The Problem with Programs

I was at a meeting today with other business leaders, a representative of the state's Department of Health, Blue Cross/Blue Shield rep and a few consultants. After describing the growing health problem in the US, they outlined a goal to put the state at #1 in health rankings. Their goal is to create a network of business leaders around the state that will make changes at the worksites, thus influencing their employees' health.

After describing the good elements of a worksite wellness program, we went around the room and talked about a hurdle or challenge our own organization has faced. Most of the hurdles and challenges had to do with time, commitment of resources involved in the program and how to keep it fresh. Most of the problems, as I see it, are related to the fact that the effort is a program.

People fail at diets (a program) and two-thirds of heart disease patients don't change their lifestyle because they've been put on a program (by themselves).

One of the things we're discovering in a community-wide effort is that real, sustainable impact happens when the cultural norms change. Some program elements can help: education, events, and so on. People won't change until they know that 1) their new behavior is being encouraged, supported and a lot like everyone else (most people are not early-adopters); 2) that what they used to do is no longer condoned or tolerated (compare our expectations today with the norms of the 1950's and 1960's around smoking--watch the TV show "Mad Men" for a history lesson). If it's just accepted that everyone eats fruits, vegetables and other healthy foods as opposed to 3 meals a day of hamburgers, hot dogs, processed foods, etc., people will change when others react in shock that someone would never have a vegetable at a dinner for their family. People will start to exercise more when they feel more and more left out of the water cooler conversations when people talk about their walking/running/biking successes.

Wellness will also happen when it's supported by the corporate culture. When the culture (collaboration, teamwork, values and expectations, etc.) and corporate systems (metrics, goals, etc.) show how important wellness is, and rewards improvements accordingly, people will get on board because they're letting their teammates down. People who are unwell will appear less productive and contributing less to controlling expenses (medical insurance premiums for the group). They will be encouraged when the corporation is already talking about work-life balance, safety, care for them as individuals and care for their families.

To be a success, and it can be, wellness needs to be part of the culture, and not a program. Dee Eddington of the University of Michigan has proven this. Dr. Rosie Ward has shown this also, as well as many other health experts. Beer, Eisenstaat, et.al. in a Harvard Business Review article in 1990 showed that change programs fail, because they are a program. Glad to know their research has finally caught up to what I've known for thirty years about creating and sustaining change in organizations.

Food diets, exercise programs and heart-healthy lifestyles can be adopted for success when people have a support group--call it a family, a community or a corporation that has also adopted the new norms of behavior.