy to prevent and  Provide time and accommodations for address sexual harassment. well-being (e.g., stress prevention, management, mental health)  The worksite has a policy to prevent and address bullying.

Workplace Bullying Institute

X Physical Environment

Social Environment

What Kind of Environment Does Your Worksite Have?

Physical Environment

Social Environment

14 What Kind of Environment “Zen,” Comfort, Does Your Worksite Have? Relaxation Room Employees feel comfortable to relax in a quiet space

Sanders et al., 2013; Park, 2010 Kelly, King, Vander Laan, 2012

Environmental Prompts Environmental Prompts

 Fresh air Give employees access to:  Sunlight, natural light  Nature outside  Windows

 Garden (can step away from work  Nature inside environment) (e.g., plants)

Tom et al., 1981; Faris et al., 2012 Rachel et al., 2009; Sadler et al., 2001 Aries et al., 2010; Kaplan, 1993; Lottrup et al., 2015; Lottrup et al., 2012 Largo-Wight et al., 2011; Lottrup et al, 2013; Dijkstra et al., 2006

Environmental Prompts Environmental Prompts

Employees benefit from having windows Worksite offers personal, private spaces in their workspaces, can view trees, vegetation

Farley, Veitch, 2001; Finnegan, Solomon, 1981; Leather et al., 1998

15 Environmental Set-Up Co-Working Centers Seating arrangements to facilitate communication and collaboration among employees.

Dijkstra et al., 2006

Environmental Set-Up

 Adequate ventilation Physical Environment  Non-florescent, adequate lighting  Tobacco and smoke-free Social Environment  Moderate temperatures

 Adequate office cleaning

Abdel-Hamid, 2013; Jeffreys, 2000

Social Environment Social Environment

Employees take uninterrupted meal breaks  Worksite offers at least annual social events

 Worksite offers sports team for employees

Rugulies et al., 2016 Rugulies et al., 2016 Sanders et al., 2013 Sanders et al., 2013

16 Social Environment: Social Environment: Employees Need Meaning Expectations and Career

 Employees need meaningful and/or  Employees need to know what is stimulating work expected of them in their roles

 Reduce employees’ repetitive work  Employees need career development opportunities

Rappaport, 1991

Rappaport, 1991

Social Environment: Social Environment: Control in Decision-Making Match and Communication

Employees benefit from participating in and  Demands of the work (e.g., work load, having some control in decision-making pace) need to match employees’ abilities that affects their jobs

 Two-way organizational communication must be valued

Zhou et al., 2015 Zhou et al., 2015

Social Environment: Social Environment Support  Managers are willing to redesign work to  Co-workers need to improve fit or decrease stress respect and support one another  Worksite supportive of work flexibility for non- work demands  Worksite to foster social support among colleagues

 Supervisors to support their

employees Joyce, Pabayo, Critchley, Bambra, 2010

Rugulies et al., 2016; Yang et al., 2016; Zhou et al., 2015

17 Social Environment: Social Environment: Commitment to Worksite Volunteer

 Employees feel supported by their worksite  Does the worksite encourage employees to volunteer in the community?

 Employees are committed to the worksite

Wagner, 2007 Jain, Giga, cooper, 2013

Well-Being

 Continue to develop your plan.

Next Steps  Additional planning materials for Well-Being are available online (workwellks.com).

WorkWellKS

Next Steps

 Implement your comprehensive well-being plan!

 Once the well-being plan is implemented and can be maintained, consider tackling your next Elizabeth Ablah, PhD, MPH health priority – and plan to implement it Professor comprehensively! [email protected]

WorkWellKS.com

18 Questions?

WorkWellKS

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