Building Cultures of Health and Well-Being

Creating and Sustaining Supportive Organizational Environments

INTRODUCTION

Every company has a culture. Not every company has a culture of health and well-being.

According to the proceedings of a conference convened at the Harvard Business School in 2016, every company, no matter its size, impacts health and well-being in four distinct ways (¹): 1) through the healthfulness and safety of the products and services it sells (consumer health); 2) through its employee health work practices, policies, and benefits (employee health); 3) through support and investments made in the communities where it does business or where its employees reside (community health); and 4) through the impact of its operations on the environment (environmental health). Taken together, these four elements constitute a “Population Health Footprint” that the company imparts on the health of a population. The effort to ensure that the net impact of the Population Health Footprint is positive and optimal may be considered a critical component in the pursuit of building a culture of health and well-being.

The past 10 to 15 years have seen the emergence of the concept we now refer to as a culture of health. Notably, the Robert Wood Johnson Foundation (RWJF) has made a commitment to building a culture of health in the United States that has been integrated into the core business of its grant-making, communications, and policy efforts (²). The RWJF places the building of a culture of health in the context of the broader community and society as a whole. Whereas no specific definition of what a culture of health is has yet been proposed by RWJF, the organization believes that it will involve the activation of 10 specific components (²):

1. Good health flourishes across geographic, demographic, and social sectors.
2. Attaining the best health possible is valued by our entire society.
3. Individuals and families have the means and the opportunity to make choices that lead to the healthiest lives possible.
4. Business, government, individuals, and organizations must work together to foster healthy communities and lifestyles.
5. Everyone has access to affordable, quality health care because it is essential to maintain, or reclaim, health.
6. No one is excluded.
7. Health care is efficient and equitable.
8. The economy is less burdened by excessive and unwarranted health care spending.
9. The health of the population guides public and private decision-making.
10. Americans understand that we are all in this together.

A CULTURE OF HEALTH DEFINED

More specific to the employer setting, ACSM’s Worksite Health Handbook, 2nd edition, published in 2009, is an early resource that describes an in-depth approach to building a culture of health at the workplace (³) —a context that is inclusive of the roles of employers, the workplace, the worker, and their families. This resource introduces a definition specific to the workplace setting, which states: “A culture of health is a workplace ecology in which the dynamic relationship between human beings and their work environment nurtures personal and organizational values that support the achievement of a person’s best self while generating exceptional business performance.” As a result, a culture of health reflects the intersection between personal and organizational values and overall business performance. Important components within this set of interacting elements include organizational paradigms (mental models that commit people to shared rules and standards around how they behave), leadership roles that shape and maintain a healthy organizational culture, and cultural values (reflecting characteristics that are shared by the members of a group, i.e., workforce).

THE ENERGY THAT DRIVES THE POPULATION HEALTH FOOTPRINT

The Population Health Footprint (described earlier) outlines four dimensions that cumulatively impact health and well-being. The Population Health Footprint is presented specific to an organizational environment but does not specify the drivers that generate the organizational energy to ensure that the cumulative impact is positive, i.e., that the impact is a net-positive contribution to health and well-being. In March of 2017, as part of the Harvard Advanced Leadership Initiative at the Harvard Business School, I had the chance to present and discuss my ideas about the role of organizational values in building a culture of health and well-being (⁴). From my perspective, organizational values are deeply motivational to people and represent a source of energy that generates the drive to achieve high levels of performance in the four dimensions of the Population Health Footprint. I propose six organizational values that include those previously presented in ACSM’s Worksite Health Handbook (³). These values include the following:

• Localness: best decisions are made as close to the action or customer as possible or practical.
• Merit: the judging of work-related ideas is based on their inherent merit rather than the degree of political connivance.
• Openness: the unfettered flow of information in the company.
• Leanness: the wise stewardship of company resources.
• Trust: confidence in the reliability, truth, ability, or strength of a person or an entity.
• Respect: to act in a way that shows appreciation for the qualities of people and the contributions they make to the larger organization.

Figure 1 depicts the way in which the Population Health Footprint interacts with these organizational (cultural) values that create and sustain the energy to drive toward net-positive impact.

Figure 1: The interplay between the Population Health Footprint and organizational values.

HOW TO BUILD A CULTURE OF HEALTH AND WELL-BEING

Obviously, there is more than one road that leads to Rome. Each individual organization is itself in the best position to determine the best way to pursue excellence. Previously reported case examples in ACSM’s Health & Fitness Journal^® indicate that the application of best practice principles to the local situation is a highly efficient and effective means to do so (^5–7). So at least one path that may get you from here to there is to apply principles of best practice program design (⁵). Yet, although such a path may provide the critical building blocks of this work, it does not specify the process. The process of shaping the desired culture is likely as important as any other component of the work because it relates to the approach, behaviors, actions, and values the workforce experiences. The degree to which the workforce participates in this effort is important as well. Once again, we can turn to ACSM’s Worksite Health Handbook for a description of a process designed to shape a culture of health (³).

A simple process designed to shape a culture of health and well-being involves three steps that are intentionally linked to net-positive impacts. These steps include: 1) surfacing, 2) communicating, and 3) aligning. Surfacing refers to implementing conversations and dialogue throughout the company to determine what the most important operational, cultural, and personal values are and what matters most for the achievement of the organization’s mission. Communicating reflects connecting the learnings from what has surfaced to the process, people, and departments to make the change happen. Aligning relates to the process by which organizational policies, practices, and programs are connected to the identified values, beliefs, and attitudes. Figure 2 presents the ideas discussed here in an integrated process and impact model designed to help shape a positive culture of health and well-being.

Figure 2: Process and impact model for shaping a culture of health and well-being. (Adapted from ACSM’s Worksite Health Handbook, 2nd edition. Used with permission.)

PARTING THOUGHTS

Building cultures of health and well-being can follow different paths for different organizations. Regardless of what path is chosen, it is a good idea to incorporate best practice design principles and follow a process that is inclusive and participatory. Furthermore, being deliberate in creating an experience in which the workforce is part of the process and linking the work to the desired outcome values and impacts is very much an integral part of the approach. This brief column has outlined a process and pathway that organizations may consider as they pursue excellence in creating a net-positive organizational health and well-being culture.