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. 

Changing culture of occupational health and wellness

How does leadership and culture influence employee health and wellness and should OHS professionals be focusing more on culture change or implementing interventions?

A 2013 Wellness in the Workplace survey report, commissioned by The Southern Cross Health Society, Gallagher Bassett and BusinessNZ investigated the link between wellness and absence and the associated cost to business.

It identified that 'While prior research has examined some of the issues discussed, there has been no previous attempt to combine the quantitative aspects of absence with those relating to its costs and drivers and the wellness and wellbeing of employees'.

Key messages were that:

• Employee absenteeism does indeed cost the New Zealand economy considerably
• Despite New Zealand’s favourable showing compared with a similar UK survey, areas remain where New Zealand businesses can improve
• Any gains to the national economy require changes from both the public and private sector, but that there are more clear areas where the public sector could do better

Why will this be increasingly important into the future?

• Firstly the report identifies that with an improving economy, New Zealand’s long-term problem of hiring suitable staff with the right skill sets will become more acute.
• Secondly, the report reminds us about the looming reality of an aging workforce, highlighting that only 12.5% of business have policies or arrangements in place to attract and support older workers e.g. (reduced hours of work, working time flexibility, lighter duties or a degree of focus on transition to retirement).

So, what is the problem with absence for organisations?  In short absence impacts on business in many ways and ultimately affects both revenues and profits.  The report identified that the direct costs of absence alone amounted to NZ$1.26b across the New Zealand economy in 2012.  In day to day figures, the average absence level per employee is 4.5 days per year.  As a result the average (median) absent employee in 2012 typically cost an organisation in New Zealand NZ$837 a year which is a considerable amount for a singe person.  In comparison and on a positive note this is about half the cost that is currently being attributed to absence in the UK.

So what are the primary causes of absense in New Zealand?  There were differences for manual vs non-manual employees which I won't discuss in this blog, but interestingly the most widespread drivers identified by far were not directly work related:

• non-work related illness and injury, followed by 
• Caring for a family member/dependent due to illness/injury

But even if they're not directly work related, they may still be indirectly work related.  This was indeed the overwhelming consensus of the survey respondents (as shown in the reproduced 'Figure 11' below).

The report identified that people overwhelmingly believed that the most effective options for managing absence levels was to improve employee engagement - a culture and leadership orientated solution.  In addition, then next most effective solution identified were a policy and procedure based interventions of flexible working arrangements and line managers taking primary responsibility for managing absence.  These are very 'work' related and workplace culture orientated suggestions for non-work related problems. 

Its important to then acknowledge that direct occupational health and wellness initiatives do also figure prominently,  including return to work plans, training and support for managers on managing absence and health & wellbeing programs.

But it does beg the question what should HR and OHS leaders focus on to improve absenteeism within our organisations?  In my opinion it depends upon a number of factors relating to our situation including our role and position within the organisation, the current culture within the organisation and indeed the size and type of the organisation.  In addition our own skill, experience and aims are important too.

The reasons for this are whilst culture change and group engagement might be the the most effective solution, they may also be the the hardest to achieve and while various health and wellbeing initiatives may be less effective they may be the things that we have use to have the most influence in our current situation.

Culture change requires a commitment to change that must come from the leaders within an organisation.  So lets consider, for example that maybe you are not currently a leader, but that you have strong aspirations that you carry out in a powerful way to indeed make a considerable difference in how engaged people around the work they do and how the organisation operates.  Even if you are totally committed and use your skills and abilities wisely to become a successful influencer it takes time!  In a small organisation you typically have to influence a business owner who has final say.

In a large organisation, there are many layers of power and politics to work through to influence the culture and work on improving engagement on a large scale, unless you are employed in a leadership position and can have direct influence.

When we consider policy and procedural changes to general working arrangements like 'flexible work hours' and line managers taking responsibility for managing absence.  These are general HR interventions that require firstly engagement with the HR leaders and secondly a strong line manager engagement to ensure that any newly implemented policies do indeed become widely followed procedures.

There are many organisations where policies are not 'living' and are disconnected from the real day-to-day procedures people follow.  If an organisation is going through major change, downsizing, upsizing or merging it will influence whether it is timely attempt to implement or update policies. 

Finally, when we consider direct wellness interventions its important that the intervention is appropriate for the individuals or the group that it is being provided to.  This might sound quite straight forward, but I have been in many a conversation with program coordinators implementing occupational health and wellness initiatives because they like the sound of them, without actively and rigorously identifying he needs of the group.

The Wellness in the Workplace survey report identified the biggest reasons for absence were

• non-work related illness and injury, followed by 
• Caring for a family member/dependent due to illness/injury.

But the details around these factors will vary from industry to industry and from workplace to workplace.  As we have also seen, the root causes might not be what we think once we scratch the surface.  So we need to carefully identify what team members would want addressed within a wellness program.  From there we also need to address how best to address it and what types of interventions would best suit peoples practical situation.  As a very simple example would seminars be useful for people who are out driving all the time or would webinars be more useful or should a team of pipelayers be sent an email or given a handout card at a toolbox talk?  Different resources will have different impact.       

Interestingly the most effective wellness programs have strong elements of 'engagement' and 'culture change' built in, for example:

• Team members are engaged to identify needs
• Team members are recruited to create a network of champions/influencers
• Programs are linked to business strategy and core values
• Senior leaders are recruited to promote the program

In summary, there are a number of elements to consider when aiming to address absence and associated wellness related factors in the workplace.  Its important to realise that issues that appear one way on the surface, may actually have deeper root causes.  As such the best actions can sometimes involve service related interventions or at other times policy and procedural changes.  In addition its important to find solutions not only that address the specific needs of the people they are intended for but also that you are able to carry out most effectively considering the political, cultural and financial situation of your organisation.

10 Self-Made Billionaires Who Remain Grounded and Humble, by Matthew Toren

Here is an interesting post from Matthew Toren on http://www.blogtrepreneur.com.  His post is titled:

10 Self-Made Billionaires Who Remain Grounded and Humble

He introduces his article by explaining that remaining humble and grounded might be just as challenging as obtaining riches and success. In life, most of us seek out wealth and power, but if we can remain humble and wise along the journey, then that is the true reflection of successful life. There are many success stories, but few who have chosen to be humble and show the world that status symbols are not the real definition of their achievement. Here are 10 self-made billionaires who remain grounded and humble with their feet planted firmly on the ground:

Follow this link to read the full post

Warm regards

Chris

Discover your Spark on iTunes

I'm excited to say that my book, Discover your Spark is now on iTunes.

To find it click here

Are People Sick of Your Leadership Style?

I have been interested in the link between leadership, culture and health for a number of years now.  Having worked in both the health and leadership fields for some time I have often hunted for research looking at the link between leadership and wellness.

In my soon to be published book I discuss the example of North Korea vs South Korea.  Here are two countries with so much in common physically and environmentally, but now with highly divergent leadership styles and political systems for fifty odd years.  A simple health point of comparison is mortality.  That the average lifespan of a person in South Korea is a wonderful 81 years while for their South Korean cousins its a dismal 68years!  Its a very basic comparison, but certainly begs a few questions.

So what does this have to do with work and running a business?  Well, the first point is that the link between employee wellness and productivity has been studied and documented well enough to know that a wellness is linked to productivity.  In Positive Proof, an analysis of the cost effectiveness of worksite wellness, Larry S Chapman reviewed 42 high quality studies to confirm that a well structured wellness program can provide a return on investment for a business of up to 500%.

The second point is that we know health and in particular chronic 'lifestyle' related conditions like heart disease, arthritis, diabetes and cancer are on the rise.  The recent A Problem Worth Solving report from Arthritis Victoria Arthritis, identified that Arthritis alone currently affects approximately 26.7% of the Australian population.  The majority of the people are of working age and its costing the country over $55 billion directly and indirectly.

The really interesting point though is that there is an increasing body of research linking leadership and culture to employee health...and therefore business productivity.  An article published in the Science Daily blog in July 2013 titled 'Transformational Leadership Has Positive Effects On Employee Well-Being' identified a recent piece of research from Germany published in the july Journal of Occupational and Environmental Medicine by Christine Jacobs of University of Cologne and colleagues.  For the study workers at six German information and communication technology companies were surveyed regarding their employer's leadership style and psychological well-being.

For the study 'transformational' leadership score was defined to include leading by example, making employees feel they are contributing to a common goal, providing intellectual stimulation, and giving positive feedback for good performance.  Jacobs and coauthors concluded that "Such training programs can be seen as another essential component of workplace health promotion and prevention efforts and therefore should receive wide support," 
 
The leadership culture of a business and its associated systems of governance and decision making may affect productivity in more ways than we currently realise.  More research is certainly needed but this is a very relevent topic both as a way to improve productivity and also reduce the cost of employee illness and associated issues. With chronic conditions on the rise and he cost of health predicted to exceed the GDP of the nation at current trends in the next few decades this will have increasing relevance. 

Collaborate to Win a World Cup!

The following is a you tube video from New Zealand titled "Teds Tips on participative leadership for Downer".  In it, Graham Henry who is the former coach of the New Zealand All Blacks discusses his take on how collaborative  leadership systems  work in practice to improve team performance.  He explains how he successfully employed a representative management structure with the Rugby World Cup winning New Zealand All Blacks throughout his tenure.