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Ideas and insights for today’s people-centered leaders.

Corporate wellness programs are typically not measured or measured only at very broad levels, such as cost savings or return on investment (ROI). The field of “occupational therapy” provides an alternative perspective, using evidence-based principles to improve and measure employee health, wellbeing, and occupational performance, where “occupation” refers to the tasks individuals find personally meaningful.

Workplace wellness is hot. Zappos offers Recess Tuesdays, Google supplies ping pong tables, Procter & Gamble offers meditation classes, and Citigroup provides on-site medical services. Fortune magazine describes the wellness programs of the Fortune 100 companies, and suggests benefits such as:

  • Healthier, more productive working employees
  • Lower stress levels
  • Lower turnover / higher employee retention rates
  • Fewer sick days
  • Lower insurance premiums
  • Protection of a company’s greatest asset – the employee
  • Higher self-esteem and a greater team-building mentality
  • Increased energy and vitality in the workplace
  • A more optimistic, positive attitude
  • A greater eagerness to succeed and lead, along with the energy to do so
  • Improvement in family life brings improvement into the workplace
  • Greater community synergy, greater company synergy

The Limits of Typical Wellness Program Measurement and Analysis

Do corporate wellness programs work? Virgin Pulse’s survey of over 1,000 HR professionals showed widespread belief that the best programs take a holistic approach, addressing mental, emotional, and physical health.

Yet, most wellness programs are unmeasured or measured only by the number of participants.  Research suggests troubling participation patterns.  

A 2015 survey by Fidelity Investments and the National Business Group on Health (NBGH) showed expenditures of $693 per year per employee. Yet, only 40% of employees participate, according to a 2015 RAND Corporation report. The evidence that does exist regarding medical cost savings and ROI is mixed and often inclusive. How can HR leaders help organizations do better?

[Recommended Read: Make HR Analytics a Priority, But See the Bigger Picture]

Wellness programs are typically generic (e.g. fitness or nutrition), but strive to address specific challenges (such as obesity and smoking) in high-risk groups that face the most significant costs and work disruption. Yet, less than 20% of such populations are ready to act.

Understanding and measuring the reasons can enhance wellness at work.

How Occupational Therapy Informs Wellness Measurement and Analytics

Occupational Therapy (OT) offers insights into human behavior and valid measures to better track program effects. These insights and measures can help explain the mixed results for costs and ROI, and reveal program design options that reflect the holistic and individual-based approach that HR leaders endorse.  

For example, the Occupational Self-Assessment OSA measures these 21 items:

  • Concentrating on my tasks
  • Physically doing what I need to do
  • Taking care of the place where I live
  • Taking care of myself
  • Taking care of others for whom I am responsible
  • Getting where I need to go
  • Managing my finances
  • Managing my basic needs (food, medicine)
  • Expressing myself to others
  • Getting along with others
  • Identifying and solving problems
  • Relaxing and enjoying myself
  • Getting done what I need to do
  • Having a satisfying routine
  • Handling my responsibilities
  • Being involved as a student, worker, volunteer, or family member
  • Doing activities I like
  • Working toward my goals
  • Making decisions based on what I think is important
  • Accomplishing what I set out to do
  • Effectively using my abilities

Individuals rate each item on their competence (how easy or difficult it is) and the perceived value (how important it is). The OSA items are general enough to apply to almost everyone, and have shown validity in many different languages, cultures and populations. Imagine what insights might result if you measured your employees on the OSA before, during and after a wellness program.  

The OSA reflects the OT principle of harnessing intrinsic motivation to affect behavior change. Participation rates alone tell you little about why those who need it most are declining “Exercise Mondays” or the softball team. Measures like the OSA might more clearly reveal the priorities of high-risk populations that could most benefit from wellness programs.

Targeting the Pivotal “Stage of Change”

The Stages of Change Model often used in OT, proposes six stages of wellness engagement:

  1. Pre-contemplation- the person is not yet aware of a problem
  2. Contemplation- the person acknowledges a problem
  3. Preparation- the person plans to make a change
  4. Action- the person changes their behavior
  5. Maintenance- the person sustains the behavior change
  6. Termination- The program ends because the change sticks and relapse is unlikely

Corporate wellness programs typically assume employees are ready to change their lifestyle, so they  emphasize enhanced program awareness, convenience and social or extrinsic incentives, that address the preparation and action stages of the model.  

Yet if high-risk populations are disengaged in the pre-contemplation and contemplation stages, OT calls for a focus on intrinsic motivation. High-risk individuals may have no interest in hitting the gym, but may be highly motivated to be better able to “get along with others,” “get where they need to go,” or even “relax and enjoy themselves.”

OT focuses on less threatening starting points and self-care, that build ultimately into a healthy lifestyle.

Bringing OT “Out of the Clinic” and “Into the Workplace”

The typical organization doesn’t measure wellness program outcomes. If measured, it’s usually participation rates, or in rare cases the overall program cost savings and ROI. Yet, important variables lurk in the “black box” between your wellness program offering, participation, behavior and ultimate outcomes. OT frameworks and measures can illuminate these variables, and improve your design and results.

HR leaders strive to be more analytic, evidence-based, and data-driven. Success often hinges less on better numbers and more on better logical frameworks and mental models.  

Such frameworks and models often exist in evidence-based disciplines like OT, but they must be brought from the clinic into the workplace.

OT professionals typically work in rehabilitation, such as helping children engage in school, helping the injured regain life skills, and helping aging adults adapt to physical and cognitive declines. Yet, some OTs already lead workplace programs in ergonomics, transitional return-to-work programs, and functional capacity evaluations. There is additional potential, and HR leaders and OT professionals have much to offer each other.

About the Authors:

John Boudreau is professor and research director at the University of Southern California’s Marshall School of Business and Center for Effective Organizations, and author of the forthcoming books, “Lead the Work” with Ravin Jesuthasan and David Creelman and “Global Trends in Human Resource Management” with Edward E. Lawler III.

Brittany Frederick is a recent graduate from the University of Southern California’s Doctorate of Occupational Therapy program. She completed her residency at USC’s Occupational Therapy Faculty practice, where she designed and delivered workplace wellness, lifestyle management, and disease management programs.  

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About the author: John Boudreau

John Boudreau is professor and research director at the University of Southern California’s Marshall School of Business and Center for Effective Organizations, and Boudreau is the author of two forthcoming books, “Human Resource Excellence” with Edward E. Lawler III and “Reinventing Jobs” with Ravin Jesuthasan.

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