With Employee Wellness, Is Showing Up Just as Good as Shaping Up?

Bob Merberg has been providing thoughtful commentary on ShapeUp’s recently released survey data in an excellent series on his blog. His most recent post in the series, Engagement vs. Participation: Shaping Up or Just Showing Up?, ponders whether it’s enough for employers to merely strive for participation:

When I first started hearing about health engagement, the very purpose of the phrase was to set engagement apart from participation. Engagement referred to having a genuine and emotionally influenced connection to health and, in many cases, health behavior change. Participation meant merely taking some sort of action — regardless of sincerity or value (completing a program, getting a biometric screening, and so forth).

Some employees participate in programs exclusively to obtain an incentive. Are they engaged?”

Wellness vs. compliance

I agree with Bob about there being a difference between participation and engagement. That difference, as I see it, is the degree to which someone is actually invested in his or her health. By that I mean actively educating him or herself about it and taking pains to improve and manage it versus checking a box to get something done — merely participating — without care or mindfulness for what health benefits it may deliver.

Bob continues his argument about whether it’s enough for employers to concentrate on and calculate participation as if it matters until he reaches this final point:

In our environment of incentive-laced wellness programs, embodied by the proliferation of so-called outcomes-based programs, the distinction between participation and true engagement becomes even more significant. When an employee enrolls in a program (or, I’ll argue, even achieves a biometric improvement) exclusively to reduce their insurance premium or access a better medical plan, it may not be because they are engaged. Heck, it’s barely participation. I’d use a completely different word to describe it: compliance.

And I’m not sure compliance is wellness, at all.”

Behavior change isn’t easy

Here’s where I veer from Bob’s line of thought. If behavior change were easy and people did what they (and we) knew was best for their health, compliance wouldn’t be enough. But in our real world, neither of those is true, and so compliance becomes a matter of grave importance.

Here’s an example: Yesterday a friend updated me about her brother-in-law’s health condition. At 42 years-old, he had a serious heart attack. His mother flew to his side to help him with recovery and to manage his business, and she’s been aghast as she’s watched him resume smoking, continue his excessive drinking, and in all other ways be non-compliant with his recommended recovery. While my friend was shocked at his behavior, I informed her that going back to old habits, even after a heart attack, was quite normal, unfortunately.

In this case, were my friend’s brother-in-law to be compliant, he’d be back on the road to wellness. In fact, he’d be on a better road than he was before the heart attack.

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I see this, too, with employees and their stories of complying with biometric screenings, or complying with preventive checkups, or complying with tobacco-free workplace policies. or really, even nudging people through behavioral cues and the built environment. There’s no intrinsic motivation involved. It’s pure requiring, guiding or steering.

We may not have their hearts and minds when we start with compliance and participation, but we do start influencing what they do with their bodies. With that, the hope is their hearts and minds may follow.

Note: This post doesn’t extend to outcome-based wellness efforts, for which I have reservations.

This was originally published on Fran Melmed’s free-range communication blog.


5 Comments on “With Employee Wellness, Is Showing Up Just as Good as Shaping Up?

  1. The fact remains that many employees are engaged with or without incentives. They should be rewarded for their behavior. Moreover, those who will comply merely for the incentive will be doing so at a benefit to themselves and therefore (in this case) the company. I see little merit in making the distinction between participation and engagement as it relates to the topic of employee wellness programs. If there are concerns with the merely participating participants, perhaps you could set the bar higher for incentives? 

    1. I’m not sure if you had a chance to read my original blog, which Fran referred to, Adam. I argue that true engagement and participation, especially when motivated by incentives, are often quite different. Consider, for example, two hypothetical employees — let’s call them Nick and Samantha. Nick is just doing a biometric screening for the incentive. He doesn’t fast as he’s been instructed; he completes his screening; then disregards the results and loses the written record of them. It happens. Samantha, on the other hand, has been looking forward to the screening; followed pre-screening instructions; eagerly gets her results; listens to the counselor/coach and asks questions; brings her results to her next doctor’s appointment; and hopefully even tries to make lifestyle changes to improve her values.

      By most employers’ measures, both Nick and Samantha have “participated” and it seems most employers would categorize both as having engaged in the program. But only Samantha is truly engaged. To suggest that Nick has demonstrated “engagement” simply illustrates a misunderstanding of what the word means, and misrepresents, to anyone who does know the definition of engagement, what actually has taken place.

  2. There is another issue floating around on LinkedIn —- the issue of whether to penalize employees for not participating or not improving their health.   We are on a slippery slope here.   I’m all for wellness programs. In fact one company found 3 employees that had beginning stages of cancer as a result of biometric screening — something a regular annual exam set of bloodtests would never have picked up.   And incentives are fine — not for participation but showing results.

    But PENALIZING employees that don’t improve their health —- not’s shocking.   Who is the doctor here?   The employer?   Are you willing to determine whether a person’s bad health is a true medical issue that cannot be helped?   I don’t think so.

    So please keep this out of your programs.

    1. I appreciate your thoughts on the matter, Jacque. I’d be interested in info about the company that found 3 employees that had beginning stages of cancer as a result of biometric screening, which a routine set of bloodtests would not have found. It seems quite extraordinary. Do you happen to know what kind of cancer and what kind of blood tests?


      1. It was a former employer of mine and I cannot reveal the name.   But is a company on my LI profile that is not as large as the other two.   That should give you a big hint!   Don’t know the type of cancer.   We used different clinics in each country that could do the battery of tests we wanted done.   There were about 30 tests run.  They were more extensive than the ones your doctor normally runs with your annual physical exam.   Don’t have a list of all the blood test names either!   But let me give you another example.   I had what my doctor thought was a blood condition that was affecting my hearing.   So I want to a doctor that specialized in just blood disorders.   I had 20+ tests run —- that were much more in depth than anything I or my regular doctor had seen.  

        I guarantee you that if you ask your regular doctor to see a list of tests run on the two vials of blood drawn — assuming it is the “normal” request for screening (meaning that you are healthy and this is normal, regular exam) you would only see 7-8 results and what they tested for.   I have copies of my blood results and that is the number I have.   Normal blood screenings are broad — if a problem is seen — or may be seen — then more rigorous/indepth screening is done.

        So you can see that testing for 30+ conditions is more in depth.   I am a firm believer in blood screenings.   And no self-reporting HRA —- meaningless.

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