Riding the titanic wave of mobile health apps

Thanks blackberrycool.com for this image

A recent MIT report By Nanette Byrnes aptly titled 'Mobile Health's Growing Pains' and referencing Endeavour Consultancy Partners research has identified that mobile health technology solutions are yet to be fully accepted by consumers.

You know the ones I mean...im talking about the new health apps on your iphone or Samsung and the wristbands like FitBit and Jawbone and all the other 'solutions' that are being advertised widely at the moment.  So what to health industry stakeholders like us need to be aware of?  Here is my take...

The report identifies that while entrepreneurs and investment organisations are throwing money at these new ideas, the most important group 'consumers/patients' are still yet to be fully convinced. 

In a follow up article by Dan Verel (Medcitynews.com), he comments that while the report identifies one in 10 Americans owns some sort of health tracking device, from FitBit to Nike to Jawbone,  more than half of those devices are no longer being used by the patient.

The report and follow up article both report that with respect to mobile applications, while more than 100,000 are available, but “very few” have been downloaded 500 times, while more than two-thirds of consumers have stopped using the apps, according to a PWC report.

In addition the MIT report identifies that since the start of 2013, more than $750 million in venture capital has been invested in companies that do everything from turn your smartphone into a blood pressure gauge to snapping medical–quality images of the inner ear. Apple, Qualcomm, Microsoft, and other corporate giants are creating mobile health products and investing in startups.

This feels to me like a small scale version of the 2000's internet boom where money was being thrown around wildly for any 'good idea', in the hope of getting market leader advantage.  These initial ideas are sold as being appealing for all and they are sold on the promise of health, rather than a known understanding that they are the right solution for you.

This is because they are not actually properly tested on the people who are going to utimately use them.  Wild assumptions are made of an app that appeals to everybody rather than specific niches.  Or they are not properly tested to see how long they are going to be useful for.  This is just a normal part of the 'new technology' cycle.

Mobile apps will certainly have a big place in the future and it is great to have the new ideas becoming real, but the market has a long way to go to mature and have products that consumers want and find useful.  At the moment we still have a lot of 'coverall apps' that a expected to appeal to everybody for everything. 

But there certainly are those that are being developed with more specific uses and target groups in mind and this is a further step in the right direction.  For those of us working in health, its important not to get overawed by the excitement of these trends, but to stay aware of the good things that are being done so we can spot the opportunities when they arise (in my mind at least, anyway).  I believe that as next steps we need to better understand who actually wants to use apps, what specifically they want to use them for, how long they might need the app for and how they need it to look and feel.

The evolution of organisational performance and workplace wellness interventions

The industrial revolution in the 19th century dramatically changed the way people lived and worked.  Production of many goods moved into large urban factories.  Child labour was common.  The working week could range from 10 - 16hrs per day in harsh conditions.

This, amongst a myriad of other factors, lead to the push for a more effective and sustainable systems to manage the demands placed on workers.  These types of industrial changes and associated performance management responses were occurring all through the industrialising world including in Europe, North America and Australasia.  

In one example of the focus of the time, by 1817 in the UK a prominent campaigner Robert Owen had coined the slogan: "Eight hours labour, Eight hours recreation, Eight hours rest"(MUSV, Publicity Works, History Fact Sheet - www.8hourday.org.au.

In Australia and New Zealand, there were initial successes in achieving an eight-hour day for skilled workers in the 1840s and 1850s through the countries respective labour movements.  In Australia, Victorian based action was leading the way.   

On April 21st 1856, stonemasons and building workers marched through the city of Melbourne to demand regulated working hours with no pay loss.  Their demands were granted although it took much more campaigning and a number of decades for these successes to evolve into widespread legislation for all workers.

As the 8 hour day movement also grew 'across the ditch' in New Zealand, the government of the time acted a bit more swiftly and as such legislation was passed in the late 1800's.  By 1890 a day in October had became one of annual celebration.  It became known as Labour Day or Eight-Hour Demonstration Day.  Legislation eventually followed and in addition in 1899 government legislated for 'labour day' to become a public holiday.

In 1916 in the state of Victoria, Australia, the Victoria Eight Hours Act was finally passed granting the eight-hour day to all workers within the state.  Legislative acknowledgment was achieved nationally in the 1920s.

Shift forward to the 21st century and there is a general consensus that health and well-being of workers has a strong influence effect on workplace performance and that productivity of employees experiencing poor health is diminished. 

As a consequence, its widely understood that workplaces that support workers health and well-being can realise a benefit of enhanced organisational performance (State of the Service Report 2012-13, Ch 4 Employee Health and Well-being).

Its also widely acknowledged with growing acceptance in management circles that health and well-being refers to combined physical, mental, psychological and emotional state of employees (K. Danna and RW Griffin, Health and Well-being in the Workplace: A Review and Synthesis of the Literature, J Management (1999) vol25, no.3, p357-384).

So what are the other main ways that organisations can and often do support employees health and well-being for the benefit of both the worker and the organisation?  I have compiled the following list of the the major initiatives an organisation can offer or implement  which impact on employee health and well-being.

1. Work Itself
2. Workplace Culture / Leadership
3. Paid Sick Leave
4. Flexibility / Reasonable Adjustment
5. Support for Line Managers
6. Injury / Illness Triage
7. Graduated Return to Work
8. Occupational Health Interventions
9. Wellness Programs

This is clearly a wide-ranging list so lets now explore these options in a bit more detail to see how they translate to actual actual activities and interventions that any organisation can implement.

1. Work itself - Work provides income, structure and purpose.  the 2010 Australasian Faculty of Occupational and Environmental Medicine Paper acknowledged that 'the findings are unambiguous, work is good for health and well-being'.
2. Paid Sick Leave -  Paid sick leave allows for an employee to access medical care, recover more quickly, prevent illness from developing, prevent the spread of disease in the workplace.  It also contributes to increased productivity by allowing unwell employees to recuperate more effectively and return to full productivity more quickly (Scheil-Adlung and L Sandner, The Case for Paid Sick Leave, World Health Organisation, (2010).) 
3. Flexibility / Reasonable adjustment  - This can include any adjustment in the way a person does their work, from flexibility in hours so they can care from family members to adjustments in  workplace furniture due to variations in size, shape or physical limitations.
4. Support for line managers  - in larger organisations, line managers are often the ones primarily responsible for managing employees health and well-being related issues as they arise.  This often occurs without any formal training or experience, and its widely acknowledged that organisations who do support line managers in this task will reap the rewards (Wellness in the Workplace, NZ, 2013) 
5. Injury / Illness triage - When people become ill or injured they don't always seek help straight away.  There are many reasons for this, but regardless, immediate access to appropriate support can dramatically improve outcomes.  There is a growing trend towards telephone based injury and illness triage services, for example UHG Injury Track which is a product my current employer offers.
6. Graduated Return to Work (RTW) - RTW programs are established programs that have been shown to reduce chronic illness and indirect productivity cost to the employer and demonstrate the value of the employee to the organisation (Scheil-Adlung and L Sandner, The Case for Paid Sick Leave, World Health Organisation, (2010), ComCare.First Steps Back: a guide to Suitable Employment for rehabilitation Case Managers) 
7. Occupational Health Interventions - Some workplaces or roles involve increased risk of illness or injury due to the nature of the work or environment.  Protective interventions like health assessments, task modification, toxin surveillance and vaccination can reduce and minimise risk of illness or injury
8. Wellness programs - With the rise in lifestyle related chronic health conditions, organisation wide wellness programs have been widely shown to be beneficial to individuals and provide a return on investment for organisations. 
9. Workplace Culture / Leadership style - high levels of employee engagement is widely understood to directly impact on workplace performance, but it has also been recognised as having a significant impact on personal and occupational illness, caring and both personal and work related injuries (NZ Wellness in the Workplace Report 2013).  The sense of control that employees have over their work, along wiht the demands of the workplace, combine to affect the likelihood of job strain and subsequently the likelihood of workplace stress. (R Karasek, Lower Health Risk with Increased Job Control among White Collar Workers’, Journal of Organizational Behavior, (1990), vol. 11, no. 3, pp. 171_185 ) 

In summary, employee health and wellness has a strong influence on their productivity and ability to help and organisation achieve high levels of performance.  In turn, there are a number of different mechanisms available to an organisation to ensure all employees are supported to be able to 'be well' and when required to manage health issues as effectively and efficiently as possible.

Whilst even work itself can have a positive effect on our health and well-being, in our modern society workplace mechanisms have evolved and 'revolved' and in many workplaces now link together as a sophisticated web of management tools. 

As a result organisations that acknowledge the value of people in improving productivity can gain a significant competitive advantage in their marketplaces by helping their people maintain good health and well-being.  Smart organisations and intelligent managers understand this and use all these interventions in their fullest capacity.