How to Measure ROI

How should employers measure return on investment (ROI) as it applies to wellness programs? Should it be based strictly on a medical cost-savings ratio? Should time off from work (or lack thereof) be most prominent in the overall analysis? I think most experts would agree that a combination of the two is important to consider when attempting to quantify success in corporate wellness. However, in addition to medical savings and absenteeism, what about presenteeism? Where does this factor in? Shouldn't having energized, engaged employees, who are not just showing up and punching a clock, count as much as anything in the calculus of figuring out whether a program is or isn't really working? We at Foundation Wellness think so. In today's post, I will address the issue of presenteeism and how it can be improved through onsite wellness programming.

In a 2015 Society for Human Resources Management article, author Jennifer Schaefer correctly points out:

"When employees aren’t feeling well, either physically or emotionally, their productivity declines. Consider the difference between an employee who rolls out of bed and drags in to work versus an employee who exercises before coming to work. Exercise produces natural opiates or endorphins, which increase energy, enhance mood and promote overall wellness. The result? The employee who is exercising, and typically healthier as a result, will likely show up to work with more energy and enhanced positivity."

Imagine what dollar amount, in the plus column, could be added to ROI if everyone at your workplace adopted a healthy, active lifestyle--if everyone there exercised at some point of the day, most days of the week.

Now, before going any further, let me be clear: In this discussion of presenteeism, I am using the term in the context of wellness, which is defined as the pursuit of optimal health. We are not simply talking about avoiding catching colds or stomach bugs. You can be considered technically "healthy" for work just as long as you don't have an illness that prohibits you from performing the task at hand (and end up making everyone else in the office furious because you passed it on to them). However, wellness is a different story. If an employee is plagued by depression, anxiety, and/or other mood disorders, which can drain one's energy and cause constant distractions, then he or she is not well. If a person suffers from obesity, chronic back pain, osteoarthritis exacerbated by sedentary lifestyle, or digestive and other disorders brought about by poor diet, then he or she may be technically okay to work, but is not well, and consequently isn't nearly as productive as he or she could be.

According to the Anxiety and Depression Association of America, "exercise may improve mental health by helping the brain cope better with stress. In one study," their website continues, "researchers found that those who got regular vigorous exercise were 25 percent less likely to develop depression or an anxiety disorder over the next five years." All work environments contain inherent stressors such as job deadlines, personality conflicts, and perceived lack of autonomy. Even the best workplaces aren't completely immune from these types challenges, and therefore most people, at one time or another, have experienced work-related feelings of being stressed, anxious, or a bit "down." And for some, no matter how well they seem to manage their lives, there is a clinical component to a mood disorder that will require some form of medicinal help (just as some require a blood-pressure lowering agent no matter how much they cut back on sodium or do aerobic exercise).  However, many workers become chronically and unnecessarily stressed, simply due to a combo of life's inherent stressors and an ineffective or nonexistent wellness plan. This has harmful health ramifications not always easily recognized, even (or, in some cases, especially) by the person experiencing them. And the connection to the employer is clear: Distracted, low-energy workers, debilitated by chronic stress and/or pain, can cost their employers nearly as much as workers who take too many days off. They do so through distracted mistakes, oversights, and injuries incurred while on the job.

So, this form of presenteeism is not about "phoning it in" and willfully scamming employers while doing little work. It is instead about workers getting caught up in a negative, downward health spiral. As Paul Hemp states in an oft-cited 2004 Harvard Business Review article, "Presenteeism, as defined by researchers, isn’t about malingering (pretending to be ill to avoid work duties) or goofing off on the job (surfing the Internet, say, when you should be preparing that report). The term—which has gained currency despite some academics’ uneasiness with its somewhat catchy feel—refers to productivity loss resulting from real health problems." In the same article, Hemp lists the estimated cost of depression to employers, as well as the combination of "pain conditions such as arthritis, headaches, and back problems." In 2003, the former added up to $35 billion in reduced work performance and the latter cost employers nearly $47 billion.

A more recent estimate from Gallup placed the cost for employers of depression-related absenteeism alone at $23 billion annually--not to mention the additional costs accrued by workers ill-equipped to perform when they are on the job. And according to a 2013 Integrated Benefits Institute study, low-back pain cost U.S. employers $13,100 in sick days and $8,300 in presenteeism per 100 workers. After adding in short-term and long-term disability and workers compensation, U.S. employers were set back a whopping $34,600 per 100 workers.

The good news here for those of you searching for a silver lining? Many health problems affecting absenteeism and presenteeism are influenced by lifestyle. In other words, we can actually do something about them. Physically active people are less likely to develop chronic illnesses such as heart disease, respiratory disease, type 2 diabetes, cancer, high blood pressure, and osteoporosis than their less active counterparts. And when they are predisposed to develop certain chronic illnesses--for example, hypertension runs in some families and is prevalent even among some ethnic groups--then things like exercise and proper diet help to manage these diseases and make it less likely that they will lead to serious health complications and death. 

So, if you are an employer or key decision maker at your workplace, please consider adopting workplace initiatives like smoking-cessation programs, biometric screenings, and medical plans with a robust preventive-health component in order to combat the insidious effects of presenteeism. And please consider adding an onsite wellness component, one that actually gets people up and moving and encourages them in a personal way to make better choices for their overall health. Just a few  minutes a day of physical activity can make a positive difference in the health and wellness of your workforce. And a well workforce translates to a healthier company bottom line.