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The Workplace and Health

Why the Workplace?

In the next 10 years, shifting demographic, technology and cultural trends[1] will pose significantly complex problems for organizations. These issues are so complex, and so outside our past experience, that it is unlikely that any CEO, or senior management team acting alone, will be able to plan or predict either the new situation or the correct response. Leaders will have to draw on the full intelligence of all the people inside the organization in order to work their way through these issues.


In this context of change, the leadership imperative in the next decade will be to create a responsive organization that can read the environmental signals, create new meaning and be able to adapt in ever shorter periods of time. Only a high trust organization will be able to do this.


The barrier that faces most organizations today is that trust is weak and there are signs that trust is getting weaker. We label this aspect of the broader issue today “Workplace Health”.


What is going on in the workplace

Trend of increasing stress and loss of trust - Most traditional workplaces have evidence that they are experiencing a growing trend of stress, absence, illness and brittleness. Trust is falling and cynicism is building.


Absence and Illness - Arguably your largest direct and indirect “controllable” cost - Increasing internal friction appears to be wearing down the parts and reducing the operational capability of the whole organization. Total direct costs of casual absence and workplace illness have risen by 27% since 1997 and now average at about 17% of payroll[2]. Workplace health, absence and replacement costs have become one of the largest direct costs in most organizations. Labour relations in the health sector are becoming more bitter.


What you cannot measure you cannot manage - Most organizations can only sense this malaise and consider these costs anecdotally.


While they may have excellent measurement systems that follow, predict and manage customers, money and inventory, most organizations cannot empirically and easily follow, predict and manage the human aspects of organizational life. They usually only have access to general survey data and are not able to pinpoint specific “hot spots” or to see patterns across the organization. Without such a picture, it is hard to make effective decisions about fixing the problems or in making progress toward a high performance and collaborative workplace.


Easy access to inexpensive and empirical workplace data will be essential for any organization that is serious about creating a competitive workplace.


Having the correct perspective that will enable you decide what to measure and manage is the starting point.

Measurement and Action - The Need for a Systemic Approach

Lots of action but little progress – Having the right people in the right jobs feeling good about what they do and sharing their observations and knowledge with each other will be the essential ingredient for coping with all the change that is bearing down upon us.


Survey after survey shows that the quality of the workplace is becoming a key issue in the attraction and retention of quality staff.. In response, many leaders have introduced workplace flex programs. As workplace absence grows and drives more overtime many leaders have introduced attendance management programs. As workplace illness has increased many leaders have responded by increasing access to more medical staff.  In spite of all this effort, the situation is not improving for most organizations.


Have we asked the right questions and do we measure the right things in the right way? Do we have the right perspective?


Focus on the Individual – Most approaches to the “workplace issue” focus on the individual. This type of individualistic perspective implies that attendance is mainly a personal discipline issue. It implies that an individual’s poor health can be remedied by offering them better access to health information and to exercise. It implies that we can find for each person an ideal balance point between work and home. It implies that management can make use of general survey information to offer better programming to meet these individual needs.


The need for a systems approach - What is emerging, is that the workplace health issue cannot be improved by working at the individual level but only by working at the system level. What do we mean by this statement? We need to shift our perspective from the individual alone to the individual in the context of  a social environment. We know now social environments send signals that drive collective behaviour[5]


What is now clear is that how managers behave and how the hierarchy is organized are the two most powerful social environmental signals in the workplace. Success in transforming the workplace will have to focus on what this new insight means.


Research based - We offer two important pieces of research to substantiate this systemic viewpoint. The work of Dr Linda Duxbury in Ottawa and the work of Dr Sir Michael Marmot in England.


The Supportive Manager - Dr Linda Duxbury has recently completed a blockbuster survey with 31,000 respondents in the public service and the private sector.[6] Her conclusion is that individual worker’s health, attitude and satisfaction are directly linked to the attitude and behaviour of the manager. Her research makes a clear connection between the manager’s behaviour, or style, and everything that happens to the employees for good or for bad. In effect, she comes to the same conclusions as Doug Wilms’s research on Parenting Styles and Family Functioning[7]. She shows how managerial behaviour affects commitment, learning, attendance, performance, health and even healthcare spending. Importantly, for those now running and operating traditional workplace flex programs, she establishes why this type of programming does not work.


Programming on its own is not working - In particular she shows that, when the workplace has a traditional managerial culture, that 84% of workers do not use workplace family friendly programs and 74% do not use flex programs. Her bottom line was that 86% of those surveyed coped by reducing the quality of what they did. This insight has significant implications for how we think about performance and how to get it.


The conclusion is that we have to look more deeply at the managerial system, or the hierarchy.


The Nature of the Managerial Hierarchy - Dr Sir Michael Marmot is the world’s leading authority on the influence of the workplace hierarchy on employee health. He goes further than Dr Duxbury in showing that the issue is the system itself. He shows conclusively that workplace illness is not driven by the individual but by the type of hierarchy that the individual finds herself in.


The two Whitehall Studies[8] show that health is found on a gradient in the workplace. Those at the top have 4 times better health than those at the bottom. Every aspect of health fits this gradient even accidents! All other personal factors, such as smoking, poor diet etc., pale into relative significance when compared with the hierarchy effect.


Sir Michael’s response is not to advocate some Utopian attempt to do away with the hierarchy. He acknowledges that all animal societies have them. His recommendation is to work to understand the nature of the hierarchy and to work to make it more collegial. He summarizes his views as follows.


The question is what is it about position in the hierarchy that determines different rates of disease?


And given that, the hierarchy in disease does change. All societies may have hierarchies but we know that the social gradient in disease is not fixed. It’s bigger in some places than others and it can change over time. This could be that the magnitude of the hierarchies change, but there are always hierarchies. But more importantly, it suggests that it is about where you are in the hierarchy that’s related to disease and can we do something about that?


So you ask is it money? Is it prestige, self esteem? And in fact what I think it is has much more to do with how much control you have over life circumstances and the degree to which you’re able to participate fully in society..”


This is the first part of an ongoing series - more later on what we can do

[1]All health systems face a retirement bulge and a recruitment challenge in the next decade. PEI’s Nurses’ average age is in the high 40’s. 41% of PEI’s doctors will be eligible for retirement. Concurrent with this retirement bulge, there will be a demographic shortage of replacements. Young professionals today seek a much more flexible and autonomous work environment than their parents. The small size of the incoming cohort gives them the negotiating power to demand these changes. The other side of the demographic shift is a huge increase in seniors as healthcare consumers. The healthcare system will therefore  face a staff/load and design bifurcation. At the same time Technology Change is accelerating forcing a steep learning curve and opening up entirely unforeseen new practices. Computer speed (per unit cost) doubled every three years between 1910 and 1950, doubled every two years between 1950 and 1966, and is now doubling every year. The paradigm shift rate (i.e., the overall rate of technical progress) is currently doubling (approximately) every decade; that is, paradigm shift times are halving every decade (and the rate of acceleration is itself growing exponentially). So, the technological progress in the twenty-first century will be equivalent to what would require (in the linear view) on the order of 200 centuries.   Working our way through what all this means and finding a viable response is beyond the capability of any individual today.

[2] Clarke/Brown

[3] $1.0 million on sick leave and $800m on relief per month

[4] There would be sick leave and LTD to add to this figure to provide a more accurate total cost

[5] In Malcolm Gladwell’s the Tipping Point, we recall that Chief Bratton turned around the crime wave in New York not by a crackdown on individual crime but by dealing with the social signals, the Graffiti and the Fare Dodging that told people that New York was not safe. Doug Wilms’s research on Families tells us the same story. Poor behaviour and poor coping skills in children are mainly a product of family functioning or the family behavioural environment..

[6] We attach a short summary of her conclusions in “The Duxbury Summary – a slide deck

[7] Wilms’ research tells us that the most destructive parenting style is Authoritarian which promotes not only destructive behaviour but severely limits learning. The next most ineffective parenting style is Permissive. The style that works is Authoritative which is a combination of rules setting and dialogue. As we learn more, it is likely that we will make the same connection to managerial style. See note 10 for more on Wilms

[8] We attach 2 abstracts detailing Whitehall I and II and an interview with Sir Michael that explains hi position very clearly

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Last update: 26/01/2003; 10:50:46 AM.