NICE has published guidance on workplace health and wellbeing. It is a crucial development for employers.
- NICE guidance provides a solid evidence-based approach to implementing a successful workplace wellbeing strategy
- Senior executives and line managers are identified as key role models and practitioners who need to be supported
- Public Health England research found the importance of being physically active at work, particularly in largely sedentary jobs
Evidence – real, rigorous evidence – can be tough to find at the best of times. But it is often the key to making the business case for developing a programme, effecting a change or adding a new benefit in an organisation.
So when the body that issues clinical guidelines for the NHS starts paying attention to workplace wellbeing, it is a rare and precious moment that should not be wasted.
In June the National Institute for Health and Care Excellence (NICE) published its first look at health and wellbeing in the workplace. Following draft guidance last September, NICE consulted widely and reviewed all the available evidence on the subject. The result was a comprehensive set of 40 recommendations covering 11 different areas within corporate organisations.
The organisation also worked as a convenient point for tying in many other research projects that have begun, which increasingly identify the workplace as a focal point for public health awareness.
Perhaps unsurprisingly, senior management and line managers are highlighted as being critical to successfully introducing and operating a wellbeing programme. Where senior leadership is concerned, three points stand out:
- Make health and wellbeing a core priority for the top management of the organisation. Value the strategic importance and benefits of a healthy workplace. Employers should encourage a consistent, positive approach to all employees’ health and wellbeing.
- Establish the business case for ensuring employees’ health and wellbeing. Make clear the link between employees’ health and wellbeing and improved productivity.
- Ensure all managers in the organisation, including directors and board members, are committed to the health and wellbeing of their workforce and act as good role models.
As NICE deputy chief executive and health and social care director Professor Gillian Leng explains, any initiative without buy-in from the top is doomed to failure. Lip service is not good enough.
“It’s clear that if you want to set a culture in an organisation and set an example, it needs to come from the top,” she says. “It’s the board that does that – it’s one of the core responsibilities of the chief executive so it needs to be led from the top and needs to cascade through the organisation. It won’t work if the chief executive and senior managers are saying to everyone else, ‘Here’s what you should be doing’, without doing it themselves.”
Indeed, two of the recommendations for senior leaders emphasise this critical situation, saying they must:
- Display the positive leadership behaviours they ask of their line managers, such as spending time with people at all levels in the organisation and talking with employees.
- Act as role models for leadership and proactively challenge behaviour and actions that may adversely affect employee health and wellbeing.
Where line mangers are concerned, there is a need to be engaged in the practicalities of the programme, but training and support are essential to promoting and understanding the wellbeing needs of their direct employees.
“They have a really important role in terms of supporting staff and understanding what personal and work issues they may have,” continues Leng. “The world is about human beings working together. That’s how we work and we have to think about relationships in the workplace and how they are supporting people to the best effect. You can’t be a line manager and think, ‘Once a year I do an appraisal and, otherwise, I just sit in my office and do my job’. You have to be there and make sure other people know what their role is and work effectively and engage with others.”
NICE also recognises the need to make the business case for health and wellbeing as an integral part of the organisation. However, about 27 million working days are lost each year to more than a million employees as a result of work-related illness, costing society an estimated £13bn (according to the annual statistics report for Great Britain 2012/13) – so it is already apparent that this situation should be addressed. And this could even be an underestimation of the true costs.
In early 2014 the Organisation for Economic Co-operation and Development (OECD) said failing to tackle mental health issues was costing the UK about 4.5% of GDP every year, with employers bearing more than half of this cost.
This 4.5% of total GDP was higher than that of any other country the OECD had examined. The economic body estimated this amounted to £70bn, of which 53% was borne by employers in lost employment and productivity – roughly £37bn. The remaining 47% came from healthcare costs.
Later in 2014 the Chartered Institute of Personnel and Development’s (CIPD) annual Absence Management survey suggested that while absence levels across the UK were falling, they were being offset by an increase in presenteeism – another key point within the NICE guidance.
Here, the NICE report urges employers to: “Be aware that a return to work from sickness does not necessarily indicate that an employee’s health and wellbeing has improved. When developing return-to-work polices, take into account that aggressive return-to-work procedures can encourage presenteeism to the detriment of the organisation.”
Perhaps the biggest current concern in absence management is mental health, which NICE raised serious points about, saying that all those with a remit for workplace health should:
- Create a supportive environment that enables employees to be proactive when and if possible to protect and enhance their own health and wellbeing;
- Develop policies to support the workplace culture such as respect for work-life balance. For example, in relation to stress, organisations could refer to the principles of the Health and Safety Executive’s Management standards for work-related stress.
The right amount of pressure
There is recognition that some amount of pressure or stimulation can be required to motivate and achieve the best results from people, but when the pressure becomes overwhelming and too stressful, it is a poor result for all concerned.
“If that goes too far, performance falls, so it is bad for the organisation and it becomes uncomfortable and unhealthy for the employee and they go off,” Leng adds. “So it’s about getting that balance of a stimulating environment without it being stressful, and about managers’ understanding of where their team is in that curve. People vary in how much they can cope with – there are no hard and fast rules, but we know managers need to be aware of these things and be trained to be in tune with it.”
Over-arching all this is the vital need to monitor and evaluate the impact of such programmes. While it is somewhat of a cliché, it is nonetheless frequently true that “what gets measured gets managed”.
However, there is a wider issue than that. Measuring and reporting those results sends an important message to staff that employers are interested enough to take note of the impact of the effect of the organisation’s policies.
“It’s a crucial part of the overall culture: keeping track of what’s going on, keeping track of implementing. And in terms of the whole organisational commitment, this feedback should be reviewed at senior level,” explains Leng. “It underpins how productive the organisation is going to be. You can’t underestimate how important it is to staff and the organisation.”
The success of this guidance will not be a quick or easy win and will depend on employer engagement. If organisations use the guidelines and apply them to their workforce, investing in people and processes, it will likely have a significant impact and should provide a stable, clear, well-defined path.
As Department of Health expert adviser on improving the welfare of working people Dame Carol Black says: “When its influence eventually comes to be measured – in terms of the quality of service and product, workplace efficiency and productivity, and staff morale – this new guidance from NICE might well prove to be the most significant ever.
“There is abundant evidence that the health, especially the mental health, and overall wellbeing of employees depends greatly on their relationships at work. That means their relationships with each other but particularly their relationships with employers, from line manager to the most senior executive and board member. These relationships are encapsulated in the concept and practice of engagement – a concept that reflects the culture of an organisation.
“The precepts contained in this guidance are simple and plainly put. They are already observed in exemplary organisations. It should not be difficult to translate them into practice.”
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