When discussing monetary and other types of reward incentives, critics feel the wellness industry has taken the wrong approach. According to Hamilton Mears, administrator of the Scripps Health wellness program, “Such incentives don’t always work as intended. A $100 incentive for achieving a program goal this year might be exciting to the employee. Next year, it doesn’t seem quite as valuable. In a few years, that $100 is simply expected. Over time, employees place less and less value on it.”

In theory, incentives encourage employees to exert more effort in practicing healthy habits. But as the sense of entitlement grows, their behavior shifts to the opposite direction. Hamilton explains that the traditional concept of incentives and disincentives is rooted in the theory of scientific management, which says people will move in the direction of a reward and away from punishment.

“This Pavlovian style reward system becomes an economic exchange between you and the employee. They will work for the money based on what they think the money is worth. So if I give you $10, you’ll put forth $10 worth of effort; but you probably won’t try $12 harder. Not only do exchanges of behavior for money lose their impact, they lead to unintended consequences.”

Social Motivation: The Better Solution

There is a strong biological imperative associated with social motivators. According to Hamilton, the power of the social structure has contributed to the survival of our species. “Imagine our ancestors on the plains of Africa. We’re not very strong and are kind of slow. To survive, we had to work together. Someone who did something to the detriment of the group was excluded, and that often meant death. A modern example of the power of groups is the profound emotional pain students experience in school when the in-crowd excludes them from their clique.”

Hamilton believes social motivators offer a better solution. “The military has done a fantastic job of tapping into social models and creating a sense of common purpose. People go to great lengths in battle to protect their team — even sacrificing their own lives. If the military used an economic reward model and my buddy was standing next to a live grenade, I’d be inclined to run the other way instead of helping him.” While reward-type incentives can encourage small repetitive tasks, Hamilton believes today’s fast-paced work environment requires more creativity and cooperation. “Research backs up the negative impact of rewards. For instance, if you take someone who already exercises regularly, such as a runner, and start paying a cash reward for this behavior, the habit might actually diminish. However, if you recognize the person within the group, positioned as a role model, the exercise will not only continue, but may increase. Social incentives tend to be more self-perpetuating in their impact.”

Hamilton described another aspect of social motivation. “We know senior management support is essential to a wellness program, but it is a strong social motivator as well. If the chief executive comes to work wearing a blue shirt and striped tie, I predict the next day many VPs will be wearing blue shirts and striped ties. Employees imitate the actions of those at the top, so we need to capitalize on that phenomenon. Strive to engage senior managers in the planning process. Find out what is important to them and what they want to see in the wellness program. Then be sure your program reflects their elements of concern and their passions.”

Many Scripps Health executives are highly visible role models of healthy behaviors. Hamilton says each has a unique passion. “You’ll often find our CEO, Chris Van Gorder, out with his trained dogs leading search and rescue teams in the mountains. He rolled up his sleeves and helped onsite in the aftermath of the Katrina and Haiti disasters. That level of involvement takes a lot of physical energy and demonstrates concern for the community. Robin Brown, chief executive of Scripps Hospital, routinely invites any employee to exercise with him for a half-hour and then buys them lunch. One of our VPs is a legal counsel and a popular fitness class instructor. Another executive is an avid cyclist who made it to the Olympic trials. We even have a former All-American college baseball player running a hospital. Such role models make it easier to inspire employees to similar behaviors.”

Incorporating Social Involvement

The Scripps Health system — based in San Diego CA — is spread throughout 32 worksites and includes 13,300 employees. In 2006, health plan consultants predicted that expenses would double over the next 3 years. Hamilton designed a wellness program to meet that challenge. “We’ve definitely seen an impact. In 2006, the average employee carried 3.68 modifiable risk factors. That number steadily decreased each year to 3.01 last year; 2012 promises to be even lower. If we only consider paid medical claims, we’ve saved $8.05 million in the last 3 years. But this would be meaningless if the employees weren’t happy. When it comes to employee satisfaction, I can honestly say we are the benchmark. Every satisfaction measurement gives our program the highest marks.”

Scripps Health wellness products and services include:
  • Measurement processes. Health risk appraisal, biometric screening, health and productivity quotient, readiness to change, satisfaction survey, needs and preferences survey.
  • Interventions. An interactive website portal that ensures employee privacy, 6-week population-based challenges offered 3 times a year, 12- or 13-week self-directed electronic modules on healthy living, monthly online seminars, personal coaching by phone or email.
  • Services. Discounted gym membership, 4 fitness centers at larger sites, about 100 exercise classes/week, healthy food options in cafeterias and vending machines, healthy catering for company events, monthly farm stands, locally grown produce delivered directly to participating employees, reference material library, chair massage.
  • Incentives. Free health plan coverage for employees meeting predetermined criteria.

Hamilton is convinced that the program’s most important component is the social involvement of volunteer wellness champions. “When it comes to social norms, those who want to be part of the in-crowd will mimic the activities of people they respect. I go to the worksite searching for the most influential people. I build a social map of those who are always at the center of what’s going on… the ones employees automatically go to… those who have the most credibility among their peers. My team and I reach out to them as a friend, and if they show an interest in wellness, I pull them in to become our program recruiters and cheerleaders. Currently we have 125 champions who have a ton of influence within the system.”

Wellness champions receive hours of personal interaction and education from Hamilton and his staff. “Monthly conference calls and seminars discuss issues and events. We provide insider information on the program’s long-range goals to put current initiatives in proper context. Although we ask for a half-hour of their time each month, many give a whole lot more.” Hamilton emphasizes the importance of gaining support from these influencers. “These are people not willing to see activities fail. They have the ability to move masses in an organization and help generate grassroots changes. The key is to nurture relationships. Solicit feedback and make their experiences with the program as personal as possible. Once your champions feel empowered and take ownership for the program, they will actively reach out to engage their whole department.”

It’s About Choices

Hamilton is a self-described Choice Architect. “Even though people say they like choices, they really don’t. Realize that many choices are made out of habit and without much thought. It’s easy to choose between 1 or 2 things. But when confronted with too many choices, people freeze up and balk at making any choices. This is a subconscious reaction that leads to mindless decisions based on habit. Look at ways to enhance the options in your employees’ environment and how these choices can become easier.”

Hamilton advocates desired behaviors as defaults. “People often make an easy choice versus doing the work necessary to make the choice they think they want. Structure your enrollment process so employees are automatically enrolled unless they opt out. In the snack bar, product placement can be very powerful. Position healthy foods so they’re the first things seen and at eye level. Locate other healthy options at the cash register for spur-of-the moment shoppers. Make undesirable choices more difficult to get. Put them at the back or require that they be prepared only on request. If you want people to be more active physically, use signs promoting the health benefits of taking the stairs. Make the stairwell more visually appealing. The CDC actually designed a building where the stairwells were easier to find than the elevators. They even slowed down the elevators to further encourage stairwell use. People still had choices, but being active became the easier choice to make.”

Hamilton concludes, “Human beings are inherently worthy of love, support, and nurturing. People want to feel good physically, psychologically, and emotionally… that they are part of something greater than themselves. Obviously, you can’t force these concepts on people, but you can plant seeds. It’s the involvement of these centers of influence that lead to growth and ownership in any program.”

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